The pseudoaneurysm involving both ventricles is an infrequent complication following myocardial infarction. The diagnosis is complex and the condition carries a high risk of rupture. Transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) are crucial for diagnosis. We present the case of a 79-year-old man who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Subsequent TTE revealed an apical pseudoaneurysm. To confirm the diagnosis and observe the progression, follow-up TTE and CMR were performed, confirming the pseudoaneurysm involving both ventricles with secondary left-to-right shunt. Surgical repair was performed, with postoperative TTE demonstrating the complete resolution of this shunt.
{"title":"Apical Left Ventricular Pseudoaneurysm With Left-to-Right Shunt: A Rare Mechanical Complication of Myocardial Infarction Involving Both Ventricles","authors":"Haoyu Lu, Ding Zhang, Huaying Fu, Tienan Chen, Feixue Li, Tong Liu, Changle Liu","doi":"10.1111/echo.70410","DOIUrl":"10.1111/echo.70410","url":null,"abstract":"<div>\u0000 \u0000 <p>The pseudoaneurysm involving both ventricles is an infrequent complication following myocardial infarction. The diagnosis is complex and the condition carries a high risk of rupture. Transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) are crucial for diagnosis. We present the case of a 79-year-old man who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Subsequent TTE revealed an apical pseudoaneurysm. To confirm the diagnosis and observe the progression, follow-up TTE and CMR were performed, confirming the pseudoaneurysm involving both ventricles with secondary left-to-right shunt. Surgical repair was performed, with postoperative TTE demonstrating the complete resolution of this shunt.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167715","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":"Fixed Traits, Changeable Paths: What We Inherit, What We Influence, and the Future of Coronary Health","authors":"Giuseppe Muscogiuri, Yousuf Zakko","doi":"10.1111/echo.70405","DOIUrl":"10.1111/echo.70405","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167788","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":"Letter to the Editor: Comments on \"Left Ventricular Mass Index and Relative Wall Thickness Predict Atrial High-Rate Episodes in Patients With Pacemaker Implantation\"","authors":"Yang Gao, Keda Lu","doi":"10.1111/echo.70386","DOIUrl":"10.1111/echo.70386","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167767","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}
Federico Marchini, Maria Mele, Elena Marchetti, Laura Rotondo, Federica Frascaro, Michele Malagù, Rita Pavasini, Elisabetta Tonet, Matteo Serenelli, Alberto Cossu, Filomena Longo, Maria Lo Monaco, Erika Bertella, Gianluca Campo, Matteo Bertini
Purpose
Atrial fibrillation (AF) is highly prevalent in patients with transfusion-dependent beta-thalassemia (TDT). Speckle tracking echocardiography (STE) provides detailed information about left ventricular (LV) and atrial function, however its role in TDT patients with AF has not been completely investigated. This study aimed to assess differences in cardiac mechanical parameters between thalassemia patients with and without history of AF.
Methods and results
223 TDT patients in sinus rhythm were enrolled and, among them, 26 (11%) had history of AF. A complete STE analysis with the evaluation of global longitudinal strain (GLS), peak atrial longitudinal strain (PALS) and myocardial work (MW) indices were performed. The primary endpoint was the difference in STE parameters. The secondary endpoint was the prevalence of cardiac mechanical dysfunction. Patients with history of AF showed significantly lower values of GLS (19% vs 21%, p = 0.01) and PALS (24% vs 35%, p < 0.001) compared to those without AF. AF patients showed higher prevalence of both ventricular and atrial mechanical dysfunction (respectively 27% vs 12%, p = 0.03 and 42% vs 11%, p < 0.001). PALS showed high discriminative ability (AUC 0.76, 95% CI 0.66–0.85) with an optimal cut-off value of 25.9% to detect those with history of AF.
Conclusions
Among TDT patients, those with history of AF showed lower values of GLS and PALS. Both LV and atrial mechanical dysfunction were significantly prevalent in patients with history of AF and PALS showed high diagnostic accuracy for the detection of AF.
Clinical trial registration
ClinicalTrials.gov id NCT05508932
目的：心房颤动（AF）在输血依赖性β -地中海贫血（TDT）患者中非常普遍。斑点跟踪超声心动图（STE）提供了左室（LV）和心房功能的详细信息，但其在TDT合并房颤患者中的作用尚未完全研究。方法与结果：纳入223例有窦性心律的TDT患者，其中26例（11%）有房颤病史。采用全纵应变（GLS）、峰值心房纵应变（PALS）和心肌功（MW）指标进行完整的STE分析。主要终点是STE参数的差异。次要终点是心脏机械功能障碍的患病率。与无房颤的患者相比，有房颤病史的患者GLS（19%对21%，p = 0.01）和PALS（24%对35%，p < 0.001）值显著降低。房颤患者室性和心房机械功能障碍的患病率均较高（分别为27%对12%，p = 0.03和42%对11%，p < 0.001）。PALS对AF病史的鉴别能力较高（AUC 0.76, 95% CI 0.66-0.85），最佳临界值为25.9%。结论：在TDT患者中，有AF病史的患者GLS和PALS值较低。心房机械功能障碍和左室机械功能障碍在有房颤病史的患者中普遍存在，PALS对房颤的诊断准确率较高。临床试验注册号：ClinicalTrials.gov id NCT05508932。
{"title":"Assessing Cardiac Mechanical Dysfunction in Transfusion-Dependent β-Thalassemia With History of Atrial Fibrillation: The Role of Speckle Tracking Echocardiography","authors":"Federico Marchini, Maria Mele, Elena Marchetti, Laura Rotondo, Federica Frascaro, Michele Malagù, Rita Pavasini, Elisabetta Tonet, Matteo Serenelli, Alberto Cossu, Filomena Longo, Maria Lo Monaco, Erika Bertella, Gianluca Campo, Matteo Bertini","doi":"10.1111/echo.70408","DOIUrl":"10.1111/echo.70408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is highly prevalent in patients with transfusion-dependent beta-thalassemia (TDT). Speckle tracking echocardiography (STE) provides detailed information about left ventricular (LV) and atrial function, however its role in TDT patients with AF has not been completely investigated. This study aimed to assess differences in cardiac mechanical parameters between thalassemia patients with and without history of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>223 TDT patients in sinus rhythm were enrolled and, among them, 26 (11%) had history of AF. A complete STE analysis with the evaluation of global longitudinal strain (GLS), peak atrial longitudinal strain (PALS) and myocardial work (MW) indices were performed. The primary endpoint was the difference in STE parameters. The secondary endpoint was the prevalence of cardiac mechanical dysfunction. Patients with history of AF showed significantly lower values of GLS (19% vs 21%, <i>p</i> = 0.01) and PALS (24% vs 35%, <i>p</i> < 0.001) compared to those without AF. AF patients showed higher prevalence of both ventricular and atrial mechanical dysfunction (respectively 27% vs 12%, <i>p</i> = 0.03 and 42% vs 11%, <i>p</i> < 0.001). PALS showed high discriminative ability (AUC 0.76, 95% CI 0.66–0.85) with an optimal cut-off value of 25.9% to detect those with history of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among TDT patients, those with history of AF showed lower values of GLS and PALS. Both LV and atrial mechanical dysfunction were significantly prevalent in patients with history of AF and PALS showed high diagnostic accuracy for the detection of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical trial registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov id NCT05508932</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Damla Raimoglou, Deniz Mutlu, Bilgehan Karadag, Baris Ikitimur, Arda Çeviker, Ayten Ozal, Efekan Dogramaci, A. Atıl Aygun, Utku Raimoglu, Kardelen Ohtaroglu Tokdil, Hasan Tokdil, Eser Durmaz
Background
Contrast-enhanced transesophageal echocardiography (cTEE) is the gold standard for the detection of patent foramen ovale (PFO). However, the diagnostic yield may vary depending on the venous injection site of the saline contrast medium and the presence of anatomical variants such as the Eustachian valve (EV) or Chiari network (CN), which can alter right atrial flow dynamics. This study aims to evaluate whether the route of injection—an upper-extremity vein vs. a lower-extremity vein—affects PFO detection and whether the presence of EV or CN further influences shunt visualization.
Methods
We prospectively enrolled 174 patients referred for cTEE for suspected cardioembolic etiology. Agitated saline contrast was injected via an upper-extremity vein (brachial/antecubital vein; UEV) and via a lower-extremity vein (saphenous veins; LEV) during standardized Valsalva maneuver. Each route was tested with up to three adequately performed injections irrespective of the alternate-route result. PFO was defined as microbubbles visualized traversing the interatrial septum within the first five cardiac cycles after right atrial opacification and Valsalva release. EV/CN was recorded. EV length and mobility and atrial septal aneurysm (ASA) were assessed by re-review of archived TEE images.
Results
PFO was detected in 73/174 (42.0%) by either route. UEV was positive in 58/174 (33.3%) and LEV in 64/174 (36.8%) (p = 0.307). Among PFO-positive patients, 49 (67.1%) were positive with both routes, 9 (12.3%) only with UEV injection, and 15 (20.5%) only with LEV injection. EV was present in 56/174 (32.2%) and CN in 4/174 (2.3%); among PFO-positive patients, EV was present in 31/73 (42.5%) and CN in 2/73 (2.7%). In EV-positive PFO patients (n = 31), positive LEV injection detected 31/31 (100%) whereas positive UEV injection detected 17/31 (54.8%) (p = 0.000122). LEV-only positivity occurred in 9/11 patients with EV length ≥10 mm versus 5/20 with EV length <10 mm (OR 13.5, p = 0.0068).
Conclusion
LEV injection improves detection in EV-positive patients, supporting an anatomy-guided approach in which LEV injection is added when EV is visualized or when UEV injections are inconclusive.
{"title":"Influence of Venous Access Site and Right Atrial Anatomical Variants on the Detection of Patent Foramen Ovale During Agitated Saline Contrast Transesophageal Echocardiography","authors":"Damla Raimoglou, Deniz Mutlu, Bilgehan Karadag, Baris Ikitimur, Arda Çeviker, Ayten Ozal, Efekan Dogramaci, A. Atıl Aygun, Utku Raimoglu, Kardelen Ohtaroglu Tokdil, Hasan Tokdil, Eser Durmaz","doi":"10.1111/echo.70401","DOIUrl":"10.1111/echo.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Contrast-enhanced transesophageal echocardiography (cTEE) is the gold standard for the detection of patent foramen ovale (PFO). However, the diagnostic yield may vary depending on the venous injection site of the saline contrast medium and the presence of anatomical variants such as the Eustachian valve (EV) or Chiari network (CN), which can alter right atrial flow dynamics. This study aims to evaluate whether the route of injection—an upper-extremity vein vs. a lower-extremity vein—affects PFO detection and whether the presence of EV or CN further influences shunt visualization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively enrolled 174 patients referred for cTEE for suspected cardioembolic etiology. Agitated saline contrast was injected via an upper-extremity vein (brachial/antecubital vein; UEV) and via a lower-extremity vein (saphenous veins; LEV) during standardized Valsalva maneuver. Each route was tested with up to three adequately performed injections irrespective of the alternate-route result. PFO was defined as microbubbles visualized traversing the interatrial septum within the first five cardiac cycles after right atrial opacification and Valsalva release. EV/CN was recorded. EV length and mobility and atrial septal aneurysm (ASA) were assessed by re-review of archived TEE images.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PFO was detected in 73/174 (42.0%) by either route. UEV was positive in 58/174 (33.3%) and LEV in 64/174 (36.8%) (<i>p</i> = 0.307). Among PFO-positive patients, 49 (67.1%) were positive with both routes, 9 (12.3%) only with UEV injection, and 15 (20.5%) only with LEV injection. EV was present in 56/174 (32.2%) and CN in 4/174 (2.3%); among PFO-positive patients, EV was present in 31/73 (42.5%) and CN in 2/73 (2.7%). In EV-positive PFO patients (n = 31), positive LEV injection detected 31/31 (100%) whereas positive UEV injection detected 17/31 (54.8%) (<i>p</i> = 0.000122). LEV-only positivity occurred in 9/11 patients with EV length ≥10 mm versus 5/20 with EV length <10 mm (OR 13.5, <i>p</i> = 0.0068).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LEV injection improves detection in EV-positive patients, supporting an anatomy-guided approach in which LEV injection is added when EV is visualized or when UEV injections are inconclusive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Number</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167797","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}
Cardiac dimensions generally exhibit a linear relationship with body size and gender and are commonly indexed to body surface area (BSA) to detect abnormal volume measurements. This study aimed to evaluate right ventricular (RV) indices in relation to BSA and gender using both two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography.
Methods
A cross-sectional analysis was conducted on 295 patients between 2023 and 2024. Demographic and clinical data were extracted from medical records. RV parameters including RV basal (RVBD), mid-cavity (RVMD), and longitudinal dimensions (RVLD) were assessed via 2D echocardiography. Volumetric and functional indices such as RV end-systolic volume (RVESV), RV end-diastolic volume (RVEDV), and RV ejection fraction (RVEF) were measured using 3D echocardiography. Data analysis was performed using SPSS version 24.
Results
Of the 295 participants, 50.8% were male, with a mean age of 45.2 ± 14.48 years. The most robust correlation was found between BSA and RVMD (r = 0.633, p < 0.001). Other 2D parameters showed weaker or non-significant associations. In 3D echocardiographic evaluation, BSA demonstrated significant positive correlations with RVEDV (r = 0.626, p < 0.001) and RVESV (r = 0.520, p < 0.001). Moreover, age had a significant inverse relationship with several RV parameters (p < 0.05).
Conclusion
This study highlights the significant influence of gender and BSA on some RV morphology and volume as assessed by both 2D and 3D echocardiography.
目的：心脏尺寸通常与体型和性别呈线性关系，通常与体表面积（BSA）挂钩，以检测异常的体积测量。本研究旨在利用二维（2D）和三维（3D）经胸超声心动图评估右心室（RV）指数与BSA和性别的关系。方法：对2023 ~ 2024年295例患者进行横断面分析。从医疗记录中提取人口统计学和临床数据。通过二维超声心动图评估左心室参数，包括左心室基底（RVBD）、中腔（RVMD）和纵向尺寸（RVLD）。采用三维超声心动图测量左室收缩末容积（RVESV）、右室舒张末容积（RVEDV）、右室射血分数（RVEF）等容积和功能指标。使用SPSS version 24进行数据分析。结果：295例患者中，男性占50.8%，平均年龄（45.2±14.48）岁。BSA与RVMD的相关性最强（r = 0.633, p < 0.001）。其他2D参数的相关性较弱或不显著。在三维超声心动图评价中，BSA与RVEDV （r = 0.626, p < 0.001）和RVESV （r = 0.520, p < 0.001）呈显著正相关。此外，年龄与一些右心室参数呈显著负相关(p)。结论：本研究强调了性别和脑白蛋白对左心室形态和体积的显著影响，这是通过二维和三维超声心动图评估的。
{"title":"The Association Between Right Ventricular Size, Gender, and Body Surface Area Using Transthoracic Echocardiography: A Cross-Sectional Analysis","authors":"Niloufar Akbari Parsa, Yasaman Borghei, Seyedeh Fatemeh Mirrazeghi, Fatemeh Baharvand, Arsalan Salari, Aseme Pourrajabi, Bahareh Gholami-Chaboki, Saeed Nourzad","doi":"10.1111/echo.70409","DOIUrl":"10.1111/echo.70409","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Cardiac dimensions generally exhibit a linear relationship with body size and gender and are commonly indexed to body surface area (BSA) to detect abnormal volume measurements. This study aimed to evaluate right ventricular (RV) indices in relation to BSA and gender using both two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional analysis was conducted on 295 patients between 2023 and 2024. Demographic and clinical data were extracted from medical records. RV parameters including RV basal (RVBD), mid-cavity (RVMD), and longitudinal dimensions (RVLD) were assessed via 2D echocardiography. Volumetric and functional indices such as RV end-systolic volume (RVESV), RV end-diastolic volume (RVEDV), and RV ejection fraction (RVEF) were measured using 3D echocardiography. Data analysis was performed using SPSS version 24.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 295 participants, 50.8% were male, with a mean age of 45.2 ± 14.48 years. The most robust correlation was found between BSA and RVMD (<i>r</i> = 0.633, <i>p</i> < 0.001). Other 2D parameters showed weaker or non-significant associations. In 3D echocardiographic evaluation, BSA demonstrated significant positive correlations with RVEDV (<i>r</i> = 0.626, <i>p</i> < 0.001) and RVESV (<i>r</i> = 0.520, <i>p</i> < 0.001). Moreover, age had a significant inverse relationship with several RV parameters (<i>p </i>< 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights the significant influence of gender and BSA on some RV morphology and volume as assessed by both 2D and 3D echocardiography.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167783","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}
Krzysztof Serafin, Julia Murlewska, Agnieszka A. Nocuń, Dariusz Zawisza, Katarzyna Zawisza, Marcin T. Wiecheć
Background
Each myocardial function parameter has limitations. The myocardial performance index (MPI) relies solely on cardiac time intervals and appears optimal. However, its accuracy may be compromised in fetuses with prolonged atrioventricular (AV) conduction time and variable fetal heart rate (FHR). We evaluated whether ejection fraction (EF) and fractional area change (FAC), assessed by two-dimensional speckle-tracking echocardiography (2D-STE), are less influenced by AV conduction time and FHR than MPI.
Methods
We studied 468 fetuses without structural, hemodynamic, or major vessel abnormalities. Fetuses with AV time >90th percentile for the corresponding trimester comprised the study group. MPI and its components, AV time, and FHR were measured using simultaneous left ventricular (LV) inflow and outflow pulsed-wave Doppler (PWD) recordings. LV EF and FAC were assessed via 2D-STE.
Results
AV time correlated strongly with isovolumic contraction time (ICT) in both the second (r = 0.73, p < 0.001, after Bonferroni correction) and third trimesters (r = 0.63, p < 0.001). AV time showed moderate correlation with MPI in both trimesters (second: r = 0.41; third: r = 0.34; p < 0.001). MPI increased significantly with prolonged AV time. EF and FAC remained robust and independent regardless of AV time or FHR changes. A significant negative correlation between FHR and ejection time (ET) was observed in both trimesters (second: r = –0.56; third: r = –0.60; both p < 0.001). Logistic regression identified MPI as the sole parameter discriminating between groups (AUC >0.7), whereas EF and FAC showed no discrimination (AUC ≈0.5).
Conclusions
This study demonstrated that the LV MPI showed a significant dependence on AV conduction time. In contrast, LV EF and FAC, calculated using 2D-STE, remained robust and independent of variations in AV conduction time and FHR in healthy fetuses.
背景：每个心肌功能参数都有局限性。心肌表现指数（MPI）仅依赖于心脏时间间隔，表现为最佳。然而，在房室传导时间延长和胎儿心率（FHR）变化的胎儿中，其准确性可能会受到损害。我们通过二维斑点跟踪超声心动图（2D-STE）评估射血分数（EF）和分数面积变化（FAC）是否比MPI更受房室传导时间和FHR的影响。方法：我们研究了468例无结构、血流动力学或主要血管异常的胎儿。在相应的三个月，AV时间为bb0 - 90百分位的胎儿组成研究组。同时采用左心室（LV）流入和流出脉冲波多普勒（PWD）记录MPI及其组成、AV时间和FHR。通过2D-STE评估左室EF和FAC。结果：AV时间与孕中期（r = 0.73, p < 0.001，经Bonferroni校正）和孕晚期（r = 0.63, p < 0.001）等容收缩时间（ICT）密切相关。两个妊娠期AV时间与MPI均有中度相关性（第二个r = 0.41，第三个r = 0.34, p < 0.001）。MPI随AV时间延长而显著升高。无论AV时间或FHR变化如何，EF和FAC都保持稳健和独立。FHR与射血时间（ET）在两个妊娠期均呈显著负相关（第二个：r = -0.56；第三个：r = -0.60；均p < 0.001）。Logistic回归发现MPI是组间唯一的判别参数（AUC≈0.5），而EF和FAC没有区别（AUC≈0.5）。结论：本研究表明左室MPI对房室传导时间有明显的依赖性。相比之下，使用2D-STE计算的LV EF和FAC保持稳健，并且与健康胎儿的房室传导时间和FHR的变化无关。
{"title":"Impact of Atrioventricular Conduction Time and Heart Rate on Fetal Left Ventricular Function Quantification—The Role of 2D Speckle-Tracking Echocardiography","authors":"Krzysztof Serafin, Julia Murlewska, Agnieszka A. Nocuń, Dariusz Zawisza, Katarzyna Zawisza, Marcin T. Wiecheć","doi":"10.1111/echo.70404","DOIUrl":"10.1111/echo.70404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Each myocardial function parameter has limitations. The myocardial performance index (MPI) relies solely on cardiac time intervals and appears optimal. However, its accuracy may be compromised in fetuses with prolonged atrioventricular (AV) conduction time and variable fetal heart rate (FHR). We evaluated whether ejection fraction (EF) and fractional area change (FAC), assessed by two-dimensional speckle-tracking echocardiography (2D-STE), are less influenced by AV conduction time and FHR than MPI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 468 fetuses without structural, hemodynamic, or major vessel abnormalities. Fetuses with AV time >90th percentile for the corresponding trimester comprised the study group. MPI and its components, AV time, and FHR were measured using simultaneous left ventricular (LV) inflow and outflow pulsed-wave Doppler (PWD) recordings. LV EF and FAC were assessed via 2D-STE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AV time correlated strongly with isovolumic contraction time (ICT) in both the second (<i>r</i> = 0.73, <i>p</i> < 0.001, after Bonferroni correction) and third trimesters (<i>r</i> = 0.63, <i>p</i> < 0.001). AV time showed moderate correlation with MPI in both trimesters (second: <i>r</i> = 0.41; third: <i>r</i> = 0.34; <i>p</i> < 0.001). MPI increased significantly with prolonged AV time. EF and FAC remained robust and independent regardless of AV time or FHR changes. A significant negative correlation between FHR and ejection time (ET) was observed in both trimesters (second: <i>r</i> = –0.56; third: <i>r</i> = –0.60; both <i>p</i> < 0.001). Logistic regression identified MPI as the sole parameter discriminating between groups (AUC >0.7), whereas EF and FAC showed no discrimination (AUC ≈0.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated that the LV MPI showed a significant dependence on AV conduction time. In contrast, LV EF and FAC, calculated using 2D-STE, remained robust and independent of variations in AV conduction time and FHR in healthy fetuses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151257","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 Atrial Function and Tricuspid Regurgitation in Chronic Thromboembolic Pulmonary Hypertension","authors":"Gianluca Pagnoni, Aurora Vicenzi, Francesca Coppi","doi":"10.1111/echo.70406","DOIUrl":"10.1111/echo.70406","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151232","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}
Diego Rangel-Rivera, Gustavo Lemus Barrios, Alejandro Herrera Frey, Carlos-Eduardo Guerrero-Chalela, Juan Felipe Vasquez-Rodriguez
We present the case of a 26-year-old woman who underwent bilateral lung transplantation. In the postoperative period, she developed impaired oxygenation and pulmonary opacities predominantly on the left side. Transesophageal echocardiography revealed a finding initially interpreted as thrombus in the left pulmonary vein. However, multimodality imaging established that the appearance was due to redundant donor pulmonary vein wall tissue folded at the anastomosis by the surgical technique, without significant obstruction. A multidisciplinary team chose conservative management, with good clinical and imaging outcomes at 6-month follow-up.
{"title":"False Thrombus in the Pulmonary Vein: Multimodality in Post–Lung Transplantation","authors":"Diego Rangel-Rivera, Gustavo Lemus Barrios, Alejandro Herrera Frey, Carlos-Eduardo Guerrero-Chalela, Juan Felipe Vasquez-Rodriguez","doi":"10.1111/echo.70403","DOIUrl":"10.1111/echo.70403","url":null,"abstract":"<div>\u0000 \u0000 <p>We present the case of a 26-year-old woman who underwent bilateral lung transplantation. In the postoperative period, she developed impaired oxygenation and pulmonary opacities predominantly on the left side. Transesophageal echocardiography revealed a finding initially interpreted as thrombus in the left pulmonary vein. However, multimodality imaging established that the appearance was due to redundant donor pulmonary vein wall tissue folded at the anastomosis by the surgical technique, without significant obstruction. A multidisciplinary team chose conservative management, with good clinical and imaging outcomes at 6-month follow-up.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151271","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}
Cuma Süleymanoğlu, Fuat Polat, Deniz Elçik, Nihat Kalay
Background
COVID-19 has been associated with significant cardiovascular complications, yet the long-term cardiovascular consequences and prognostic biomarkers in moderate versus severe disease remain incompletely characterized. This study aimed to evaluate longitudinal cardiovascular changes, identify mortality predictors, and assess the discriminative performance of fractional exhaled nitric oxide (FeNO) and endothelin-1 (ET-1) in hospitalized COVID-19 survivors.
Methods
This prospective cohort study enrolled 480 hospitalized COVID-19 patients (240 moderate, 240 severe by WHO criteria) who survived to discharge between June 2020 and December 2023. Baseline and 1-year echocardiography, inflammatory biomarkers including FeNO and ET-1, and clinical outcomes were assessed. Multivariable Cox regression identified mortality predictors, and ROC analysis evaluated biomarker discriminative performance.
Results
Severe COVID-19 patients demonstrated significant baseline right ventricular dysfunction with reduced TAPSE (16.63 ± 2.43 vs. 20.36 ± 3.68 mm, p < 0.001) and impaired RVPA coupling (0.60 ± 0.14 vs. 0.88 ± 0.45, p < 0.001). Progressive cardiovascular deterioration occurred over 1 year, with pulmonary artery pressure increasing 17.8% in severe versus 7.1% in moderate disease. Two-year mortality was 16.9% overall. Independent mortality predictors included hypertension (HR 3.02), hyperlipidemia (HR 2.51), diabetes (HR 2.23), and left atrial volume index (HR 1.08 per mL/m2). FeNO and ET-1 predicted mortality specifically in severe disease (HR 1.028 and 1.035, respectively) and demonstrated excellent discriminative ability (AUC 0.892 and 0.865) for identifying severe COVID-19.
Conclusions
Moderate and severe COVID-19 survivors exhibit progressive cardiovascular deterioration, particularly affecting right ventricular function. FeNO and ET-1 serve as severity-specific prognostic biomarkers and demonstrate excellent discriminative performance, supporting their integration into risk stratification protocols for COVID-19 survivors.
背景：COVID-19与严重心血管并发症相关，但中度和重度疾病的长期心血管后果和预后生物标志物仍未完全确定。本研究旨在评估COVID-19住院幸存者的纵向心血管变化，确定死亡率预测因素，并评估分数呼出一氧化氮（FeNO）和内皮素-1 （ET-1）的判别性能。方法：本前瞻性队列研究纳入了2020年6月至2023年12月期间存活至出院的480例住院COVID-19患者（WHO标准为中度240例，重度240例）。评估基线和1年超声心动图、炎症生物标志物（包括FeNO和ET-1）和临床结果。多变量Cox回归确定了死亡率预测因子，ROC分析评估了生物标志物的判别性能。结果：严重的COVID-19患者表现出明显的基线右室功能障碍，TAPSE降低（16.63±2.43比20.36±3.68 mm, p 2）。FeNO和ET-1特异性预测重症病死率（HR分别为1.028和1.035），对重症病死率的鉴别能力较好（AUC分别为0.892和0.865）。结论：中重度COVID-19幸存者表现出进行性心血管恶化，特别是影响右心室功能。FeNO和ET-1作为严重程度特异性预后生物标志物，具有出色的鉴别性能，支持将其纳入COVID-19幸存者的风险分层方案。
{"title":"Integrated Echocardiographic and Biomarker Assessment Reveal Progressive Cardiovascular Injury After Moderate and Severe COVID-19","authors":"Cuma Süleymanoğlu, Fuat Polat, Deniz Elçik, Nihat Kalay","doi":"10.1111/echo.70407","DOIUrl":"10.1111/echo.70407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>COVID-19 has been associated with significant cardiovascular complications, yet the long-term cardiovascular consequences and prognostic biomarkers in moderate versus severe disease remain incompletely characterized. This study aimed to evaluate longitudinal cardiovascular changes, identify mortality predictors, and assess the discriminative performance of fractional exhaled nitric oxide (FeNO) and endothelin-1 (ET-1) in hospitalized COVID-19 survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cohort study enrolled 480 hospitalized COVID-19 patients (240 moderate, 240 severe by WHO criteria) who survived to discharge between June 2020 and December 2023. Baseline and 1-year echocardiography, inflammatory biomarkers including FeNO and ET-1, and clinical outcomes were assessed. Multivariable Cox regression identified mortality predictors, and ROC analysis evaluated biomarker discriminative performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Severe COVID-19 patients demonstrated significant baseline right ventricular dysfunction with reduced TAPSE (16.63 ± 2.43 vs. 20.36 ± 3.68 mm, <i>p</i> < 0.001) and impaired RVPA coupling (0.60 ± 0.14 vs. 0.88 ± 0.45, <i>p</i> < 0.001). Progressive cardiovascular deterioration occurred over 1 year, with pulmonary artery pressure increasing 17.8% in severe versus 7.1% in moderate disease. Two-year mortality was 16.9% overall. Independent mortality predictors included hypertension (HR 3.02), hyperlipidemia (HR 2.51), diabetes (HR 2.23), and left atrial volume index (HR 1.08 per mL/m<sup>2</sup>). FeNO and ET-1 predicted mortality specifically in severe disease (HR 1.028 and 1.035, respectively) and demonstrated excellent discriminative ability (AUC 0.892 and 0.865) for identifying severe COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Moderate and severe COVID-19 survivors exhibit progressive cardiovascular deterioration, particularly affecting right ventricular function. FeNO and ET-1 serve as severity-specific prognostic biomarkers and demonstrate excellent discriminative performance, supporting their integration into risk stratification protocols for COVID-19 survivors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133420","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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