Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques最新文献_第4页

Unmasking the Epicardial Adipose Tissue-Left Atrial Strain Nexus in HFpEF: A Potential Echocardiographic Signature of Cardiac Adaptation HFpEF中心外膜脂肪组织-左心房应变关系的揭示：心脏适应的潜在超声心动图特征。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-30 DOI: 10.1111/echo.70053

Zhen Wang, KunDi Chen, Ting Wang, Fang Nie

Purpose

This study aims to investigate the relationship between epicardial adipose tissue (EAT) and left atrial function in patients with preserved ejection fraction heart failure (HFpEF).

Methods

We conducted a cross-sectional study involving 113 patients diagnosed with HFpEF and 48 control subjects without heart failure. Echocardiography was performed to assess EAT thickness and left atrial function was quantified using Autostrain left atrium (LA), including left atrial strain during reservoir phase (LASr), left atrial strain during conduit phase (LAScd), and left atrial strain during contraction phase (LASct). Clinical and biochemical parameters were correlated with EAT and LA strain using regression analyses and generating receiver operating characteristic (ROC) curves for left atrial strain parameters.

Results

EAT thickness was significantly greater in the HFpEF group (8.0 ± 1.0 mm) compared to the control group (5.0 ± 0.7 mm). HFpEF group exhibited poorer left ventricle diastolic function, indicated by lower e' velocity, E/A ratio, and higher E/e' values. Left atrial strain parameters, including LASr (22.4 ± 9.1%), LAScd (11.9 ± 6.9%), and LASct (10.5 ± 3.9%), were all lower in the HFpEF. EAT thickness was positively correlated with NT-proBNP, triglycerides, and fasting blood glucose. Multivariate analysis revealed significant associations between EAT and LA strain parameters even after adjusting for potential confounders. ROC curve analysis indicated that LASr had the highest diagnostic accuracy for HFpEF. Additionally, left atrial strain parameters were strongly correlated with left ventricular diastolic function.

Conclusion

Patients with HFpEF exhibit increased EAT thickness and reduced left atrial function. The thickening of EAT is associated with a decrease in left atrial strain. LA strain, particularly LASr, may serve as a sensitive indicator for early detection of left ventricular diastolic dysfunction in HFpEF.

目的：探讨保留射血分数心力衰竭（HFpEF）患者心外膜脂肪组织（EAT）与左房功能的关系。方法：我们进行了一项横断面研究，包括113例诊断为HFpEF的患者和48例无心力衰竭的对照组。超声心动图评估EAT厚度，Autostrain左心房（LA）定量左心房功能，包括储液期左心房应变（LASr）、导管期左心房应变（LAScd）和收缩期左心房应变（LASct）。采用回归分析，将临床及生化参数与EAT和LA应变进行相关性分析，并生成左心房应变参数的受试者工作特征（ROC）曲线。结果：HFpEF组EAT厚度（8.0±1.0 mm）明显大于对照组（5.0±0.7 mm）。HFpEF组左室舒张功能较差，表现为e′速度、e /A比较低，e /e′值较高。左心房应变参数LASr（22.4±9.1%）、LAScd（11.9±6.9%）、LASct（10.5±3.9%）在HFpEF组均较低。EAT厚度与NT-proBNP、甘油三酯和空腹血糖呈正相关。多变量分析显示，即使在调整潜在混杂因素后，EAT和LA应变参数之间也存在显著关联。ROC曲线分析显示LASr对HFpEF的诊断准确率最高。此外，左心房应变参数与左室舒张功能密切相关。结论：HFpEF患者表现为食道厚度增加，左心房功能降低。EAT的增厚与左心房应变的减少有关。LA菌株，尤其是LASr，可作为早期检测HFpEF左室舒张功能障碍的敏感指标。

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引用次数: 0

The Evaluation of Right Ventricular Synchrony by Two-Dimensional Speckle Tracking Echocardiography in Connective Tissue Disease-Associated Pulmonary Arterial Hypertension 二维斑点跟踪超声心动图评价结缔组织病相关性肺动脉高压患者的右心室同步性。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-30 DOI: 10.1111/echo.70060

Hong Ma, HongPing Wu, XiaoXuan Sun, Qiang Wang, YaGuo Zheng

Objectives

Numerous studies have demonstrated impaired right ventricular (RV) synchronicity in pulmonary arterial hypertension (PAH). However, few studies have focused on connective tissue disease (CTD)-associated PAH. This study evaluates RV dyssynchrony and its prognostic value in CTD-associated PAH.

Methods

One hundred thirteen CTD patients and 32 healthy controls were consecutively recruited. The patients were further divided into two groups: the CTD-nonPAH group (sPAP ˂ 36 mmHg, n = 60) and the CTD-PAH group (sPAP ≥ 36 mm Hg, n = 53). RV dyssynchrony was evaluated by determining the standard deviation of the heart rate–corrected intervals from QRS onset to peak strain for the four segments (RV-SD4) using 2D speckle-tracking echocardiography (2D-STE). All patients were followed up, and the primary endpoint was clinical worsening.

Results

Compared to the health control, the CTD patients exhibited obviously prolonged RV-SD4 (13.3 ± 6.8 ms vs. 41.2 ± 36.5 ms, p < 0.001). Among 113 CTD patients, the CTD-PAH patients had longer RV-SD4 than the CTD-nonPAH patients (20.8 ± 9.9 ms vs. 64.3 ± 41.6 ms, p < 0.001). RV-SD4 was moderately positively correlated with RV longitudinal strain (r = 0.632, p < 0.001), sPAP (r = 0.644, p < 0.001), and were negatively correlated with TAPSE (r = –0.547, p < 0.001), and FAC (r = –0.611, p < 0.001). In the follow-up, 23 patients experienced clinical worsening. The ROC analysis suggested that RV-SD4 level >60.6 ms predicted clinical worsening with 91.3% sensitivity and 66.7% specificity (AUC = 0.891, p < 0.001). Multivariate Cox analysis showed that TAPSE (HR = 0.739; 95% CI 0.623–0.878; p = 0.001) and RV-SD4 (HR = 6.148; 95% CI 1.718–22.000; p = 0.005) were independent predictive parameters of clinical worsening.

Conclusion

CTD patients exhibit impaired RV synchronicity, which is linked to RV function and pulmonary artery pressure. RV dyssynchrony could predict clinical worsening in CTD-PAH.

目的：大量研究表明肺动脉高压（PAH）患者右心室（RV）同步性受损。然而，很少有研究关注结缔组织病（CTD）相关的多环芳烃。本研究评估了右心室非同步化及其在ctd相关PAH中的预后价值。方法：连续招募CTD患者113例，健康对照32例。将患者进一步分为两组：ctd -非pah组（sPAP小于36 mmHg， n = 60）和CTD-PAH组（sPAP≥36 mmHg, n = 53）。通过使用2D斑点跟踪超声心动图（2D- ste）确定四节段（RV- sd4）从QRS发作到峰值应变的心率校正间隔的标准差来评估RV非同步化。所有患者均随访，主要终点为临床恶化。结果：与健康对照组相比，CTD患者RV- sd4明显延长（13.3±6.8 ms vs. 41.2±36.5 ms）， p60.6 ms预测临床恶化的敏感性为91.3%，特异性为66.7% （AUC = 0.891）。结论：CTD患者RV同步性受损，与RV功能和肺动脉压有关。右心室非同步化可以预测CTD-PAH的临床恶化。

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引用次数: 0

Prognostic Value of Advanced Echocardiography in Patients with Ischemic Heart Disease: A Comprehensive Review 高级超声心动图对缺血性心脏病患者预后的价值：综述

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-30 DOI: 10.1111/echo.70065

Shabnam Najaf Zadeh, Patrizia Malagutti, Luca Sartore, Raouf Madhkour, Martina Boscolo Berto, Christoph Gräni, Stefano De Marchi

Cardiovascular (CV) diseases caused 20.5 million deaths in 2021, making up nearly one-third of global mortality. This highlights the need for practical prognostic markers to better classify patients and guide treatment, especially in ischemic heart disease (IHD), which represents one of the leading causes of CV mortality. Transthoracic echocardiography (TTE) is a key, non-invasive imaging tool widely used in cardiology for diagnosing and managing a range of CV conditions. It is the first choice for diagnosing and monitoring patients with acute coronary syndrome (ACS). Alongside well-established echocardiographic measures, new techniques have proven useful for predicting adverse events in IHD patients, such as three-dimensional (3D) and tissue Doppler imaging (TDI), and speckle tracking technology. This review aims to explore the latest echocardiographic tools that could provide new prognostic markers for patients in the acute phase and during follow-up after an acute myocardial infarction (AMI). We focus on new imaging methods like TDI, myocardial work index (MWI), speckle-tracking strain, and 3D technologies using TTE, which are easy to use and widely available at all stages of coronary artery disease (CAD).

2021年，心血管疾病造成2050万人死亡，占全球死亡人数的近三分之一。这凸显了对实用预后标志物的需求，以更好地对患者进行分类并指导治疗，特别是缺血性心脏病（IHD），这是心血管死亡的主要原因之一。经胸超声心动图（TTE）是一种关键的非侵入性成像工具，广泛用于心脏病学诊断和管理一系列心血管疾病。它是诊断和监测急性冠脉综合征（ACS）患者的首选。除了成熟的超声心动图测量外，新技术已被证明可用于预测IHD患者的不良事件，例如三维（3D）和组织多普勒成像（TDI）以及斑点跟踪技术。本文旨在探讨最新的超声心动图工具，为急性心肌梗死（AMI）急性期和随访期间的患者提供新的预后标志物。我们专注于新的成像方法，如TDI，心肌工作指数（MWI），斑点跟踪应变，以及使用TTE的3D技术，这些技术易于使用，可广泛用于冠状动脉疾病（CAD）的各个阶段。

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引用次数: 0

Association Between Lipoprotein(a) and Dilatation of Different Aortic Segments in Hypertensive Patients 脂蛋白(a)与高血压患者不同主动脉段扩张的关系

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-30 DOI: 10.1111/echo.70061

Lin Wang, Chaoqun Ma, Xiaowei Liu, Wei Han

Purpose

There are limited reports on the potential link between Lp(a) and ARDM. Thus, we examined the relationship between Lp(a) and ARDM among hypertensive patients.

Methods

We used echocardiography to measure ARDM in 513 consecutively hospitalized patients. namely, the aortic valve annulus (Ava), sinuses of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AA) in 513 consecutive inpatients. We also examined the Lp(a), and other laboratory profiles of all participants.

Results

Lp(a) exhibited a positive and independent relationship with the SV diameter (coefficient [β] = 0.330, p = 0.002) and STJ (coefficient [β] = 0.253, p = 0.023), regardless of age, sex, height, or other clinical factors among hypertensive, but not nonhypertensive patients. We also demonstrated that a marked rise in Lp(a) levels was independently associated with SV dilatation (SVD) (OR: 1.006, 95% CI: 1.002–1.009, p = 0.002) and AA dilatation (AAD) (OR: 1.006, 95% CI: 1.000–1.011, p = 0.035) in patients with hypertension. In the subgroup analysis, elevated Lp(a) levels were significantly associated with SV dilatation in all subgroups, and with AAD in males and patients aged 65 years or younger (p < 0.05). The restricted cubic spline analysis indicated a linear association between Lp(a) levels and the risk of both SV and AAD (p < 0.05).

Conclusions

Herein, we were the first to report that among hypertensive patients, elevated Lp(a) concentrations were intricately linked to the ARDMs at SV and STJ. Moreover, we revealed that the Lp(a) level was a stand-alone indicator of SVD and AAD.

目的：关于Lp(a)和ARDM之间潜在联系的报道有限。因此，我们研究了高血压患者Lp(a)与ARDM之间的关系。方法：采用超声心动图测定513例连续住院患者的血浆动脉粥样硬化水平。即513例连续住院患者的主动脉瓣环（Ava）、主动脉窦（SV）、窦管交界处（STJ）和升主动脉（AA）。我们还检查了所有参与者的Lp(a)和其他实验室资料。结果：高血压患者Lp(a)与SV内径（系数[β] = 0.330, p = 0.002）、STJ（系数[β] = 0.253, p = 0.023）呈正相关，与年龄、性别、身高等临床因素无关，与非高血压患者无关。我们还证明，高血压患者Lp(a)水平的显著升高与SV扩张（SVD）（OR: 1.006, 95% CI: 1.002-1.009, p = 0.002）和AA扩张（AAD）（OR: 1.006, 95% CI: 1.000-1.011, p = 0.035）独立相关。在亚组分析中，所有亚组中Lp(a)水平升高与SV扩张显著相关，在男性和65岁及以下患者中与AAD显著相关（p < 0.05）。限制性三次样条分析显示，Lp(a)水平与SV和AAD的风险均呈线性相关（p < 0.05）。结论：本文中，我们首次报道了在高血压患者中，Lp(a)浓度升高与SV和STJ的ARDMs有复杂的联系。此外，我们发现Lp(a)水平是SVD和AAD的独立指标。

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引用次数: 0

Mitral Regurgitation Evaluation in Modern Echocardiography: Bridging Standard Techniques and Advanced Tools for Enhanced Assessment 现代超声心动图的二尖瓣反流评估：衔接标准技术和先进工具，增强评估效果

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-21 DOI: 10.1111/echo.70052

Laura Anna Leo, Giacomo Viani, Susanne Schlossbauer, Sebastiano Bertola, Amabile Valotta, Stephanie Crosio, Matteo Pasini, Alessandro Caretta

Mitral regurgitation (MR) is one of the most common valvular heart diseases worldwide. Echocardiography remains the first line and most effective imaging modality for the diagnosis of mitral valve (MV) pathology and quantitative assessment of MR. The advent of three-dimensional echocardiography has significantly enhanced the evaluation of MV anatomy and function. Furthermore, recent advancements in cardiovascular imaging software have emerged as step-forward tools, providing a powerful support for acquisition, analysis, and interpretation of cardiac ultrasound images in the context of MR. This review aims to provide an overview of the contemporary workflow for echocardiographic assessment of MR, encompassing standard echocardiographic techniques and the integration of semiautomated and automated ultrasound solutions. These novel approaches include advancements in segmentation, phenotyping, morphological quantification, functional grading, and chamber quantification.

二尖瓣反流（MR）是全球最常见的瓣膜性心脏病之一。超声心动图仍然是诊断二尖瓣（MV）病变和定量评估二尖瓣反流的第一线和最有效的成像方式。三维超声心动图的出现大大提高了对二尖瓣解剖和功能的评估。此外，心血管成像软件的最新进展已成为一种先进的工具，为磁共振背景下心脏超声图像的采集、分析和解读提供了强大的支持。本综述旨在概述当代 MR 超声心动图评估的工作流程，包括标准超声心动图技术以及半自动和自动超声解决方案的整合。这些新方法包括在分割、表型、形态学量化、功能分级和腔室量化方面的进步。

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引用次数: 0

Navigating the Spectrum of Double-İnlet Left Ventricle Presentations: Contemporary Retrospective Cohort Study 双左心室表现谱导航：当代回顾性队列研究。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-18 DOI: 10.1111/echo.70054

Aydın Ocal, Oya Demirci, Gizem Elif Dizdarogulları, Nurdan Erol, Ilker Kemal Yucel

Purpose

We presented the experience of a tertiary care center for maternal and fetal diseases and assessed the findings fetuses with double-inlet left ventricle (DILV) regarding fetal echocardiography, prenatal course including fetal growth and death, and postnatal outcome.

Methods

In this retrospective study, patients diagnosed with DILV via prenatal ultrasound in the maternal–fetal medicine department between 2015 and 2023 were included to evaluate important aspects of prenatal diagnosis and course, as well as postnatal management and outcome.

Results

There were 33 DILV cases prenatally diagnosed and postnatally confirmed. Genetic abnormality was detected in two (8%) of 25 fetuses that had undergone genetic tests. Pulmonary artery obstruction was observed in 10 (30.3%) fetuses; pulmonary stenosis was found in nine, and pulmonary atresia in one. Aortic arc abnormalities were found in 11 (33.3%) fetuses. The great arteries were malpositioned in the 29 (87.8%) fetuses. The median duration of follow-up for the infants was 12 (2–96) months, and 22 (66.6%) of 33 cases survived. Among the 27 (81.8%) live births, 24 infants required univentricular palliation.

Conclusions

Remarkable implications of this study were that unless extra-cardiac and genetic anomalies accompany DILV, the probability of a chromosomal anomaly is low; that univentricular repair could be performed in almost all cases; and that the major causes of poor prognosis may be related to the restrictive bulboventricular foramen and severe aortic obstruction. Although long-term survival rates after univentricular repair appear to be high, these patients require long-term follow-up and repeated surgical procedures.

目的：我们介绍了一家三级保健中心对母胎疾病的经验，并评估了双入口左心室（DILV）胎儿的超声心动图、产前病程（包括胎儿生长和死亡）和产后结局。方法：回顾性分析2015 - 2023年在母胎内科经产前超声诊断为DILV的患者，对其产前诊断、病程、产后处理及转归等重要方面进行评价。结果：33例DILV经产前诊断及产后确诊。在25例接受基因检测的胎儿中，有2例（8%）检测到遗传异常。肺动脉阻塞10例（30.3%）；肺狭窄9例，肺闭锁1例。11例（33.3%）胎儿发现主动脉弧度异常。29例（87.8%）胎儿大动脉位错。中位随访时间为12（2-96）个月，33例患儿中有22例（66.6%）存活。在27例（81.8%）活产婴儿中，24例婴儿需要单室姑息。结论：本研究的显著意义是，除非DILV伴有心脏外异常和遗传异常，否则染色体异常的可能性很低；几乎所有病例都可以进行单心室修复；预后不良的主要原因可能与限制性球室孔和严重的主动脉阻塞有关。虽然单心室修复后的长期存活率似乎很高，但这些患者需要长期随访和反复手术治疗。

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引用次数: 0

Speckle Tracking Echocardiography-Based Correlation Between Left Atrial Strain and Functional Capacity in Patients With Hypertrophic Cardiomyopathy 基于斑点追踪超声心动图的肥厚型心肌病患者左心房应变与功能能力的相关性研究

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-18 DOI: 10.1111/echo.70051

Mohit D. Gupta, Rupesh Agrawal, Shekhar Kunal, Girish Meenahalli Palleda, Brijesh Kumar, Dixit Goyal, Ankit Bansal, Vishal Batra, Rajeev Kumar Malhotra, Jamal Yusuf

Introduction

The left atrium (LA) dilates and its function decreases as a chronic secondary change in hypertrophic cardiomyopathy (HCM). LA strain is a more sensitive measure of LV filling pressure than LA volume and can be used to predict the functional capacity in HCM.

Objective

To analyze LA strain in patients with HCM and its correlation with exercise tolerance.

Methods

A total of 113 patients with HCM were enrolled. All patients underwent detailed clinical evaluation, 24-h Holter monitoring, exercise stress testing, two-dimensional echocardiography with LA strain analysis using speckle tracking imaging. Assessment of functional capacity was done in terms of metabolic equivalents (METs). HCM patients with METS >6.0 were included in Group A while those with METS ≤ 6.0 were included Group B. Correlation of various parameters of LA strain (left atrial reservoir strain [LASr], left atrial conduit strain [LAScd], and left atrial contraction strain [LASct]) was done with functional capacity.

Results

The mean age of the study population was 47 ± 10.77 years with the majority of them being males (71.9%). Group B patients had significantly lower LASr (12.95% ± 8.61% vs. 22.16% ± 16%; p < 0.001), LAScd (−7.28% ± 6.29% vs. −12.74% ± 8.40%; p < 0.001), and LASct (−7.44 ± 4.46 vs. −11.19 ± 6.53; p < 0.001). Multivariable linear regression analysis reported LASr to be an independent predictor of METs and had a quadratic relationship with log-odds with negative linear and positive quadratic coefficients. LASr was the strongest echocardiographic predictor of reduced METS with an AUC of 0.78 (95% confidence interval [CI]: 0.68–0.88), sensitivity of 71.8%, and specificity of 82.9%.

Conclusion

LA strain parameters are associated with functional capacity in patients with HCM with lower LA strain values being associated with poor functional capacity.

简介：肥厚性心肌病（HCM）的慢性继发性改变是左心房（LA）扩张和功能下降。LA应变是左室充注压力较LA容积更敏感的指标，可用于预测HCM的功能容量。目的：分析HCM患者LA应变及其与运动耐量的关系。方法：共纳入113例HCM患者。所有患者均接受详细的临床评估、24小时动态心电图监测、运动负荷测试、二维超声心动图及斑点跟踪成像LA应变分析。功能能力的评估是根据代谢当量（METs）进行的。将METS≤6.0的HCM患者作为A组，将METS≤6.0的HCM患者作为b组。将LA应变（左心房贮液应变[LASr]、左心房导管应变[LAScd]、左心房收缩应变[LASct]）各项参数与功能容量进行相关性分析。结果：研究人群平均年龄为47±10.77岁，男性居多（71.9%）。B组患者LASr显著低于对照组(12.95%±8.61%∶22.16%±16%；结论：LA应变参数与HCM患者的功能容量有关，LA应变值较低与功能容量较差有关。

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引用次数: 0

Single Coronary Origin From Right Coronary Sinus With Intraseptal Course: How to Make Diagnosis by Echocardiography 单支冠状动脉起源于右冠状动脉窦，伴隔膜内走向：如何通过超声心动图进行诊断。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-18 DOI: 10.1111/echo.70050

Massimiliano Cantinotti, Alberto Clemente, Guglielmo Capponi, Nadia Assanta

We describe a rare case of a male adolescent with anomalous aortic origin of the left coronary artery from the right sinus with intraseptal course (L-ACAO-IS), which was diagnosed at transthoracic echocardiography. The case we presented confirms how echocardiography is accurate in the diagnosis of even challenging coronary artery origin anomalies such as L-ACO-IS. Coronary artery origin evaluation should be an integral part of echocardiography examinations in infants, children, and young adults, especially those undergoing physical activity. We also remark the importance of using multiple views including short axis, long axis, and modified (anteriorized) 4-chamber view which is very helpful for a better evaluation of coronary artery origin and their proximal course.

我们描述了一个罕见的情况下，男性青少年与左冠状动脉异常的主动脉起源从右窦与脑室内病程（L-ACAO-IS），这是经胸超声心动图诊断。我们提出的病例证实了超声心动图如何准确诊断即使是具有挑战性的冠状动脉起源异常，如L-ACO-IS。冠状动脉起源评估应该是婴儿、儿童和年轻人超声心动图检查的一个组成部分，特别是那些进行体育锻炼的人。我们也注意到使用多个视图的重要性，包括短轴，长轴和改良（前化）四室视图，这对于更好地评估冠状动脉起源及其近端路线非常有帮助。

引用次数: 0

Impact of Diabetes Mellitus on Left Ventricular Mechanics and Long-Term Outcome in Patients with Hypertrophic Cardiomyopathy 糖尿病对肥厚性心肌病患者左心室力学和远期预后的影响。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-11 DOI: 10.1111/echo.70048

Hala Mahfouz Badran, John Anis Helmy, Nagalaa Fahem Ahmed, Magdi Yacoub

Background

Type 2 diabetes mellitus (T2DM) intensifies the clinical symptoms of heart diseases and leads to a worse prognosis in heart failure patients. Although hypertrophic cardiomyopathy (HCM) and DM rarely co-occur, particularly in older individuals, the impact of DM on cardiac function and outcomes in individuals with HCM remains insufficiently understood.

Methods

A total of 421 HCM patients were included and followed up in a prospective cohort study (mean 68.7 months). In the diabetic HCM group (n = 47), patients had a mean age of 47 ± 17 years, and 31 (66%) were male, while the non-diabetic HCM group (n = 374) had a mean age of 44 ± 14 years, and 246 (65%) were male. At study entry, all patients underwent echocardiographic evaluation, encompassing left ventricular (LV) regional and global longitudinal strain (GLS), as well as strain rate (SR) analysis.

Results

In diabetic HCM, there was a greater prevalence of hypertension (p < 0.0001), while the ratio of septal to posterior wall thickness (PWT) (p < 0.003) and E' value were lower (p < 0.009) compared to non-diabetic HCM. No significant difference between groups in NYHA class or cardiac phenotype. Diabetic HCM exhibited notable reductions in GLS (p < 0.02), systolic SR (SRsys) (p < 0.04), and early diastolic SR (SRe) p < 0.006. Additionally, there was a significant inverse correlation between LVGLS and HbA1c levels (r = −0.58, p < 0.0001), and the duration of diabetes (r = −0.39, p < 0.006). Hospitalization rates were greater in the diabetic HCM than in the non-diabetic group (44.7% vs.19.5%, p < 0.001). Among all demographic characteristics, phenotypic data, conventional echocardiographic measurements, and LV mechanics, diabetes emerged as the sole determinant of hospitalization among HCM patients. The presence of diabetes nearly tripled the odds of hospitalization (odds ratio: 2.813 [1.448–5.465], p < 0.002). However, diabetes did not negatively affect long-term survival, and age remained the only independent predictor of all-cause mortality.

Conclusions

In HCM, T2DM is linked to more deterioration of cardiac mechanics and contributes to unfavorable consequences by frequent hospitalization on its own, independent of age, comorbidities, or phenotype.

背景：2型糖尿病（T2DM）加重心衰患者的临床症状，导致预后较差。虽然肥厚性心肌病（HCM）和糖尿病很少同时发生，特别是在老年人中，但糖尿病对HCM患者心功能和预后的影响仍未充分了解。方法：在一项前瞻性队列研究中，共纳入421例HCM患者，随访时间平均为68.7个月。糖尿病HCM组患者47例，平均年龄47±17岁，男性31例（66%）；非糖尿病HCM组患者374例，平均年龄44±14岁，男性246例（65%）。在研究开始时，所有患者接受超声心动图评估，包括左心室（LV）区域和全局纵向应变（GLS）以及应变率（SR）分析。结果：糖尿病型HCM中高血压的发生率高于非糖尿病型HCM (p < 0.0001)，而室间隔/后壁厚度（PWT）比（p < 0.003）和E′值均低于非糖尿病型HCM （p < 0.009）。各组间NYHA类别及心脏表型无显著差异。糖尿病HCM患者GLS （p < 0.02）、收缩期SR (SRsys) （p < 0.04）和早期舒张期SR （SRe）均显著降低（p < 0.006）。此外，LVGLS与HbA1c水平（r = -0.58, p < 0.0001）和糖尿病病程（r = -0.39, p < 0.006）呈显著负相关。糖尿病HCM组的住院率高于非糖尿病组（44.7%比19.5%,p < 0.001）。在所有人口统计学特征、表型数据、常规超声心动图测量和左室力学中，糖尿病成为HCM患者住院的唯一决定因素。糖尿病患者住院的几率几乎增加了两倍（优势比：2.813 [1.448-5.465],p < 0.002）。然而，糖尿病对长期生存没有负面影响，年龄仍然是全因死亡率的唯一独立预测因子。结论：在HCM中，T2DM与更多的心脏力学恶化有关，并且由于频繁住院而导致不良后果，与年龄、合并症或表型无关。

{"title":"Impact of Diabetes Mellitus on Left Ventricular Mechanics and Long-Term Outcome in Patients with Hypertrophic Cardiomyopathy","authors":"Hala Mahfouz Badran, John Anis Helmy, Nagalaa Fahem Ahmed, Magdi Yacoub","doi":"10.1111/echo.70048","DOIUrl":"10.1111/echo.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Type 2 diabetes mellitus (T2DM) intensifies the clinical symptoms of heart diseases and leads to a worse prognosis in heart failure patients. Although hypertrophic cardiomyopathy (HCM) and DM rarely co-occur, particularly in older individuals, the impact of DM on cardiac function and outcomes in individuals with HCM remains insufficiently understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 421 HCM patients were included and followed up in a prospective cohort study (mean 68.7 months). In the diabetic HCM group (<i>n</i> = 47), patients had a mean age of 47 ± 17 years, and 31 (66%) were male, while the non-diabetic HCM group (<i>n</i> = 374) had a mean age of 44 ± 14 years, and 246 (65%) were male. At study entry, all patients underwent echocardiographic evaluation, encompassing left ventricular (LV) regional and global longitudinal strain (GLS), as well as strain rate (SR) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In diabetic HCM, there was a greater prevalence of hypertension (<i>p</i> < 0.0001), while the ratio of septal to posterior wall thickness (PWT) (<i>p</i> < 0.003) and E' value were lower (<i>p</i> < 0.009) compared to non-diabetic HCM. No significant difference between groups in NYHA class or cardiac phenotype. Diabetic HCM exhibited notable reductions in GLS (<i>p</i> < 0.02), systolic SR (SRsys) (<i>p</i> < 0.04), and early diastolic SR (SRe) <i>p</i> < 0.006. Additionally, there was a significant inverse correlation between LVGLS and HbA1c levels (<i>r</i> = −0.58, <i>p</i> < 0.0001), and the duration of diabetes (<i>r</i> = −0.39, <i>p</i> < 0.006). Hospitalization rates were greater in the diabetic HCM than in the non-diabetic group (44.7% vs.19.5%, <i>p</i> < 0.001). Among all demographic characteristics, phenotypic data, conventional echocardiographic measurements, and LV mechanics, diabetes emerged as the sole determinant of hospitalization among HCM patients. The presence of diabetes nearly tripled the odds of hospitalization (odds ratio: 2.813 [1.448–5.465], <i>p</i> < 0.002). However, diabetes did not negatively affect long-term survival, and age remained the only independent predictor of all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In HCM, T2DM is linked to more deterioration of cardiac mechanics and contributes to unfavorable consequences by frequent hospitalization on its own, independent of age, comorbidities, or phenotype.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 12","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808484","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

Left Ventricular False Tendons: A Morphological Study by Echocardiography 左心室假肌腱：超声心动图形态学研究。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2024-12-10 DOI: 10.1111/echo.70049

Aizhuo Chen, Jinqing Chen

Purpose

This is a prospective study aimed to investigate the morphology of left ventricular false tendons (LVFTs) using echocardiography and explore its associations with age, sex, body mass index (BMI), congenital heart structural abnormalities, and premature ventricular contractions (PVCs).

Methods and Results

We analyzed data from 889 individuals who underwent consecutive echocardiograms at our ultrasound department between December 2023 and February 2024. Routine echocardiograms were performed to detect congenital structural abnormalities, with a focus on identifying LVFT. We examined the prevalence, number, and distribution of LVFTs, as well as their correlation with age, sex, BMI, and congenital heart structural abnormalities. LVFTs were detected in 460 of 889 cases (51.74%), totaling 672 LVFTs. LVFT prevalence significantly differed not only between sexes but also between ages. LVFT prevalence was higher in individuals with lower BMI. There was no significant difference in congenital heart structural abnormalities between the groups, but the composition of distinct types of structural abnormalities differed between the groups. The incidence of PVCs in the LVFT-positive group was significantly higher than in the LVFT-negative group.

Conclusions

The prevalence of LVFTs is notably higher in males than females and tends to decrease with advancing age and increasing BMI. LVFTs display diverse morphological features and may interact synergistically with certain congenital heart structural abnormalities. LVFTs can easily lead to PVCs in healthy people, but the risk of leading to malignant PVCs does not seem to be high. Correctly recognizing the morphological characteristics of LVFTs helps to distinguish similar ultrasonic images of different diseases, thus avoiding missed diagnoses and misdiagnoses in ultrasound work and clinical practice.

目的：本研究是一项前瞻性研究，旨在利用超声心动图研究左心室假腱（LVFTs）的形态，并探讨其与年龄、性别、体重指数（BMI）、先天性心脏结构异常和室性早搏（pvc）的关系。方法和结果：我们分析了2023年12月至2024年2月期间在我们超声科连续接受超声心动图检查的889名患者的数据。常规超声心动图检测先天性结构异常，重点是识别LVFT。我们检查了LVFTs的患病率、数量和分布，以及它们与年龄、性别、BMI和先天性心脏结构异常的相关性。889例患者中有460例（51.74%）出现lvft，共计672例。LVFT患病率不仅在性别之间存在显著差异，而且在年龄之间也存在显著差异。BMI越低，LVFT患病率越高。先天性心脏结构异常在两组间无显著差异，但不同类型结构异常的组成在两组间存在差异。lvft阳性组的室性早搏发生率明显高于lvft阴性组。结论：男性LVFTs患病率明显高于女性，且随年龄增长和BMI升高呈下降趋势。LVFTs表现出多种形态特征，并可能与某些先天性心脏结构异常协同作用。在健康人群中，LVFTs很容易导致室性早搏，但导致恶性室性早搏的风险似乎并不高。正确认识LVFTs的形态学特征有助于区分不同疾病的相似超声图像，从而避免超声工作和临床实践中的漏诊和误诊。

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引用次数: 0