Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function–a key prognostic factor in TR–remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes.
{"title":"Assessment of the Right Ventricle Function in Patients With Significant Tricuspid Regurgitation: A Review","authors":"Corentin Bourg, Tristan Raoult, Sabina Istratoiae, Jérémy Beaumont, Erwan Donal","doi":"10.1111/echo.15933","DOIUrl":"https://doi.org/10.1111/echo.15933","url":null,"abstract":"<p>Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function–a key prognostic factor in TR–remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.15933","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451721","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}
{"title":"Echocardiography of the Right Ventricle for Outcome Prediction in Heart Failure","authors":"Robert Naeije","doi":"10.1111/echo.70008","DOIUrl":"https://doi.org/10.1111/echo.70008","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451247","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}
Christian Basile, Alessandra Scatteia, Daniele Giacopelli, Paolo Gallo, Salvatore Pezzullo, Costantino Mancusi, Carmine E. Pascale, Paola Gargiulo, Federica Marzano, Pasquale Perrone-Filardi, Stefania Paolillo, Santo Dellegrottaglie
Background
Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure and electrical dyssynchrony. Cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular (LV) function. However, the feasibility of using CMR with active CRT is still uncertain.
Purpose
To assess the feasibility of a CRT “off-on” protocol during CMR and measure the acute effects of CRT interruption on LV function.
Methods
Patients underwent CMR before (pre-CRT) and 6 months after (post-CRT) an MR-conditional CRT defibrillator implantation. The post-CRT scan included two complete sets of cine images, one with inactive (post-CRTOFF) and one with active CRT (post-CRTON), maintaining a continuous connection between device and programmer.
Results
Out of 29 enrolled patients, 8 (28%) had complete and analyzable post-CRT data. Unsuccessful procedures were attributed to connection problems between the CRT device and the programmer (n = 10), poor image quality (n = 7), and lack of patient cooperation (n = 4). LV ejection fraction significantly increased between pre-CRT scan (28.1%) and both post-CRTOFF (37.9%; p = 0.046) and post-CRTON CMR (35.0%; p = 0.037), with a nonstatistically significant trend toward decreased LV volumes. No adverse events or significant changes in device electrical parameters (including battery level) were detected during the post-CMR scan period.
Conclusion
A CRT “off-on” protocol during CMR studies can be safely executed in patients with an MR-conditional CRT defibrillator. However, technical improvements are needed to facilitate high-quality scans during active CRT. Favorable changes in LV function induced by CRT remodeling were not acutely reversed with the interruption of electrical therapy.
{"title":"Feasibility of a Cardiac Magnetic Resonance Protocol for “off-on” Cardiac Resynchronization Therapy Evaluation","authors":"Christian Basile, Alessandra Scatteia, Daniele Giacopelli, Paolo Gallo, Salvatore Pezzullo, Costantino Mancusi, Carmine E. Pascale, Paola Gargiulo, Federica Marzano, Pasquale Perrone-Filardi, Stefania Paolillo, Santo Dellegrottaglie","doi":"10.1111/echo.70003","DOIUrl":"https://doi.org/10.1111/echo.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure and electrical dyssynchrony. Cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular (LV) function. However, the feasibility of using CMR with active CRT is still uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess the feasibility of a CRT “off-on” protocol during CMR and measure the acute effects of CRT interruption on LV function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients underwent CMR before (pre-CRT) and 6 months after (post-CRT) an MR-conditional CRT defibrillator implantation. The post-CRT scan included two complete sets of cine images, one with inactive (post-CRT<sub>OFF</sub>) and one with active CRT (post-CRT<sub>ON</sub>), maintaining a continuous connection between device and programmer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 29 enrolled patients, 8 (28%) had complete and analyzable post-CRT data. Unsuccessful procedures were attributed to connection problems between the CRT device and the programmer (<i>n</i> = 10), poor image quality (<i>n</i> = 7), and lack of patient cooperation (<i>n</i> = 4). LV ejection fraction significantly increased between pre-CRT scan (28.1%) and both post-CRT<sub>OFF</sub> (37.9%; <i>p</i> = 0.046) and post-CRT<sub>ON</sub> CMR (35.0%; <i>p</i> = 0.037), with a nonstatistically significant trend toward decreased LV volumes. No adverse events or significant changes in device electrical parameters (including battery level) were detected during the post-CMR scan period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A CRT “off-on” protocol during CMR studies can be safely executed in patients with an MR-conditional CRT defibrillator. However, technical improvements are needed to facilitate high-quality scans during active CRT. Favorable changes in LV function induced by CRT remodeling were not acutely reversed with the interruption of electrical therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451246","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}
Thymoma is a relatively uncommon thoracic solid tumor, and considered to possess malignant potential. Usually, the lung, pleura, and mediastinum are the most frequently affected sites for metastasis in thymoma. However, the thymoma presenting simultaneous intrathoracic and extrathoracic metastases are exceedingly rare. Herein, we present an exceptionally uncommon case of invasive thymoma with multiple metastases. Furthermore, our case underscores the indispensable role of multimodality imaging in confirming the primary diagnosis and guiding treatment decisions.
{"title":"A Case of Invasive Thymoma Complicated by Multiple Metastases","authors":"Yuqiong An, Fang Nie","doi":"10.1111/echo.15947","DOIUrl":"https://doi.org/10.1111/echo.15947","url":null,"abstract":"<div>\u0000 \u0000 <p>Thymoma is a relatively uncommon thoracic solid tumor, and considered to possess malignant potential. Usually, the lung, pleura, and mediastinum are the most frequently affected sites for metastasis in thymoma. However, the thymoma presenting simultaneous intrathoracic and extrathoracic metastases are exceedingly rare. Herein, we present an exceptionally uncommon case of invasive thymoma with multiple metastases. Furthermore, our case underscores the indispensable role of multimodality imaging in confirming the primary diagnosis and guiding treatment decisions.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447517","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 illustration depicts the complete occlusion of all supra-aortic branches due to Takayasu arteritis, as shown in invasive coronary angiography and CT angiography (a) Catheter angiography showing the occluded branches of the aortic arch (*). (b) Sagittal CT angiography showing calcification in the occluded supra-aortic branches (arrows) and thickened aortic wall (dashed arrow).
{"title":"Supra-Aortic Branch Occlusion From Takayasu Arteritis","authors":"Muhammed Tekinhatun, Faruk Ertaş","doi":"10.1111/echo.15961","DOIUrl":"https://doi.org/10.1111/echo.15961","url":null,"abstract":"<p>This illustration depicts the complete occlusion of all supra-aortic branches due to Takayasu arteritis, as shown in invasive coronary angiography and CT angiography (a) Catheter angiography showing the occluded branches of the aortic arch (*). (b) Sagittal CT angiography showing calcification in the occluded supra-aortic branches (arrows) and thickened aortic wall (dashed arrow).\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449182","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}
For the repair of atrial/ventricular septal defects (ASD/VSD), transthoracic echocardiography (TTE) is easy to perform, cost-effective, and does not require general anesthesia and intubation. Still, TTE is not universally accepted. To compare efficacy and safety of TTE versus transesophageal echocardiography (TEE) to guide percutaneous ASD/VSD closure.
Methods
PubMed, Embase, and the Cochrane library were searched for articles published from their inception to December 2023. The primary outcome was the procedural success rate. The secondary outcomes were residual shunt, late complications, procedure time, and fluoroscopy time. All meta-analyses were performed using a random-effects model.
Results
Eight studies and 1295 patients were included. There were no significant differences between TTE and TEE regarding the procedural success rate (OR = 1.93, 95% CI: 0.90–4.13, p = 0.092; I2 = 52.2%, Pheterogeneity = 0.063) and residual shunt rate (OR = 0.81, 95% CI: 0.38–1.76, p = 0.600; I2 = 0%, Pheterogeneity = 0.518). Compared with TEE, TTE reduced the frequency of late complications (OR = 0.25, 95% CI: 0.14–0.43, p < 0.001; I2 = 13.8%, Pheterogeneity = 0.326), reduced the procedure time (WMD = −8.92, 95% CI: −12.08, −5.75, p < 0.001; I2 = 87.4%, Pheterogeneity < 0.001), and reduced the fluoroscopy time (WMD = −5.08, 95% CI: −9.59, −0.56, p = 0.028; I2 = 95.6%, Pheterogeneity < 0.001). The sensitivity analyses showed that the results of the meta-analyses were robust.
Conclusion
Compared with TEE, TTE showed no differences regarding the rates of success and residual shunt, but there were lower rates of late complications and shorter procedure and fluoroscopy times.
{"title":"Efficacy and Safety of Transthoracic Versus Transesophageal Echocardiography for Monitoring Closure of Atrial or Ventricular Septal Defects: A Systematic Review and Meta-Analysis","authors":"Lele Ben, Yuanhao Zhang, Yu Wang, Weizhen Xing, Jianping Cai, Yu Han","doi":"10.1111/echo.15955","DOIUrl":"https://doi.org/10.1111/echo.15955","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>For the repair of atrial/ventricular septal defects (ASD/VSD), transthoracic echocardiography (TTE) is easy to perform, cost-effective, and does not require general anesthesia and intubation. Still, TTE is not universally accepted. To compare efficacy and safety of TTE versus transesophageal echocardiography (TEE) to guide percutaneous ASD/VSD closure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Embase, and the Cochrane library were searched for articles published from their inception to December 2023. The primary outcome was the procedural success rate. The secondary outcomes were residual shunt, late complications, procedure time, and fluoroscopy time. All meta-analyses were performed using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight studies and 1295 patients were included. There were no significant differences between TTE and TEE regarding the procedural success rate (OR = 1.93, 95% CI: 0.90–4.13, <i>p</i> = 0.092; <i>I</i><sup>2</sup> = 52.2%, <i>P</i><sub>heterogeneity</sub> = 0.063) and residual shunt rate (OR = 0.81, 95% CI: 0.38–1.76, <i>p</i> = 0.600; <i>I</i><sup>2</sup> = 0%, <i>P</i><sub>heterogeneity</sub> = 0.518). Compared with TEE, TTE reduced the frequency of late complications (OR = 0.25, 95% CI: 0.14–0.43, <i>p</i> < 0.001; <i>I</i><sup>2</sup> = 13.8%, <i>P</i><sub>heterogeneity</sub> = 0.326), reduced the procedure time (WMD = −8.92, 95% CI: −12.08, −5.75, <i>p</i> < 0.001; <i>I</i><sup>2</sup> = 87.4%, <i>P</i><sub>heterogeneity</sub> < 0.001), and reduced the fluoroscopy time (WMD = −5.08, 95% CI: −9.59, −0.56, <i>p</i> = 0.028; <i>I</i><sup>2</sup> = 95.6%, <i>P</i><sub>heterogeneity</sub> < 0.001). The sensitivity analyses showed that the results of the meta-analyses were robust.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared with TEE, TTE showed no differences regarding the rates of success and residual shunt, but there were lower rates of late complications and shorter procedure and fluoroscopy times.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.15955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443369","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}
Madison I. Goldberger, Angela Pollak, Matthew Fuller, Katherine Sun, Fawaz Alenezi, Donald Glower, Alina Nicoara
Introduction
The hemodynamic effects of mitral valve repair (MVr) with respect to transmitral pressure gradients (TMPGs) have not been described well in patients undergoing leaflet preservation techniques. In a population of patients undergoing robotic MVr with leaflet preservation, we investigate the expected change of the postrepair intraoperative TMPG in the postoperative follow-up period.
Methods
We retrospectively studied 144 adult patients who underwent robotic MVr. Demographic, clinical, procedural, and echocardiographic data were collected and analyzed.
Results
We found a slight increase in the mean TMPG from the intraoperative postrepair to the immediate postoperative period (intraoperative 3.3 ± 1.4 mmHg vs. first postoperative transthoracic echocardiography [TTE] follow-up 3.6 ± 1.9 mmHg, p = 0.016) with a gradual decline in the long-term follow-up (mean TMPG at last follow-up TTE 2.4+2.1 mmHg). When dichotomizing the patient population using a cutoff of 3 mmHg for the intraoperative mean TMPG, patients with an intraoperative mean TMPG > 3 mmHg had higher mean TMPG gradients at first TTE (4.5 ± 2.4 vs. 3.1 ± 1.3 mmHg, p < 0.001) as well as at last TTE (3.0± 2.2 vs. 2.1 ± 2.0 mmHg, p = 0.01) when compared with patients with an intraoperative mean TMPG ≤ 3 mmHg. There was no difference in clinical outcomes.
Conclusions
Although the hemodynamic effect of MVr seems to be small, patients with an intraoperative TMPG > 3 mmHg have a higher mean TMPG at follow-up. The hemodynamic effect does not seem to have an impact on clinical outcome.
{"title":"Transmitral Pressure Gradients in Patients With Degenerative Mitral Regurgitation After Robotic Mitral Valve Repair With Leaflet Preservation Techniques","authors":"Madison I. Goldberger, Angela Pollak, Matthew Fuller, Katherine Sun, Fawaz Alenezi, Donald Glower, Alina Nicoara","doi":"10.1111/echo.70001","DOIUrl":"https://doi.org/10.1111/echo.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The hemodynamic effects of mitral valve repair (MVr) with respect to transmitral pressure gradients (TMPGs) have not been described well in patients undergoing leaflet preservation techniques. In a population of patients undergoing robotic MVr with leaflet preservation, we investigate the expected change of the postrepair intraoperative TMPG in the postoperative follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively studied 144 adult patients who underwent robotic MVr. Demographic, clinical, procedural, and echocardiographic data were collected and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found a slight increase in the mean TMPG from the intraoperative postrepair to the immediate postoperative period (intraoperative 3.3 ± 1.4 mmHg vs. first postoperative transthoracic echocardiography [TTE] follow-up 3.6 ± 1.9 mmHg, <i>p</i> = 0.016) with a gradual decline in the long-term follow-up (mean TMPG at last follow-up TTE 2.4+2.1 mmHg). When dichotomizing the patient population using a cutoff of 3 mmHg for the intraoperative mean TMPG, patients with an intraoperative mean TMPG > 3 mmHg had higher mean TMPG gradients at first TTE (4.5 ± 2.4 vs. 3.1 ± 1.3 mmHg, <i>p</i> < 0.001) as well as at last TTE (3.0± 2.2 vs. 2.1 ± 2.0 mmHg, <i>p</i> = 0.01) when compared with patients with an intraoperative mean TMPG ≤ 3 mmHg. There was no difference in clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although the hemodynamic effect of MVr seems to be small, patients with an intraoperative TMPG > 3 mmHg have a higher mean TMPG at follow-up. The hemodynamic effect does not seem to have an impact on clinical outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443586","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}
Peter L. M. Kerkhof, Rienzi A. Diaz-Navarro, Neal Handly
Ejection fraction (EF) is an incomplete metric and requires consideration of an associated companion (EFC) metric. This figure is based on 96 cardiac patients, including those with acute myocardial infarction (MI). For mid-range EF (with values ranging from 40% to 50%) the brown-colored area indicates the distribution of the EFC for these patients. Only the combination of EF and EFC can define the unique location of each patient. Likewise, data points are spread for any other EF range, for example, those with 55<EF<60% (see yellow area). Volume data obtained by cardiac magnetic resonance imaging (courtesy of Prof. R. A. Diaz-Navarro).
射血分数（EF）是一个不完整的指标，需要考虑相关的辅助指标（EFC）。本图基于 96 名心脏病患者，包括急性心肌梗死（MI）患者。对于中等范围的 EF 值（从 40% 到 50% 不等），棕色区域表示这些患者的 EFC 分布情况。只有 EF 和 EFC 的组合才能确定每位患者的独特位置。同样，任何其他 EF 范围的数据点也会分布，例如，EF 为 55<EF<60% 的患者（见黄色区域）。心脏磁共振成像获得的体积数据（由 R. A. Diaz-Navarro 教授提供）。
{"title":"How the Crystal Ball Helps to Beat Ejection Fraction as Predictor of Mortality After Myocardial Infarction","authors":"Peter L. M. Kerkhof, Rienzi A. Diaz-Navarro, Neal Handly","doi":"10.1111/echo.15936","DOIUrl":"https://doi.org/10.1111/echo.15936","url":null,"abstract":"<p>Ejection fraction (EF) is an incomplete metric and requires consideration of an associated companion (EFC) metric. This figure is based on 96 cardiac patients, including those with acute myocardial infarction (MI). For mid-range EF (with values ranging from 40% to 50%) the brown-colored area indicates the distribution of the EFC for these patients. Only the combination of EF and EFC can define the unique location of each patient. Likewise, data points are spread for any other EF range, for example, those with 55<EF<60% (see yellow area). Volume data obtained by cardiac magnetic resonance imaging (courtesy of Prof. R. A. Diaz-Navarro).\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443400","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}
To predict recurring atrial fibrillation (AF) following radiofrequency catheter ablation by assessing the attributes of the left atrium and the left atrial (LA) appendage (LAA) using transesophageal echocardiography (TEE) and speckle tracking imaging.
Methods
The structural and functional indices of the LA and LAA of 80 patients with AF who underwent preoperative transthoracic echocardiography and TEE were measured. Recurrence was recorded postoperatively at 3, 6, and 12 months. The independent determinants of recurring AF were identified by logistic regression, and their optimum cutoff values, sensitivity, and specificity were estimated from the receiver operating characteristic (ROC) curves.
Results
The recurrent and nonrecurrent groups comprised 17 and 63 patients, respectively. The LA internal diameter, LA end-diastolic and end-systolic volumes, LAA length, diameter and area of the opening of the LAA, and LAA end-diastolic volume were higher in the recurrent group. The LA strain in the reservoir phase, the ejection fraction and filling velocity of the LAA, the LAA emptying velocity (LAAeV), and the LAA strain (LAAS) reduced considerably. Multifactorial regression analyses demonstrated that the LAAeV and LAAS were independent determinants of recurring AF. ROC curve analysis revealed that the LAAeV and LAAS predicted postoperative recurrence at 34.5 cm/s (area under the curve [AUC]: 0.954, sensitivity: 94.1%, and specificity: 92.1%) and 11.61% (AUC: 0.925, sensitivity: 82.4%, and specificity: 95.2%), respectively, while the AUC, sensitivity, and specificity of the combined predictors (LAAeV + LAAS) were 0.978, 94.1%, and 93.7%, respectively.
Conclusion
The LAAeV and LAAS independently influenced the postoperative recurrence of AF.
{"title":"Assessing Left Atrial Appendage Functions by Transesophageal Echocardiography and Speckle Tracking Imaging to Predict Recurring Atrial Fibrillation Post-Radiofrequency Catheter Ablation","authors":"Xinyu Hao, Wei Li, Qunying Zhang, Le Cao, Jinshu Wang, Ling Guo, Qiang Zhang","doi":"10.1111/echo.15958","DOIUrl":"https://doi.org/10.1111/echo.15958","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To predict recurring atrial fibrillation (AF) following radiofrequency catheter ablation by assessing the attributes of the left atrium and the left atrial (LA) appendage (LAA) using transesophageal echocardiography (TEE) and speckle tracking imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The structural and functional indices of the LA and LAA of 80 patients with AF who underwent preoperative transthoracic echocardiography and TEE were measured. Recurrence was recorded postoperatively at 3, 6, and 12 months. The independent determinants of recurring AF were identified by logistic regression, and their optimum cutoff values, sensitivity, and specificity were estimated from the receiver operating characteristic (ROC) curves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The recurrent and nonrecurrent groups comprised 17 and 63 patients, respectively. The LA internal diameter, LA end-diastolic and end-systolic volumes, LAA length, diameter and area of the opening of the LAA, and LAA end-diastolic volume were higher in the recurrent group. The LA strain in the reservoir phase, the ejection fraction and filling velocity of the LAA, the LAA emptying velocity (LAAeV), and the LAA strain (LAAS) reduced considerably. Multifactorial regression analyses demonstrated that the LAAeV and LAAS were independent determinants of recurring AF. ROC curve analysis revealed that the LAAeV and LAAS predicted postoperative recurrence at 34.5 cm/s (area under the curve [AUC]: 0.954, sensitivity: 94.1%, and specificity: 92.1%) and 11.61% (AUC: 0.925, sensitivity: 82.4%, and specificity: 95.2%), respectively, while the AUC, sensitivity, and specificity of the combined predictors (LAAeV + LAAS) were 0.978, 94.1%, and 93.7%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The LAAeV and LAAS independently influenced the postoperative recurrence of AF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435340","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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