Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques最新文献

Purpose

To characterize subclinical changes in left atrial (LA) and right atrial (RA) volumetric and strain parameters in hypertension (HTN) comorbid with obstructive sleep apnea (OSA) and to identify the prognostic value of atrial mechanics for adverse cardiovascular events in the left ventricular (LV) function-preserved HTN with OSA patients.

Methods

A total of 177 HTN patients with preserved LV function were enrolled and underwent speckle tracking echocardiography. They were divided into two groups: 104 with OSA (HTN-OSA group, mild: 36; moderate: 35; severe: 33) and 73 without OSA controls (HTN-non OSA group). During the 1-year follow-up, adverse cardiovascular events, including heart failure, atrial fibrillation, stroke and cardiovascular death, were recorded.

Results

HTN-OSA group demonstrated larger LA phasic volumes (p < 0.05), lower LA strain and volumetric function during reservoir and conduit period than HTN-non OSA group (p < 0.05). RA size increased, RA reservoir and contraction strain decreased in HTN-OSA versus non-OSA cases (p < 0.05). LA reservoir (LASr), pump strain and RA strain (RASr) decreased progressively with worsening OSA (p < 0.05). LASr ≤17.5% and RASr ≤36.5% were the optimal cutoffs for independently predicting adverse events. Furthermore, their combination further enhanced predictive performance (AUC = 0.883).

Conclusion

Patients with HTN and OSA exhibit significant bi-atrial dilation and functional impairment compared to those with HTN alone. Moreover, in HTN-OSA patients with preserved LV function, LASr and RASr can detect cardiac functional alterations in different OSA stages and demonstrate robust predictive efficacy for adverse cardiovascular outcomes.

Background

Noninvasive myocardial work (MW), based on speckle-tracking technology and incorporating left ventricular (LV) afterload, significantly reduces the load dependency of parameters. MW has been widely used to assess LV function after TAVI in patients with aortic stenosis (AS); however, its application in this context for pure aortic regurgitation (AR) remains rare. This study aims to (1) assess the specific and overall trends of conventional echocardiographic and MW indices after TAVI in patients with pure AR, providing insight into the process and mid-term outcomes of post-TAVI LV functional improvement in this population; (2) evaluate the post-TAVI functional recovery patterns in patients with preserved vs. reduced left ventricular ejection fraction (LVEF); and (3) explore the relationship between MW indices and LV reverse remodeling (LVRR) following TAVI in patients with pure AR.

Methods

In this prospective cohort study, 43 patients with pure AR who underwent TAVI between January 2023 and July 2024 were enrolled. Serial transthoracic echocardiography was performed at baseline and at 1 week, 1 month, 3 months, and 6 months post-TAVI. Conventional echocardiographic parameters and noninvasive MW indices were analyzed offline.

Results

LVEF, LVGLS, LVGWI, LVGCW, and LVGWE exhibited an overall trend of initial decline followed by subsequent improvement after TAVI, whereas GWW showed an initial increase followed by a decrease. In contrast, LVEDD and LVEDV demonstrated a continuous decline throughout the follow-up period. At 6 months post-TAVI, LVGWI, LVGCW, and LVGWE were significantly reduced, while LVGWW was significantly increased compared with baseline (all p < 0.05). At baseline, post-TAVI, and at 6-month follow-up, LVGLS, LVGWI, and LVGCW were all significantly higher in the LVRR group compared to the non-LVRR group (p < 0.05).

Conclusion

TAVI effectively improves LV function in pure AR, irrespective of baseline LVEF. Noninvasive MW analysis proved to be an effective tool for assessing postoperative improvements in LV myocardial function. The reduction in MW indices at 6 months post-TAVI may reflect partial recovery rather than functional deterioration. Better MW indices at baseline may be associated with LVRR.

Background

The importance of right ventricular (RV) function assessment has been a hot topic in cardiac surgery, and perioperative RV function is known to determine the outcome of cardiac surgery. However, RV echocardiographic assessment is challenging due to RV geometric changes. Currently, a 3D-derived RV assessment is recommended.

Previous studies have shown that RV function is reduced more in surgical aortic valve replacement (SAVR) than in transcatheter aortic valve replacement (TAVR); however, RV assessment in these studies was mostly performed using 2-dimensional echocardiography. Moreover, very few studies have assessed the difference in RV function between full sternotomy (full-SAVR) and mini-sternotomy AVR (mini-SAVR). This study assessed RV function in three types of AVR using 3D RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (RVFAC).

Methods

This is a prospective, observational study at a university hospital setting. Participants are adult patients who underwent TAVR, mini-SAVR, and full-SAVR.

Measurements and Main Results

Sixty-seven patients were enrolled in this study (22, 22, and 23 patients in the TAVR, mini-SAVR, and full-SAVR groups, respectively). The % change (pre- and post-procedure) in 3D RVEF, RVFAC, and TPASE in TAVR, mini-SAVR, and full-SAVR were as follows: 3D RVEF: 4.51 ± 10.89 (TAVR), −13.67 ± 19.81 (mini-SAVR), and −8.36 ± 18.24 (full-SAVR) (p = 0.003). RVFAC: 4.35 ± 12.33 (TAVR), −8.28 ± 23.88 (mini-SAVR), and −9.49 ± 20.92 (full-SAVR) (p < 0.001). TAPSE: 10.46 ± 24.17 (TAVR), −22.14 ± 32.48 (mini-SAVR), and −32.48 ± 31.81 (full-SAVR) (p < 0.001). Comparisons were adjusted for age, gender, central venous pressure, catecholamine amount, and each preoperative RV index.

Conclusion

There was significantly more worsening of 3D RVEF, RVFAC and TAPSE after full-SAVR and mini-SAVR than after TAVR.

Background

Light chain cardiac amyloidosis (AL-CA) is an infiltrative cardiomyopathy characterized by the deposition of abnormally folded proteins in the myocardium and atrial walls. This study aims to evaluate right atrial (RA) stiffness—defined as the ratio of tricuspid E/e’ (reflecting right ventricular diastolic function) to RA reservoir strain (right atrial reservoir strain (RASr), reflecting RA mechanical properties)—using speckle-tracking echocardiography, predicting the primary outcome in AL-CA, and assessing its incremental predictive value.

Methods

Seventy-eight patients (age: 59.40 ± 8.92 years; 60.3% male) with AL-CA and available follow-up data were studied by biopsy, noncardiac biopsy with supportive cardiac imaging. Clinical and routine echocardiographic data were retrospectively analyzed, with all-cause mortality followed during the period from September 2021 to September 2024.

Results

The median follow-up duration was 736 days (interquartile range: 375–1096 days). All-cause mortality occurred in 28 patients (36%). Restricted cubic spline (RCS) analysis identified a RA stiffness threshold of 0.9 as a robust outcome predictor (p < 0.001). Cox regression analysis showed RA stiffness (Tricuspid E/e’/RASr) was independently associated with adverse outcomes (adjusted hazard ratio = 4.33, p < 0.001). Kaplan–Meier survival curves demonstrated significant survival differences stratified by RA stiffness. Incorporating RA stiffness into the New York Heart Association(NYHA)functional class and Mayo 2012 models significantly improved their predictive accuracy (all p < 0.001).

Conclusion

RA stiffness evaluated by speckle-tracking echocardiography has prognostic value in AL-CA, adding incremental predictive value to conventional staging models.

Aim

To investigate the effects of an 8-weeks of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) program on ventricular-arterial coupling (VAC) in young women with obesity.

Methods

Twenty-four obese women completed an 8-week supervised aerobic training program (3 sessions/week) assigned to either HIIT (n = 11) or MICT (n = 13). The HIIT protocol involved four 4-min bouts at 85%–95% of the maximum heart rate (HR_max), while the MICT consisted of continuous walking/running for 41 min at 65%–75% of HR_max. VAC was assessed using two methods: (1) the ratio of pulse wave velocity to global longitudinal strain (PWV/GLS), and (2) the ratio of arterial to ventricular elastance (E_a/E_es).

Results

Both HIIT (−0.35 ± 0.01 to −0.31 ± 0.05 m/s%; p = 0.005) and MICT (−0.35 ± 0.01 to −0.30 ± 0.05 m/s%; p = 0.003) significantly improved the PWV/GLS ratio. However, only HIIT led to a significant reduction in the E_a/E_es ratio (0.88 ± 0.07 to 0.80 ± 0.09 mmHg/mL; p = 0.024), with a significant correlation between relative changes in PWV/GLS and E_a/E_es ratio (r = 0.749; p = 0.008).

Conclusions

Both HIIT and MICT improved VAC as assessed by PWV/GLS ratio in young obese women. In contrast, elastance-derived improvements (E_a/E_es) were observed only following HIIT. These findings suggest that PWV/GLS may serve as a more sensitive and integrative marker for detecting exercise-induced improvements in VAC.

Objective

Atrial fibrillation (AF), a common arrhythmia, significantly increases the risk of severe cardio-cerebrovascular events. The left atrioventricular coupling index (LACI), which evaluates the synergistic function of the left atrium and ventricle and overall cardiac performance, is closely associated with cardiovascular outcomes. However, its relationship with post-ablation recurrence remains unclear. This study aimed to quantify left atrial coupling index (LACI) using real-time three-dimensional echocardiography (RT-3DE) to predict late recurrence and guide personalized therapeutic strategies, thereby reducing recurrence rates.

Methods

Patients with paroxysmal AF undergoing initial radiofrequency ablation at Yichang Central People's Hospital (October 2019–December 2023) were categorized into recurrence, non-recurrence, and healthy control groups. Clinical data on left atrial structural/functional parameters were collected. Independent predictors of postoperative recurrence were screened by statistical analysis, and the predictive accuracy of the LACI was assessed using ROC (receiver operating characteristic) curves.

Results

This study included 100 patients who underwent AF ablation (26 with recurrence) and 58 healthy controls. Univariate analysis indicated that left atrial diameter (LAD), left atrial end-diastolic volume (LAEDV), LACI, left atrial ejection fraction (LAEF), mitral E velocity, and left atrial reservoir strain (LAGLS) were associated with recurrence. Multivariate regression analysis ultimately identified LAGLS and LACI as independent predictors (both p < 0.05). ROC analysis demonstrated that LACI had an area under the curve (AUC) of 0.772 (95% CI: 0.666–0.878, p = 0.004) for predicting recurrence.

Conclusion

Left atrial mechanical dispersion serves as an independent predictor of late AF recurrence post-ablation, offering robust predictive value for identifying high-risk patients.