Right ventricular (RV) function determines symptom burden and clinical outcomes in pulmonary hypertension (PH). Global wasted work (GWW) quantifies mechanical inefficiencies in RV performance associated with elevated afterload, but is inadequately characterized in precapillary PH. We assessed the association of GWW with echocardiographic indices of RV remodeling, RV–PA coupling and invasive hemodynamics, and evaluated its prognostic significance in precapillary PH.
Myocardial work indices were measured by 3D echocardiography in patients with well-defined precapillary PH who underwent right heart catheterization within 24 hours. Patients with poor image quality, significant valvular lesions and associated left heart disease were excluded. Among 61 patients, those with GWW ≥ 38 mmHg/% (n = 31) exhibited larger RV end-systolic volume (60 [42–71] vs. 42 [35–46] mL/m2, p = 0.009), lower TAPSE (17 [16–20] vs. 20 [17–23] mm, p = 0.04), higher Ea (1.32[0.98–1.57] vs. 0.92 [0.64–1.29] mmHg/mL, p = 0.02) and higher pulmonary vascular resistance (11.1 [8.1–14.2] vs. 5.4 [3.4–8.7]WU, p = 0.002). GWW decreased as RV longitudinal strain and RV—PA coupling improved and increased with lower cardiac index and higher pulmonary vascular resistance. GWW outperformed conventional right ventricular indices in identifying patients at risk of death or transplantation (HR: 2.5 [1.1–5.7], p = 0.02).
Elevated GWW is associated with RV remodeling, worsening RV function and reduced survival in precapillary PH. Our results suggest that GWW may offer incremental prognostic value over conventional RV metrics, with potential implications for risk stratification and therapy management. Larger studies are warranted to validate these findings.
Kidney disease (KD) is a common comorbidity of heart failure with reduced ejection fraction (HFrEF). In this retrospective study, we sought to investigate measures of cardiac structure and function in relation to prevalent and incident kidney failure in subjects with HFrEF.
Subjects with a left ventricular ejection fraction (LVEF) ≤ 45% were included retrospectively from a large HF clinic. Patients were stratified into three groups: (1) no KD at baseline or during follow-up, (2) incident KD during follow-up, (3) prevalent KD. Echocardiographic parameters included LVEF, global longitudinal strain (GLS), tricuspid annular plane systolic excursion (TAPSE), and E/e′ ratio. Associations with incident KD were assessed using uni- and multivariable Cox regression.
The final population consisted of 1138 subjects (mean age 68.1 years (SD 11.8), male sex 72.8%), of which 53 (4.7%) had prevalent KD. During a median follow-up period of 9.9 years, 229 (21.1%) of those without KD at baseline developed KD, and the remaining 856 (75.2%) did not. At baseline, LVEF, GLS, TAPSE, and E/e′ ratio were incrementally impaired across groups 1 through 3. While all four measures were associated with incident KD in univariable Cox regression, only LVEF (p = 0.023), TAPSE (p = 0.009), and E/e′ ratio (p = 0.041) remained significant in adjusted analysis.
Among HFrEF patients, future onset of KD and prevalent KD were increasingly associated with impaired GLS, LVEF, TAPSE, and E/e′ ratio. Furthermore, LVEF, TAPSE, and E/e′ ratio were independent predictors of incident KD.
We report two cases of hypertrophic cardiomyopathy in young adults, both presenting with characteristic familial and clinical features, along with imaging abnormalities. Further evaluation revealed the underlying diagnosis to be Danon disease—an X-linked dominant disorder caused by mutations in the LAMP-2 gene. A comprehensive Medline search revealed a lack of published Indian literature specifically addressing Danon disease. Here, we present the clinical profiles and cardiac MRI findings of these two genetically confirmed cases.
Cancer therapy-related cardiac dysfunction (CTRCD) remains a critical limitation of cancer therapy, with implications for morbidity and survivorship. Echocardiography is an established surveillance tool, while electrocardiography (ECG) may offer earlier, low-cost detection of subclinical cardiotoxicity. The relative diagnostic yield of these modalities is uncertain.
To systematically review and compare echocardiography and ECG for early detection of CTRCD in patients receiving cancer therapy.
Following PRISMA 2020 guidelines, PubMed, Embase, Scopus, and CENTRAL were searched through May 2025. Eligible studies included prospective or retrospective cohorts reporting echocardiographic and ECG outcomes in adults undergoing chemotherapy. Data on left ventricular ejection fraction (LVEF), diastolic function, global longitudinal strain (GLS), and ECG abnormalities were extracted. Pooled incidence and effect estimates were calculated using random-effects models. Risk of bias was assessed with QUADAS-2.
Thirteen cohort studies involving 1440 patients were included. The pooled incidence of echo-defined CTRCD was 10% (95% confidence interval [CI] 7%–16%), with higher rates among anthracycline-treated cohorts. Diastolic dysfunction and GLS reduction occurred in up to 40% of patients, frequently preceding a decline in LVEF. ECG abnormalities were observed in 35% (95% CI 22%–49%), most commonly QTc prolongation, ST–T changes, fragmented QRS, and atrial fibrillation. Routine ECG demonstrated low sensitivity compared with echocardiography, though continuous monitoring and AI-enhanced ECG showed potential for earlier detection.
Echocardiography remains the cornerstone for CTRCD surveillance, with GLS and diastolic indices providing early warning. ECG abnormalities are frequent but inconsistent predictors; their role may expand with continuous and AI-based approaches. A multimodal surveillance strategy integrating echo and advanced ECG may improve cardio-oncology care.
This study aimed to determine whether left atrial (LA) strain can identify early alterations in LA function in diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP chemotherapy regimen and whether these alterations can prospectively predict the subsequent development of cancer therapy–related cardiac dysfunction (CTRCD).
DLBCL patients scheduled to receive the R-CHOP regimen were prospectively recruited for this study. Echocardiography was performed at T0 (pre-chemotherapy), T1 (after the third cycle), T2 (end of 6–8 cycles), and T3 (1-year post-T2). Left ventricular global longitudinal strain (LV GLS), LA reservoir strain (LASr), LA conduit strain (LAScd), LA contraction strain (LASct), and LA stiffness index (LASI) were calculated using speckle tracking echocardiography (STE). Patients were divided into CTRCD and non-CTRCD groups based on a > 15% reduction in LV GLS.
Seventeen patients (23.6%) developed to CTRCD after chemotherapy. Patients who developed CTRCD were relatively older (67 [57–71] vs. 60 [49–68], p < 0.05). A significant deterioration in LASr, LAScd, and LASI at T1 persisted throughout the follow-up period. Relative changes in LASr (≥ 23.4%) and LASI (≥ 20.0%) were robust predictors of subsequent CTRCD development. The LASr > 35% criterion in the validation cohort demonstrated substantial agreement with the 2016 ASE guidelines.
LASr and LASI effectively identify early alterations in LA function in DLBCL patients. Relative changes in LASr and LASI are robust predictors of subsequent CTRCD development.
Assessment for percutaneous left atrial appendage occlusion device peri-device leak (pLAAO-PDL) is an important decision point in determining anticoagulation strategy. Measurement of leak size is commonly done with TEE by measuring the 2D vena contracta of the leak. A potential concern is that by measuring a leak only in 2D, there is a risk of missing a larger crescentic leak spanning a more significant circumferential area. Such findings, though largely undiscussed in the current literature, could impact clinical decision-making regarding continuation of anticoagulation.
TEE reports for patients receiving a plug-like left atrial appendage occlusion device (LAAO) at Atrium Health Wake Forest Baptist or at Atrium Health Carolina's Medical Center from 2021 to 2024 were reviewed. Any reported leaks of 2.5 mm or greater were re-measured by an attending cardiologist with experience in LAAO imaging using standard 2D VC measurements, as well as a traced 3D vena contracta area (3D VCA) with measurement of major and minor axes.
Twenty-nine leaks were remeasured. There was a statistically significant difference between the measured 2D VC and the major axis of the 3D VCA, which was on average three times larger. Three different morphologies of device leak were identified, including punctate, crescentic, and multi-punctate.
3D TEE is useful in distinguishing punctate leaks from crescentic leaks and highlights the fact that leaks cannot be assumed to be uniform in morphology. Given the elevated thromboembolic risks with PDLs, it is reasonable to add 3D TEE imaging to the routine implantation and monitoring of LAAO devices.
Right ventricular dysfunction (RVD) is a prognostic factor in patients with severe aortic stenosis (AS). Some patients have prolonged RVD after transcatheter aortic valve implantation (TAVI). We aimed to identify the prevalence of RVD before and after TAVI and factors associated with preexisting and prolonged RVD in patients with severe AS.
This retrospective single-center study included 198 patients with severe AS (86.0 ± 4.8 years; 72.7% female). RVD was defined as two of the three parameters being worse than the reference value: fractional area change, right ventricular free wall strain, and tricuspid annular plane systolic excursion.
Sixty-eight patients (34.3%) were diagnosed with preexisting RVD. Factors associated with preexisting RVD were left ventricular (LV) ejection fraction, LV stroke volume index, and ratio of early diastolic velocity to early diastolic annular velocity (E/e′) on the septal side in a multivariable analysis combining baseline clinical and echocardiographic parameters (all p < 0.05). One year after TAVI, 16 of 47 patients (34.0%) were classified as having prolonged RVD. Patients with prolonged RVD had lower LV stroke volume index, greater relative wall thickness, and lower aortic valve mean pressure gradient before TAVI than patients without prolonged RVD (all p < 0.05).
RVD in patients with severe AS is associated with lower LV ejection fraction, lower LV stroke volume index, and higher septal E/e′ at baseline. Smaller LV stroke volume, lower aortic valve mean pressure gradient, and greater relative wall thickness might be predictors of prolonged RVD 1 year after TAVI.
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