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

Background

Echocardiography and right heart catheterization (RHC) are useful in the evaluation of heart failure with preserved ejection fraction (HFpEF). We compared the two among decompensated HFpEF patients to determine their relative value in predicting all-cause mortality and a composite of cardiovascular (CV) death and heart failure (HF) readmission at 1 year.

Methods

One hundred seventy-eight decompensated HFpEF patients who underwent both procedures and survived to hospital discharge were retrospectively identified. Hospital records and the National Death Index were queried to determine outcomes. Echocardiographic and invasive parameters were tested for significant associations with each outcome. Additionally, three predictive models were developed: Model-1: basic demographics and comorbidities, Model-2: adding echocardiographic parameters, and Model-3: adding invasive hemodynamic parameters.

Results

For mortality (n = 26; 15%), echocardiographic E/average e′, invasive mean pulmonary artery pressure (mPAP), and pulmonary capillary wedge pressure (PCWP) showed significant associations. Model-1 yielded a c-statistic of 0.65; 95% CI (0.54–0.76). Adding echocardiographic and hemodynamic variables produced a nonsignificant increase to 0.71; 95% CI (0.60–0.82), though mPAP remained an independent predictor (OR 1.05; 95% CI 1.01–1.09, p = 0.025). For the composite outcome (n = 31; 17%), significant associations were found for echocardiographic right atrial reservoir strain (RAsr), E/average e′, and invasive right atrial pressure, mPAP, and PCWP. Model-1 had a c-statistic of 0.70; 95% CI (0.60–0.79). Adding echocardiographic parameters significantly increased this to 0.81; 95% CI (0.73–0.88). Adding hemodynamic parameters (model-3) resulted in a nonsignificant increase to 0.83; 95% CI (0.76–0.90).

Conclusions

Among decompensated HFpEF patients, the addition of echocardiographic parameters significantly improved model prediction for the composite endpoint of CV death and HF hospitalization. Further addition of invasive hemodynamic variables did not.

Background

Atrial arrhythmia is prevalent in patients with hypertrophic cardiomyopathy (HCM) and is prognostically deleterious. Catheter ablation (CA) has poor efficacy in HCM, making predictors of outcome valuable. Left atrial size is associated with morbidity and mortality, and E/e′ has been proposed. The current study evaluates whether these predict non-paroxysmal atrial arrhythmia, interventions for atrial arrhythmia and all-cause mortality.

Methods

233 patients from the echocardiography database were included; patients with any mitral annular calcification were excluded. Medical records were reviewed for sample characteristics. Survival analysis was performed for left atrial diameter (LAD), left atrial volume index (LAVi, by area-length method), and E/e′ with respect to endpoints, namely: non-paroxysmal atrial arrhythmia; atrial intervention (composite of CA and pace-and-ablate); and all-cause mortality. If LAD or LAVi were significant in multivariate analysis, ROC analysis and DeLong's test were performed to evaluate and compare their discriminative power.

Results

Over a median follow-up of 8 years (median age 53, 73% male), the overall prevalence of non-paroxysmal atrial arrhythmia was 31%. In multivariate models, LAVi was predictive of non-paroxysmal atrial arrhythmia and atrial intervention; LAD was only predictive of arrhythmia. LAVi demonstrated greater discriminative power for predicting atrial intervention. E/e′ was not predictive of any outcome. No echocardiographic variable predicted death in multivariate analysis.

Conclusion

LAVi may have greater clinical utility compared to two-dimensional measurements like LAD. Future work should clarify which measures of left atrial size are most appropriate in clinical practice.

Background

Left ventricular ejection fraction (LVEF) is a widely used echocardiographic prognostic marker; however, its ability to reflect forward flow is limited. Left ventricular outflow tract velocity time integral (LVOT VTI) reflects stroke distance and has prognostic value in patients with cardiac and non-cardiac pathology, yet its incremental value beyond LVEF remains incompletely defined.

Objective

To determine whether LVOT VTI confers prognostic value beyond LVEF in a large real-world cohort of hospitalized patients.

Methods

Index echocardiograms performed between January and June 2021 at a single tertiary hospital were retrospectively analyzed. Demographics, echocardiographic parameters, biomarkers, and mortality data were collected. Patients were stratified by LVOT VTI (>13 and <13 cm) and LVEF (>40% and <40%). Associations with mortality were evaluated with Cox proportional hazard models.

Results

Altogether, 1325 patients (mean age 70 years) were included; 368 (28%) died over a median follow-up of 35.9 months (IQR 34.4–37.4). Both LVEF < 40% (HR 1.95, 95% CI 1.52–2.50; p < 0.001) and LVOT VTI < 13 cm (HR 1.91, 95% CI 1.41–2.59; p < 0.001) were associated with increased mortality. LVOT VTI < 13 cm remained predictive after adjustment for LVEF, although this was attenuated after adjustment for age. Mortality was greatest in patients with both LVEF < 40% and LVOT VTI < 13 cm (HR 2.37, 95% CI 1.63–3.46; p  < 0.001).

Conclusion

LVOT VTI < 13 cm is independently associated with long-term mortality in hospitalized patients. Its incremental prognostic value beyond LVEF warrants prospective validation as a reproducible marker to enhance risk stratification in hospitalized patients.

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.