Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques最新文献_第7页

Cardiac Structure and Function Among Patients With Heart Failure With Reduced Ejection Fraction and Kidney Disease 心力衰竭伴射血分数降低和肾脏疾病患者的心脏结构和功能

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-17 DOI: 10.1111/echo.70341

Ali Hikmat Al-Rubai, Jacob Christensen, Filip Soeskov Davidovski, Caroline Espersen, Morten Sengeløv, Peter Godsk Jørgensen, Manan Pareek, Niels Eske Bruun, Thomas Fritz-Hansen, Cecilie Johnsen, Tor Biering-Sørensen

Background

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.

Methods

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.

Results

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.

Conclusion

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.

背景：肾脏疾病（KD）是心力衰竭伴射血分数降低（HFrEF）的常见合并症。在这项回顾性研究中，我们试图调查心脏结构和功能与HFrEF患者普遍和偶发肾衰竭的关系。方法：回顾性分析一家大型心衰门诊左室射血分数(LVEF)≤45%的患者。患者被分为三组：(1)基线或随访期间无KD，(2)随访期间偶发KD，(3)流行KD。超声心动图参数包括LVEF、全局纵向应变（GLS）、三尖瓣环平面收缩偏移（TAPSE）和E/ E′比。使用单变量和多变量Cox回归评估与KD事件的关联。结果：最终人群包括1138名受试者，平均年龄68.1岁（SD 11.8），男性72.8%，其中53名（4.7%）存在普遍的KD。在平均9.9年的随访期间，229名（21.1%）基线时无KD的患者发展为KD，其余856名（75.2%）未发展为KD。在基线时，LVEF、GLS、TAPSE和E/ E比值在第1组至第3组逐渐受损。虽然在单变量Cox回归中，所有四项指标都与事件KD相关，但在调整分析中，只有LVEF （p = 0.023）、TAPSE （p = 0.009）和E/ E’比（p = 0.041）仍然具有显著性。结论：在HFrEF患者中，未来发病的KD和流行的KD与GLS、LVEF、TAPSE和E/ E比值受损的关系越来越密切。此外，LVEF、TAPSE和E/ E比值是KD事件的独立预测因子。

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引用次数: 0

Cardiac MRI in Danon's Disease—A Phenocopy of Hypertrophic Cardiomyopathy in Young Adults Danon病的心脏MRI——青年人肥厚性心肌病的表型分析。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-14 DOI: 10.1111/echo.70337

Mayank Goyal, Vineeta Ojha, Shyam Murti Bohare, Abhishek Dhiman, Priya Jagia

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.

我们报告两例年轻人肥厚性心肌病，均表现出典型的家族性和临床特征，并伴有影像学异常。进一步的评估显示，潜在的诊断是Danon病——一种由LAMP-2基因突变引起的x连锁显性疾病。一项全面的Medline搜索显示，缺乏专门针对达农病的已发表的印度文献。在这里，我们提出的临床资料和心脏MRI发现这两个遗传确诊病例。

引用次数: 0

“Electrocardiographic and Echocardiographic Monitoring for Early Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-Analysis” 心电图和超声心动图监测早期化疗引起的心脏毒性：系统回顾和荟萃分析

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-08 DOI: 10.1111/echo.70331

Param Darpan Sheth, Chandana Srinath, Prasad Mayagondanahallay Chandrashekaraiah, Radha Wajapey Madhukar, Manjappa Mahadevappa

Background

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.

Aim

To systematically review and compare echocardiography and ECG for early detection of CTRCD in patients receiving cancer therapy.

Methods

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.

Results

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.

Conclusions

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.

癌症治疗相关性心功能障碍（CTRCD）仍然是癌症治疗的一个关键限制，对发病率和生存率有影响。超声心动图是一种成熟的监测工具，而心电图（ECG）可以提供更早，低成本的亚临床心脏毒性检测。这些模式的相对诊断结果是不确定的。目的系统评价和比较超声心动图与心电图在肿瘤治疗中早期发现CTRCD的价值。方法按照PRISMA 2020指南，检索PubMed、Embase、Scopus和CENTRAL至2025年5月。符合条件的研究包括报告接受化疗的成人超声心动图和心电图结果的前瞻性或回顾性队列。提取左室射血分数（LVEF）、舒张功能、总纵应变（GLS）和心电图异常数据。使用随机效应模型计算合并发生率和效应估计值。采用QUADAS-2评估偏倚风险。结果纳入13项队列研究，共1440例患者。超声定义CTRCD的总发生率为10%(95%可信区间[CI] 7%-16%)，蒽环类药物治疗组的发生率更高。高达40%的患者发生舒张功能障碍和GLS降低，通常发生在LVEF下降之前。心电图异常占35% (95% CI 22%-49%)，最常见的是QTc延长、ST-T改变、QRS片段化和房颤。与超声心动图相比，常规心电图的灵敏度较低，尽管持续监测和人工智能增强心电图显示出早期发现的潜力。结论超声心动图仍然是CTRCD监测的基础，GLS和舒张指数可提供早期预警。心电图异常是频繁但不一致的预测指标；它们的作用可能会随着持续和基于人工智能的方法而扩大。综合超声和先进心电图的多模式监测策略可能改善心脏肿瘤护理。

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引用次数: 0

Left Atrial Function in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP Chemotherapy Regimen: A Speckle Tracking Echocardiographic Study R-CHOP化疗方案治疗弥漫性大b细胞淋巴瘤患者左心房功能：斑点跟踪超声心动图研究

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-07 DOI: 10.1111/echo.70339

Baozhen Wang, Xiaoyi Hao, Yang Yu, Wenwen Cao, Dangui Huang, Guangping Xie, Shan Yang, Hong Zhao, Ying Zhang, Hui Hao, Yaxin Zhang

Objective

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).

Methods

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.

Results

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.

Conclusion

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.

目的本研究旨在确定左心房（LA）品系是否可以识别弥漫大b细胞淋巴瘤（DLBCL）患者接受R-CHOP化疗方案后LA功能的早期改变，以及这些改变是否可以前瞻性地预测癌症治疗相关性心功能障碍（CTRCD）的后续发展。方法前瞻性招募计划接受R-CHOP方案的DLBCL患者。超声心动图分别在T0（化疗前）、T1（第三周期后）、T2（6-8周期结束）和T3 （T2后1年）进行。采用斑点跟踪超声心动图（STE）计算左室整体纵向应变（LV GLS）、左室储层应变（LASr）、左室导管应变（LAScd）、左室收缩应变（LASct）和左室刚度指数（LASI）。根据左室GLS降低15%，将患者分为CTRCD组和非CTRCD组。结果17例（23.6%）患者化疗后出现CTRCD。发生CTRCD的患者年龄相对较大（67[57-71]对60 [49-68]，p < 0.05）。在随访期间，T1时LASr、LAScd和LASI的显著恶化持续存在。LASr（≥23.4%）和LASI（≥20.0%）的相对变化是后续CTRCD发展的可靠预测因子。验证队列中的LASr标准为35%，与2016年ASE指南基本一致。结论LASr和LASI可有效识别DLBCL患者LA功能的早期改变。LASr和LASI的相对变化是后续CTRCD发展的可靠预测指标。

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引用次数: 0

Effect of Cardioprotection on Right Ventricular Function in Breast Cancer Patients Receiving Potentially Cardiotoxic Therapy—A Letter to the Editor 心脏保护对接受潜在心脏毒性治疗的乳腺癌患者右心室功能的影响——致编辑的一封信

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-06 DOI: 10.1111/echo.70335

Mian Zain Hayat, Mohsin Tariq, Syed Ali Raza Zaidi, Muhammad Ahmad

引用次数: 0

A Novel Measurement of Percutaneous Left Atrial Appendage Occlusion Device Peri-Device Leak Using Major and Minor Axes of a Three-Dimensional Vena Contracta Area 利用三维静脉收缩区长、小轴测量经皮左心耳闭塞装置周围泄漏的新方法。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-06 DOI: 10.1111/echo.70334

Andrew Biscardi, Jordan Tannenbaum, Andrew Kott, Prashant Bhave, Austin Seals, Jeffrey Corbett, Karl Richardson

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

目的：评估经皮左心耳闭塞器围漏（pLAAO-PDL）是确定抗凝策略的重要决策点。泄漏大小的测量通常通过测量泄漏的二维静脉收缩来完成TEE。一个潜在的问题是，如果只测量二维泄漏，就有可能错过一个更大的月牙形泄漏，该泄漏跨越更大的周向区域。这些发现，虽然在目前的文献中大部分未被讨论，但可能影响有关抗凝治疗继续的临床决策。方法：回顾2021年至2024年心房健康维克森林浸信会或心房健康卡罗莱纳医疗中心接受塞状左心房附件闭塞装置（LAAO）患者的TEE报告。任何报告的2.5 mm或更大的泄漏由具有LAAO成像经验的主治心脏病专家重新测量，使用标准的2D VC测量，以及跟踪的3D静脉收缩区（3D VCA），测量长轴和小轴。结果：重测渗漏29处。测量的2D VC与3D VCA的长轴之间有统计学意义的差异，3D VCA的长轴平均大3倍。确定了三种不同形态的设备泄漏，包括点状，新月形和多点状。结论：三维TEE可用于区分点状泄漏和新月形泄漏，并强调泄漏不能在形态学上是均匀的。考虑到pdl的血栓栓塞风险升高，在LAAO装置的常规植入和监测中增加3D TEE成像是合理的。

{"title":"A Novel Measurement of Percutaneous Left Atrial Appendage Occlusion Device Peri-Device Leak Using Major and Minor Axes of a Three-Dimensional Vena Contracta Area","authors":"Andrew Biscardi, Jordan Tannenbaum, Andrew Kott, Prashant Bhave, Austin Seals, Jeffrey Corbett, Karl Richardson","doi":"10.1111/echo.70334","DOIUrl":"10.1111/echo.70334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 11","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453850","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

Right Ventricular Dysfunction in Patients With Severe Aortic Stenosis Before and After Transcatheter Aortic Valve Implantation 经导管主动脉瓣植入术前后严重主动脉瓣狭窄患者的右室功能障碍。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-06 DOI: 10.1111/echo.70340

Tomoka Zukeran, Michiyo Yamano, Tetsuhiro Yamano, Kan Zen, Yuki Matsubara, Kazuaki Takamatsu, Masaki Yashige, Takeshi Nakamura, Hirokazu Shiraishi, Satoaki Matoba

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

目的：右心室功能障碍（RVD）是严重主动脉瓣狭窄（AS）患者的预后因素之一。经导管主动脉瓣植入术（TAVI）后，部分患者RVD延长。我们的目的是确定TAVI前后RVD的患病率，以及与严重AS患者先前存在和延长的RVD相关的因素。方法：回顾性单中心研究纳入198例重度AS患者（86.0±4.8岁，72.7%为女性）。RVD定义为三个参数中有两个差于参考值：分数面积变化、右心室自由壁应变和三尖瓣环平面收缩偏移。结果：68例（34.3%）患者被诊断为既往存在RVD。在结合基线临床和超声心动图参数的多变量分析中，与先前存在的RVD相关的因素是左室（LV）射血分数、左室卒中容积指数和室间隔侧早期舒张速度与早期舒张环速之比（E/ E’）（均为p）。结论：严重AS患者的RVD与较低的左室射血分数、较低的左室卒中容积指数和较高的基线室间隔E/ E’相关。较小的左室卒中容量、较低的主动脉瓣平均压力梯度和较大的相对壁厚可能是TAVI后1年RVD延长的预测因素。

{"title":"Right Ventricular Dysfunction in Patients With Severe Aortic Stenosis Before and After Transcatheter Aortic Valve Implantation","authors":"Tomoka Zukeran, Michiyo Yamano, Tetsuhiro Yamano, Kan Zen, Yuki Matsubara, Kazuaki Takamatsu, Masaki Yashige, Takeshi Nakamura, Hirokazu Shiraishi, Satoaki Matoba","doi":"10.1111/echo.70340","DOIUrl":"10.1111/echo.70340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 <i>p</i> < 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 <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 11","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453857","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

Diagnostic COncordance in Aortic Regurgitation Severity AssessMent: A ComPARative Study Between Cardiologists With Different Level of Expertise, the COMPARE-AR Study 主动脉反流严重程度评估的诊断一致性：不同专业水平心脏病专家的比较研究，COMPARE-AR研究。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-06 DOI: 10.1111/echo.70336

Giacomo Maria Viani, Hekuran Bytyci, Vincenzo Viccaro, Alessandro Caretta, Susanna Landi, Andrea Milzi, Luca Bergamaschi, Susanne Anna Schlossbauer, Laura Anna Leo, Giovanni Pedrazzini, Carmine Pizzi, Anna Giulia Pavon

Purpose

Accurate echocardiographic assessment of chronic aortic regurgitation (AR) is challenging and subject to interobserver variability. We aim to evaluate reproducibility of guideline-recommended echocardiographic parameters in real-world practice and to assess cardiac magnetic resonance (CMR) as a complementary modality.

Methods

We retrospectively analyzed 99 patients referred to us for transthoracic echocardiography (TTE) for AR evaluation. A subset of 22 patients also underwent CMR. AR severity was independently graded according to ESC and ASE guidelines by two expert cardiologists and two trainees using semi-quantitative and quantitative parameters: pressure half-time (PHT), vena contracta width (VCW), and PISA-derived parameters, such as regurgitant orifice area (EROA). Interobserver agreement was analyzed using Cohen's Kappa, Bland–Altman analysis, and intraclass correlation coefficients.

Results

VCW showed the highest reproducibility (overall κ = 0.77), strong agreement across groups (EXACT team κ = 0.7, TRAIN team κ = 0.86), and high feasibility (68.7%). PHT demonstrated poor interobserver consistency (overall κ = 0.36), wide intra-team variability (EXACT team κ = 0.30 vs. TRAIN team κ = 0.39), and high feasibility (77.8%). EROA showed moderate agreement (overall κ = 0.55, EXACT team κ = 0.64, TRAIN team κ = 0.74) and low feasibility (30.3%). CMR-derived parameters (forward flow, backflow, and regurgitant fraction) displayed excellent reproducibility even between novice and expert readers.

Conclusions

VCW is the most reliable echocardiographic parameter for AR assessment, while PHT and EROA are limited by variability and feasibility, respectively. Given its reproducibility and independence from operator expertise, CMR should be considered early when TTE findings are inconclusive. A simplified TTE-first approach, followed by timely CMR, may optimize staging and management of chronic AR.

目的：准确的超声心动图评估慢性主动脉瓣反流（AR）是具有挑战性的，并受到观察者之间的差异。我们的目的是评估指南推荐的超声心动图参数在现实世界中的可重复性，并评估心脏磁共振（CMR）作为一种补充方式。方法：我们回顾性分析99例经胸超声心动图（TTE）评估AR的患者。22例患者也接受了CMR。根据ESC和ASE指南，由两名心脏病专家和两名受训者使用半定量和定量参数对AR严重程度进行独立分级：压力半衰期（PHT）、静脉收缩宽度（VCW）和由pisa衍生的参数，如回流孔面积（EROA）。使用Cohen’s Kappa、Bland-Altman分析和类内相关系数分析观察者间的一致性。结果：VCW重现性高（overall κ = 0.77），组间一致性强（EXACT team κ = 0.7, TRAIN team κ = 0.86），可行性高（68.7%）。PHT表现出较差的观察者间一致性（总体κ = 0.36），广泛的团队内部可变性（EXACT团队κ = 0.30 vs. TRAIN团队κ = 0.39）和高可行性（77.8%）。EROA的一致性中等（overall κ = 0.55, EXACT team κ = 0.64, TRAIN team κ = 0.74），可行性较低（30.3%）。cmr衍生的参数（正向流量，回流和回流分数）即使在新手和专家读者之间也显示出极好的再现性。结论：VCW是评估AR最可靠的超声心动图参数，而PHT和EROA分别受变异性和可行性的限制。考虑到CMR的可重复性和对操作者专业知识的独立性，在TTE结果不确定时应尽早考虑CMR。简化的te -first方法，然后及时进行CMR，可以优化慢性AR的分期和管理。

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引用次数: 0

Adult Congenital Heart Disease Complexity Restratification by Computed Tomography and/or Cardiac Magnetic Resonance 计算机断层扫描和/或心脏磁共振对成人先天性心脏病复杂性的再诊断。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-04 DOI: 10.1111/echo.70318

Maria de Fatima Egas-Bejar, Gabriela Meléndez-Ramirez, Stephanie Teresa Angulo-Cruzado, Sergio Alfonso Patrón-Chi, Aloha Meave González, Neftali Eduardo Antonio-Villa, Edgar García-Cruz

Purpose

To evaluate the percentage of adults with congenital heart disease (CHD) who are restratified according to classification of complexity classification with CT and/or CMR after an initial echocardiographic assessment. Accurate stratification of CHD complexity is relevant to determining the treatment. Echocardiography is the first-line imaging modality; nevertheless, the added value of computed tomography (CT) and cardiac magnetic resonance (CMR) as complementary modalities to restratify CHD complexity has not been fully explored.

Methods

We conducted a cross-sectional study of adult patients from the record CHD Unit in a third-level cardiology hospital from 2021 to 2024. CHD patients were classified according to the European Society of Cardiology (ESC) guidelines. We compared initial echocardiographic findings with CT and/or CMR using the kappa-statistic.

Results

Among 889 patients that fulfilled the inclusion criteria (women: 57%; mean age: 38.3 ± 14.4 years; genetic syndrome: 4%), the most common CHD were isolated congenital aortic valve disease and bicuspid aorta (n = 127), secundum atrial septal defect (n = 105), and tetralogy of Fallot (n = 90). The number and percentage of patients in each complexity category were mild: 180 (20.2%), moderate: 532 (59.9%), and severe: 177 (19.9%). Ten patients (1%) were restratified: 9 from the mild to moderate category and 1 from the moderate to mild category. Both imaging modalities showed strong agreement (Kappa: 0.979, 95% CI: 0.967–0.990).

Conclusion

Restratification of adult CHD occurred in a low percentage of cases. Our results suggest that in specialized centers, echocardiographic findings are comparable to CT and/or CMR findings.

目的：评估成人先天性心脏病（CHD）在初始超声心动图评估后，根据CT和/或CMR的复杂性分类重新调整的百分比。冠心病复杂性的准确分层与确定治疗方法有关。超声心动图是一线成像方式；然而，计算机断层扫描（CT）和心脏磁共振（CMR）作为补充方式重新确定冠心病复杂性的附加价值尚未得到充分探讨。方法：对某三级心脏病医院2021年至2024年冠心病住院的成年患者进行横断面研究。根据欧洲心脏病学会（ESC）指南对冠心病患者进行分类。我们使用kappa统计量将超声心动图的初始表现与CT和/或CMR进行比较。结果：在889例符合纳入标准的患者中（女性占57%，平均年龄38.3±14.4岁，遗传综合征占4%），最常见的冠心病为孤立性先天性主动脉瓣病变和双尖主动脉（n = 127）、二次房间隔缺损（n = 105）和法洛四联症（n = 90）。各复杂类型患者数量和百分比分别为轻度180例（20.2%）、中度532例（59.9%）、重度177例（19.9%）。10例（1%）患者被重新调整：9例为轻至中度，1例为中至轻度。两种成像方式显示高度一致（Kappa: 0.979, 95% CI: 0.967 ~ 0.990）。结论：成人冠心病再确诊率较低。我们的研究结果表明，在专门的中心，超声心动图的结果与CT和/或CMR的结果相当。

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引用次数: 0

Multimodality Imaging of a Woman With Hypertrophic Cardiomyopathy and Fabry Disease 肥厚性心肌病合并法布里病的多模态影像分析。

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques

Pub Date : 2025-11-03 DOI: 10.1111/echo.70332

Shing Ching, Karl Chan

A woman in her 50s with known MYBPC3-associated obstructive hypertrophic cardiomyopathy was evaluated for septal reduction therapy. The electrocardiogram, echocardiogram, and cardiac magnetic resonance found several features inconsistent with the diagnosis. Targeted screening confirmed adult-onset Fabry disease. Enzyme replacement therapy was started.

一位50多岁患有mybpc3相关梗阻性肥厚性心肌病的女性接受了鼻中隔缩小治疗。心电图、超声心动图和心脏磁共振发现了一些与诊断不一致的特征。有针对性的筛查证实成人发病法布里病。开始酶替代治疗。

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