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

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.

Aim

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.

Methods and Results

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 E_a (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).

Conclusions

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.