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Core Laboratory Versus Center-Reported Echocardiographic Assessment of the Native and Bioprosthetic Aortic Valve 核心实验室与中心报告的超声心动图对原生和生物人工主动脉瓣的评估
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-03 DOI: 10.1111/echo.70047
Bart J. J. Velders, Michiel D. Vriesendorp, Neil J. Weissman, Joseph F. Sabik III, Michael J. Reardon, Francois Dagenais, Michael G. Moront, Vivek Rao, Shinichi Fukuhara, Ralf Günzinger, Wouter J. van Leeuwen, W. Morris Brown, Rolf H. H. Groenwold, Robert J. M. Klautz, Federico M. Asch

Background

Insights into quantitative differences between core laboratory and center-reported echocardiographic assessment of the native and bioprosthetic aortic valve are lacking. We aimed to explore clinically relevant differences between these evaluations.

Methods

Data were used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial for the Avalus valve. In this trial, patients with an indication for surgical aortic valve replacement (SAVR) due to aortic stenosis or regurgitation (AR) were enrolled. Serial echocardiographic examinations were performed at each center and blindly reanalyzed by an independent echocardiographic core laboratory (ECL). For the bioprosthetic valve analysis, postoperative data throughout the 5-year follow-up were pooled. Differences between the ECL and the centers in continuous parameters were quantified in mean differences and intraclass correlation coefficients (ICCs). Agreement on AR, paravalvular leak (PVL), and prosthesis-patient mismatch (PPM) classification was investigated using Cohen's kappa coefficients.

Results

The analysis on the native aortic valve was performed on 1118 echocardiograms. The relative mean difference was largest for the left ventricular outflow tract (LVOT) area, followed by stroke volume and effective orifice area (index), with center-reported values being 11%–7% higher. High ICCs of around 0.90 were observed for the parameters peak aortic jet velocity, mean pressure gradient, and the velocity-time integral across the aortic valve. Over 5000 echocardiograms were available for the bioprosthetic valve analysis. Therein, comparable results were observed. The kappa coefficient was 0.59 (95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28 (95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM.

Conclusions

There is high agreement between the ECL and clinical centers on continuous-wave Doppler-related measurements. In contrast, agreement is low for parameters that involve measurement of the LVOT diameter. These results provide important context for the interpretation of aortic valve performance in studies that lack central ECL evaluation.

Trial Registration

ClinicalTrials.gov identifier: NCT02088554

核心实验室和中心报道的超声心动图评估天然主动脉瓣和生物假体主动脉瓣之间的定量差异尚缺乏深入了解。我们的目的是探讨这些评估之间的临床相关差异。方法采用心包外科主动脉瓣置换术(PERIGON)心脏瓣膜置换术的临床资料。在这项试验中,由于主动脉狭窄或反流(AR)而有手术主动脉瓣置换术(SAVR)指征的患者被纳入。在每个中心进行连续超声心动图检查,并由独立的超声心动图核心实验室(ECL)进行盲法再分析。对于生物假体瓣膜分析,我们汇总了5年随访期间的术后数据。连续参数中ECL与中心之间的差异以平均差异和类内相关系数(ICCs)来量化。使用Cohen's kappa系数对AR、瓣旁漏(PVL)和假体-患者错配(PPM)分类进行一致性研究。结果1118例患者超声心动图对主动脉瓣进行了分析。相对平均差异最大的是左心室流出道(LVOT)面积,其次是卒中容积和有效孔口面积(指数),中心报告值高出11%-7%。峰值主动脉射流速度、平均压力梯度和主动脉瓣速度-时间积分等参数的ICCs均在0.90左右。超过5000张超声心动图可用于生物瓣膜分析。其中,观察到可比较的结果。原生AR的kappa系数为0.59(95%可信区间[CI] 0.56, 0.63), PVL的kappa系数为0.28 (95% CI 0.18, 0.37), PPM的kappa系数为0.42 (95% CI 0.40, 0.44)。结论ECL与临床中心对连续波多普勒相关测量结果的一致性较高。相反,对于涉及LVOT直径测量的参数,一致性很低。这些结果为在缺乏中心ECL评估的研究中解释主动脉瓣性能提供了重要的背景。试验注册ClinicalTrials.gov标识符:NCT02088554
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引用次数: 0
Multimodality Imaging for Transcatheter Tricuspid Regurgitation Interventions: Novel Approaches to the Forgotten Valve 经导管三尖瓣反流干预的多模态成像:被遗忘瓣膜的新方法
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-29 DOI: 10.1111/echo.70044
Francesca Coraducci, Alessandro Barbarossa, Carla Lofiego, Fabio Vagnarelli, Nicolo Schicchi, Marco Fogante, Tommaso Piva, Filippo Capestro, Michela Casella, Marco Di Eusanio, Federico Guerra, Antonio Dello Russo

Tricuspid regurgitation (TR) poses a significant healthcare burden and is a major concern for patients who experience debilitating symptoms and face a poorer prognosis. Cardiologists are showing renewed interest in TR, as the previous belief that it was merely a bystander of left-sided heart disease has evolved. As a result, more transcatheter techniques addressing TR are emerging. Although a clear impact on mortality from these transcatheter tricuspid valve interventions (TTVI) has not yet been demonstrated, the improvement in symptoms and quality of life for patients is substantial, leading to increased use of these procedures in clinical practice. In this review, we focus on multimodality imaging as an essential tool for quantifying TR severity, assessing right ventricular (RV) function, understanding the underlying mechanisms, selecting the appropriate intervention, and ensuring thorough and accurate preprocedural planning to minimize complications.

三尖瓣反流(TR)造成了重大的医疗负担,是经历衰弱症状和面临较差预后的患者的主要关注点。心脏病专家对TR重新表现出兴趣,因为之前认为它只是左侧心脏病的旁观者的观点已经发生了变化。因此,更多针对TR的经导管技术正在出现。虽然这些经导管三尖瓣介入治疗(TTVI)对死亡率的明显影响尚未得到证实,但对患者的症状和生活质量的改善是实质性的,因此在临床实践中越来越多地使用这些手术。在这篇综述中,我们关注多模态成像作为量化TR严重程度,评估右心室(RV)功能,了解潜在机制,选择适当的干预措施以及确保彻底和准确的术前计划以减少并发症的重要工具。
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引用次数: 0
Study of Degenerative Mitral Regurgitation Using Three-Dimensional Echocardiography and EchoPAC GE Health Care Software 4D Auto MVQ: Comparison Between Transthoracic and Transesophageal Examination 使用三维超声心动图和 EchoPAC GE Health Care 软件 4D Auto MVQ 研究退行性二尖瓣反流:经胸和经食道检查的比较。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-27 DOI: 10.1111/echo.70040
Ginevra Fioretti, Alice Tolomei, Piera Ciaramella, Antonio Lio, Ernesto Cristiano, Giulio Cacioli, Federica Tempestini, Federico Ranocchi, Viviana Maestrini, Amedeo Pergolini

Background

Preoperative echocardiographic assessment is critical for patients with severe degenerative mitral regurgitation to ensure personalized surgical mitral valve repair. This study aimed to compare the diagnostic accuracy of three-dimensional transthoracic echocardiography (3D TTE) and three-dimensional transesophageal echocardiography (3D TEE) in identifying valvular lesions, using surgical findings as the reference. Additionally, we evaluated whether annular dimensional parameters derived from TTE and TEE, using dedicated 3D software, could confirm whether 3D TTE alone offers a comprehensive preoperative evaluation.

Methods

We enrolled 60 patients with severe organic mitral regurgitation scheduled for surgical valve repair. Each patient underwent preoperative 3D TTE, intraoperative 3D TEE prior to surgery, followed by annuloplasty. Mitral valve reconstructions from both TTE and TEE were compared, and dedicated 3D software (EchoPAC GE-Health-Care Software 3D-auto-MVQ) was employed to reconstruct annular geometries from both methods.

Results

Both 3D TTE and 3D TEE demonstrated comparable accuracy in identifying diseased scallops (overall accuracy: 3D TTE 91.8%, 3D TEE 98.1%, p > 0.05). However, 3D TTE was inferior to 3D TEE in identifying multiple chordal ruptures (accuracy: 3D TTE 80%, 3D TEE 100%). Quantitative analysis of the mitral annulus revealed that 3D TTE and 3D TEE yielded overlapping results for static parameters (p > 0.05), whereas dynamic parameters differed significantly (p < 0.05).

Conclusions

In the selected population, 3D TTE demonstrated diagnostic accuracy comparable to transesophageal echocardiography in identifying mitral valve lesions. Furthermore, with the use of dedicated 3D software, TTE alone may provide a comprehensive and noninvasive preoperative evaluation, particularly for static annular parameters. Further studies are warranted to corroborate these findings.

背景:术前超声心动图评估对严重退行性二尖瓣反流患者至关重要,可确保二尖瓣修复手术的个性化。本研究旨在以手术结果为参考,比较三维经胸超声心动图(3D TTE)和三维经食道超声心动图(3D TEE)在识别瓣膜病变方面的诊断准确性。此外,我们还评估了使用专用三维软件从 TTE 和 TEE 中得出的瓣环尺寸参数是否能证实仅靠三维 TTE 是否能提供全面的术前评估:我们招募了 60 名计划进行手术瓣膜修复的严重器质性二尖瓣反流患者。每位患者都接受了术前三维 TTE 和术中三维 TEE 检查,然后进行瓣环成形术。对 TTE 和 TEE 重建的二尖瓣进行比较,并使用专用三维软件(EchoPAC GE-Health-Care Software 3D-auto-MVQ )重建两种方法重建的瓣环几何形状:结果:三维 TTE 和三维 TEE 在识别病变扇贝方面的准确率相当(总体准确率:三维 TTE 91.8%,三维 TEE 98.1%,P > 0.05)。但是,三维 TTE 在鉴别多发性弦索破裂方面不如三维 TEE(准确率:三维 TTE 80%,三维 TEE 100%)。二尖瓣瓣环的定量分析显示,三维 TTE 和三维 TEE 在静态参数上得出的结果是重叠的(P > 0.05),而在动态参数上则有显著差异(P 结论:三维 TTE 和三维 TEE 在二尖瓣瓣环的定量分析上得出的结果是重叠的(P > 0.05):在所选人群中,三维 TTE 在识别二尖瓣病变方面的诊断准确性与经食道超声心动图相当。此外,使用专用的三维软件,仅 TTE 就能提供全面、无创的术前评估,尤其是静态瓣环参数。还需要进一步研究来证实这些发现。
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引用次数: 0
Multimodality Imaging in Chronic Constrictive Pericarditis 慢性缩窄性心包炎的多模态成像
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-26 DOI: 10.1111/echo.70037
Christina Karamarkou, Charalampia Maltsinioti, Oliver Bruder, Mehran Babady

This case highlights the use of multimodality imaging in the diagnosis and management of chronic constrictive pericarditis (CP) in a 37-year-old male with a history of T-wave inversions on electrocardiogram (ECG). The patient underwent adenosine stress cardiac magnetic resonance (CMR) due to suspicion of coronary artery disease (CAD). CMR revealed findings suggestive of chronic CP, including pericardial thickening and septal shudder, with computed tomography (CT) confirming the presence of pericardial calcification. The diagnosis was established through the combination of CMR and CT imaging. The patient underwent a successful pericardiectomy. This case emphasizes the crucial role of CMR and CT in diagnosing and guiding the management of CP.

本病例重点介绍了多模态成像技术在慢性缩窄性心包炎(CP)诊断和治疗中的应用,患者为一名 37 岁男性,心电图(ECG)显示 T 波倒置。由于怀疑患有冠状动脉疾病(CAD),患者接受了腺苷负荷心脏磁共振(CMR)检查。CMR显示的结果提示慢性心肌梗死,包括心包增厚和室间隔颤动,计算机断层扫描(CT)证实存在心包钙化。结合 CMR 和 CT 成像,最终确定了诊断。患者成功接受了心包切除术。本病例强调了 CMR 和 CT 在诊断和指导 CP 治疗中的关键作用。
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引用次数: 0
Advancements in Cardiac CT Imaging: The Era of Artificial Intelligence 心脏 CT 成像的进步:人工智能时代
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-25 DOI: 10.1111/echo.70042
Pietro Costantini, Léon Groenhoff, Eleonora Ostillio, Francesca Coraducci, Francesco Secchi, Alessandro Carriero, Anna Colarieti, Alessandro Stecco

In the last decade, artificial intelligence (AI) has influenced the field of cardiac computed tomography (CT), with its scope further enhanced by advanced methodologies such as machine learning (ML) and deep learning (DL). The AI-driven techniques leverage large datasets to develop and train algorithms capable of making precise evaluations and predictions. The realm of cardiac CT is expanding day by day and multiple tools are offered to answer different questions. Coronary artery calcium score (CACS) and CT angiography (CTA) provide high-resolution images that facilitate the detailed anatomical evaluation of coronary plaque burden. New tools such as myocardial CT perfusion (CTP) and fractional flow reserve (FFRCT) have been developed to add a functional evaluation of the stenosis. Moreover, epicardial adipose tissue (EAT) is gaining interest as its role in coronary artery plaque development has been deepened. Seen the great added value of these tools, the demand for new exams has increased such as the burden on imagers. Due to its ability to fast compute multiple data, AI can be helpful in both the acquisition and post-processing phases. AI can possibly reduce radiation dose, increase image quality, and shorten image analysis time. Moreover, different types of data can be used for risk assessment and patient risk stratification. Recently, the focus of the scientific community on AI has led to numerous studies, especially on CACS and CTA. This narrative review concentrates on AI's role in the post-processing of CACS, CTA, FFRCT, CTP, and EAT, discussing both current capabilities and future directions in the field of cardiac imaging.

近十年来,人工智能(AI)影响了心脏计算机断层扫描(CT)领域,机器学习(ML)和深度学习(DL)等先进方法进一步扩大了其范围。人工智能驱动的技术利用大型数据集来开发和训练能够进行精确评估和预测的算法。心脏 CT 的应用领域与日俱增,有多种工具可用于回答不同的问题。冠状动脉钙化评分(CACS)和 CT 血管造影(CTA)可提供高分辨率图像,有助于对冠状动脉斑块负担进行详细的解剖评估。心肌 CT 灌注(CTP)和分数血流储备(FFRCT)等新工具的开发增加了对狭窄的功能评估。此外,心外膜脂肪组织(EAT)在冠状动脉斑块形成中的作用也得到了深化,因而越来越受到关注。看到这些工具的巨大附加值,对新检查的需求也随之增加,如成像仪的负担。由于人工智能能够快速计算多个数据,因此在采集和后处理阶段都很有帮助。人工智能可以减少辐射剂量,提高图像质量,缩短图像分析时间。此外,不同类型的数据可用于风险评估和患者风险分层。最近,科学界对人工智能的关注引发了大量研究,尤其是对 CACS 和 CTA 的研究。这篇叙述性综述集中探讨了人工智能在 CACS、CTA、FFRCT、CTP 和 EAT 后处理中的作用,并讨论了心脏成像领域的现有功能和未来发展方向。
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引用次数: 0
Incidental Finding of a Myxoma of Unusual Location in an Elderly Patient 一名老年患者意外发现位置异常的肌瘤
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-22 DOI: 10.1111/echo.70036
Karla A. Pupiales-Davila, Maryuri M. D. Chumbes-Aguirre, Alexis Y. Fernandez-Rivera, Pablo Hernandez-Reyes, Xochitl A. Ortiz-Leon
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引用次数: 0
Multimodal Intravascular Imaging of the Vulnerable Coronary Plaque 易损冠状动脉斑块的多模式血管内成像
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-22 DOI: 10.1111/echo.70035
Andrea Milzi, Antonio Landi, Rosalia Dettori, Kathrin Burgmaier, Sebastian Reith, Mathias Burgmaier

Vulnerable coronary plaques are atherosclerotic lesions which, due to their specific phenotype, are prone to plaque rupture and to cause acute coronary syndromes, with subsequent relevant morbidity and mortality. Strategies to break the chain link between plaque vulnerability and adverse clinical events include optimized pharmacologic prevention and potentially also preemptive percutaneous coronary interventions (previously defined as “plaque sealing” or “plaque passivation”). Various morphologic features of the vulnerable plaques have been described, including aspects regarding the large necrotic lipid content, the thin fibrous cap, the presence and extent of the presence of calcifications with small size and calcification angle, and as well as the large macrophage infiltration within the plaque. The detection of these features of plaque vulnerability is possible with intravascular imaging modalities such as intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS), and optical coherence tomography (OCT). This review explores the peculiarities of these three imaging modalities for the detection of vulnerable coronary plaque features.

易损冠状动脉斑块是一种动脉粥样硬化病变,由于其特殊的表型,很容易发生斑块破裂并引发急性冠状动脉综合征,进而导致相关的发病率和死亡率。打破斑块易损性与不良临床事件之间连锁联系的策略包括优化药物预防,也可能包括先发制人的经皮冠状动脉介入治疗(以前定义为 "斑块封闭 "或 "斑块钝化")。人们已经描述了易损斑块的各种形态特征,包括坏死脂质含量大、纤维帽薄、存在钙化且钙化角度小、钙化程度大以及斑块内有大量巨噬细胞浸润等方面。血管内超声(IVUS)、近红外光谱(NIRS)和光学相干断层扫描(OCT)等血管内成像模式可检测斑块脆弱性的这些特征。本综述探讨了这三种成像模式在检测冠状动脉斑块易损性特征方面的特殊性。
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引用次数: 0
A Novel 2D Echo View to Determine Right Ventricular Lead Position on the Tricuspid Valve Level 确定三尖瓣水平右心室导联位置的新型二维回声视图
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-18 DOI: 10.1111/echo.70033
Veronika Zach, Philipp Lacour, Lina Alasfar, Alexandra Maria Chitroceanu, Cristina Rozados da Conceicao, Daniel Armando Morris, Henryk Dreger, Florian Blaschke, Matthias Schneider-Reigbert

Introduction

Recently, a subcostal en-face view of the tricuspid valve (TV) was described which can determine right ventricular (RV) lead position on the TV level. We sought to (1) prospectively evaluate the feasibility of this novel view in patients with cardiac implantable electronic devices (CIED) to visualize the position of the device lead relative to the TV leaflets and (2) study the association between lead position and degree of tricuspid regurgitation (TR).

Methods

Consecutive patients with a history of CIED implantation with at least one RV lead who underwent echocardiography for any cause at our tertiary center were included in this prospective observational study. A subcostal 2D en-face view of the TV was obtained and the position of the RV lead in the TV plane was determined whenever feasible.

Results

A total of 176 patients were included, 70% were male, the median age was 74 years. The exact RV lead position in respect to the TV plane could be determined in 112/176 patients (64%) via the proposed view. In 37 patients (21%) moderate TR could be found, while 10 patients (6%) presented with severe TR. The lead position was not associated with the degree of TR.

Conclusion

A novel 2D en-face view of the TV can accurately identify the RV lead position in the TV plane. At least moderate TR was present in 27% of patients with CIED. There was no association of lead position with the occurrence of moderate or more TR.

简介最近,有人描述了一种三尖瓣(TV)的肋下正视图,它可以确定 TV 水平上的右心室(RV)导联位置。我们试图:(1)前瞻性地评估这种新型视图在心脏植入式电子设备(CIED)患者中的可行性,以观察设备导联相对于电视瓣叶的位置;(2)研究导联位置与三尖瓣反流(TR)程度之间的关联:本前瞻性观察研究纳入了在我们的三级中心因任何原因接受超声心动图检查的连续患者,这些患者均有 CIED 植入史,且至少有一个 RV 导联。在可行的情况下,采集电视肋下二维面内切面,并确定 RV 导联在电视平面上的位置:共纳入 176 名患者,其中 70% 为男性,中位年龄为 74 岁。112/176例患者(64%)可通过拟议视图确定RV导联在TV平面上的确切位置。37名患者(21%)发现中度TR,10名患者(6%)发现重度TR。导联位置与TR程度无关:结论:新颖的二维TV正视图可准确识别TV平面上的RV导联位置。27%的CIED患者至少存在中度TR。导联位置与发生中度或更严重的TR无关。
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引用次数: 0
Takotsubo Cardiomyopathy Following MitraClip Procedure: Focus On MitraClip 手术后的 Takotsubo 心肌病:聚焦。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-17 DOI: 10.1111/echo.70027
Francesco Candido, Amedeo Pergolini, Daniele Pontillo, Marco Russo, Antonio Giovanni Cammardella, Giordano Zampi, Carla Manzara, Mauro Pennacchi, Federico Ranocchi
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引用次数: 0
Overlapping Strain Patterns in Patients With Cardiac Amyloidosis and End-Stage Renal Disease 心脏淀粉样变性和终末期肾病患者的重叠应变模式
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-17 DOI: 10.1111/echo.70039
Janez Toplišek, Marta Cvijić
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引用次数: 0
期刊
Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques
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