Benjamin T. Fitzgerald, Jonathan Chan, Alfred K. Lam, Gregory M. Scalia
{"title":"Response to “Real-World Feasibility and Challenges in Using LAS for Stress Echocardiography”","authors":"Benjamin T. Fitzgerald, Jonathan Chan, Alfred K. Lam, Gregory M. Scalia","doi":"10.1111/echo.70295","DOIUrl":"10.1111/echo.70295","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 11","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394477","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}
Andrew Y. Chang, Joel D. Kaufman, Sanjiv J. Shah, Annabel Xulin Tan, Ravi B. Patel, Helene G. Margolis, Bruce M. Psaty, Julius M. Gardin, Sadeer Al-Kindi, Thomas R. Austin, Michelle L. Bell, Kai Chen, Michelle C. Odden
Purpose
Ground-level ozone (O3) and nitrogen dioxide (NO2) are two of the most important air pollutants, with accumulating evidence linking them to incident cardiovascular disease. The tissue-level mechanisms by which they affect myocardial function remain incompletely understood, however.
Methods
We applied speckle-tracking echocardiography (STE) to explore the relationship between chronic residential gaseous air pollution exposure and cardiac mechanics in community-dwelling older adults largely free of baseline heart disease. Average annual address-specific concentrations of O3 and NO2 were estimated from 1990 to 1994 using validated spatiotemporal models. The association between each pollutant and STE measures of left ventricular average longitudinal strain (LVLS), simplified global longitudinal strain (sLVGLS), early diastolic strain rate (LVEDSR), left atrial reservoir strain (LALS), and STE-derived e′ and E/e′ ratio (E/STe′) was explored using multivariable linear and logistic regressions. sLVGLS was additionally modeled as a binary outcome with a cutoff of −16%.
Results
One thousand five hundred and seventy-six individuals were included in the analysis. We found that each part per billion increase in O3 exposure was associated with a 0.47 increase in E/STe′ ratio (95% CI: 0.06–0.88). O3 exposure was not significantly associated with LV or LA strain abnormalities, including LV GLS, EDSR, or LALS. NO2 exposure was not significantly associated with any of the STE-derived outcomes.
Conclusions
Ozone exposure may be associated with subclinical markers of diastolic dysfunction, while NO2 does not appear to be linked to echocardiographic strain abnormalities.
{"title":"Cross-Sectional Association of Ground-Level Ozone and Nitrogen Dioxide With Cardiac Mechanics Using Speckle-Tracking Echocardiography in the Cardiovascular Health Study","authors":"Andrew Y. Chang, Joel D. Kaufman, Sanjiv J. Shah, Annabel Xulin Tan, Ravi B. Patel, Helene G. Margolis, Bruce M. Psaty, Julius M. Gardin, Sadeer Al-Kindi, Thomas R. Austin, Michelle L. Bell, Kai Chen, Michelle C. Odden","doi":"10.1111/echo.70330","DOIUrl":"10.1111/echo.70330","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Ground-level ozone (O<sub>3</sub>) and nitrogen dioxide (NO<sub>2</sub>) are two of the most important air pollutants, with accumulating evidence linking them to incident cardiovascular disease. The tissue-level mechanisms by which they affect myocardial function remain incompletely understood, however.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We applied speckle-tracking echocardiography (STE) to explore the relationship between chronic residential gaseous air pollution exposure and cardiac mechanics in community-dwelling older adults largely free of baseline heart disease. Average annual address-specific concentrations of O<sub>3</sub> and NO<sub>2</sub> were estimated from 1990 to 1994 using validated spatiotemporal models. The association between each pollutant and STE measures of left ventricular average longitudinal strain (LVLS), simplified global longitudinal strain (sLVGLS), early diastolic strain rate (LVEDSR), left atrial reservoir strain (LALS), and STE-derived e′ and E/e′ ratio (E/STe′) was explored using multivariable linear and logistic regressions. sLVGLS was additionally modeled as a binary outcome with a cutoff of −16%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One thousand five hundred and seventy-six individuals were included in the analysis. We found that each part per billion increase in O<sub>3</sub> exposure was associated with a 0.47 increase in E/STe′ ratio (95% CI: 0.06–0.88). O<sub>3</sub> exposure was not significantly associated with LV or LA strain abnormalities, including LV GLS, EDSR, or LALS. NO<sub>2</sub> exposure was not significantly associated with any of the STE-derived outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ozone exposure may be associated with subclinical markers of diastolic dysfunction, while NO<sub>2</sub> does not appear to be linked to echocardiographic strain abnormalities.</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":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379704","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}
Leila Alizadeh, Sinan Khor, Jaskomal Phagoora, Anaha Raghunathan, Sukhpreet Saini, Robin S. Freedberg, Muhamed Saric
Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart malformations, characterized by four pathological features: right ventricular outflow tract obstruction/pulmonic stenosis, a ventricular septal defect, an overriding aorta, and right ventricular hypertrophy. It was initially partially defined by Nicholas Steno in the 17th century and completely described by Étienne-Louis Arthur Fallot and Maude Abbott in the 19th and 20th centuries. The advances in multimodality imaging and innovative surgical and transcatheter techniques have led to advances in the management of TOF. While initial management in the mid-20th century favored palliative procedures in infancy followed by complete surgical repair, data now support an early complete surgical repair in infancy. The major post-repair complication is the development of significant pulmonary regurgitation, necessitating either surgical or transcatheter valve replacement. Multimodality imaging is essential to the initial identification of TOF, preoperative planning, and post-procedural complication assessment.
In this review, we provide a historical perspective of the discovery and clinical management of TOF from the 1600s to the present day, as well as the role of multimodality imaging in TOF management.
{"title":"Tetralogy of Fallot: Multimodality Imaging and Key Historical Contributions to Diagnosis and Treatment","authors":"Leila Alizadeh, Sinan Khor, Jaskomal Phagoora, Anaha Raghunathan, Sukhpreet Saini, Robin S. Freedberg, Muhamed Saric","doi":"10.1111/echo.70306","DOIUrl":"https://doi.org/10.1111/echo.70306","url":null,"abstract":"<div>\u0000 \u0000 <p>Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart malformations, characterized by four pathological features: right ventricular outflow tract obstruction/pulmonic stenosis, a ventricular septal defect, an overriding aorta, and right ventricular hypertrophy. It was initially partially defined by Nicholas Steno in the 17th century and completely described by Étienne-Louis Arthur Fallot and Maude Abbott in the 19th and 20th centuries. The advances in multimodality imaging and innovative surgical and transcatheter techniques have led to advances in the management of TOF. While initial management in the mid-20th century favored palliative procedures in infancy followed by complete surgical repair, data now support an early complete surgical repair in infancy. The major post-repair complication is the development of significant pulmonary regurgitation, necessitating either surgical or transcatheter valve replacement. Multimodality imaging is essential to the initial identification of TOF, preoperative planning, and post-procedural complication assessment.</p>\u0000 <p>In this review, we provide a historical perspective of the discovery and clinical management of TOF from the 1600s to the present day, as well as the role of multimodality imaging in TOF management.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 11","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145366958","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}
Jun Xue, Di Wu, Yudong Fan, Miaomiao Zhang, Xu Wang
Purpose
This study sought to investigate the predictive effect of combining cardiac color Doppler ultrasound and carotid ultrasound for major adverse cardiac events (MACE) following percutaneous coronary intervention (PCI).
Methods
A retrospective analysis was conducted on 475 coronary heart disease (CHD) patients who underwent PCI between May 2021 and April 2024. Cardiac ultrasound parameters (left atrial diameter [LAD], left ventricular diameter in diastole [LVDd]) and carotid ultrasound metrics (plaque score, intima-media thickness [IMT], total plaque area [TPA], and gray scale median [GSM]) were collected within 48 h post-PCI. Patients were monitored for a 12-month period to record MACE incidence. After 12 months of follow-up, patients were assigned to a Without MACE group (n = 324) and a With MACE group (n = 151). Correlation and multivariate logistic regression analyses were conducted to identify predictors, and receiver operating characteristic (ROC) curves evaluated predictive accuracy.
Results
Among 151 patients (31.8%) who experienced MACE, significant predictors included diabetes requiring medication (OR = 1.80, p = 0.039), prior myocardial infarction (OR = 1.93, p = 0.009), elevated discharge heart rate (OR = 1.10, p = 0.013), Charlson Comorbidity Index (OR = 1.60, p = 0.002), maximum left ventricular thickness (OR = 1.181, p = 0.003), higher Tei index (OR = 1.386, p = 0.001), plaque score (OR = 5.032, p = 0.001), carotid IMT (OR = 2.216, p = 0.002), and TPA (OR = 1.039, p = 0.016). Protective factors included beta-blocker use (OR = 0.468, p = 0.027), higher LVEF (OR = 0.957, p = 0.009), and higher GSM (OR = 0.894, p = 0.045). The combined ultrasound model achieved an AUC of 0.833, demonstrating robust predictive accuracy.
Conclusion
Cardiac color Doppler ultrasound combined with carotid ultrasound effectively predicts post-PCI MACE by integrating cardiac function and atherosclerotic plaque characteristics. These non-invasive imaging tools offer a valuable framework for early risk assessment and personalized treatment strategies in CHD patients following PCI.
目的探讨心脏彩色多普勒超声联合颈动脉超声对经皮冠状动脉介入治疗（PCI）后主要心脏不良事件（MACE）的预测作用。方法回顾性分析2021年5月至2024年4月间行PCI治疗的475例冠心病患者。采集pci术后48 h内的心脏超声参数（左心房内径[LAD]、左心室舒张期内径[LVDd]）和颈动脉超声指标（斑块评分、内膜-中膜厚度[IMT]、总斑块面积[TPA]、灰度中位数[GSM]）。对患者进行为期12个月的监测，记录MACE的发生率。随访12个月后，将患者分为无MACE组（n = 324）和有MACE组（n = 151）。相关分析和多变量logistic回归分析确定预测因子，受试者工作特征（ROC）曲线评估预测准确性。结果151例（31.8%）MACE患者中，显著预测因子包括糖尿病用药（OR = 1.80, p = 0.039）、既往心肌梗死（OR = 1.93, p = 0.009）、出院心率升高（OR = 1.10, p = 0.013）、Charlson合并症指数（OR = 1.60, p = 0.002）、最大左室厚度（OR = 1.181, p = 0.003）、Tei指数升高（OR = 1.386, p = 0.001）、斑块评分（OR = 5.032, p = 0.001）、颈动脉IMT （OR = 2.216, p = 0.013）、p = 0.002), TPA （OR = 1.039, p = 0.016）。保护因素包括-受体阻滞剂使用（OR = 0.468, p = 0.027）、较高的LVEF （OR = 0.957, p = 0.009）和较高的GSM （OR = 0.894, p = 0.045）。联合超声模型的AUC为0.833，具有较好的预测精度。结论心脏彩色多普勒超声联合颈动脉超声综合心功能和动脉粥样硬化斑块特征，可有效预测pci术后MACE。这些非侵入性成像工具为冠心病患者PCI术后的早期风险评估和个性化治疗策略提供了有价值的框架。
{"title":"Analysis of the Predictive Effect of Cardiac Color Doppler Ultrasound Combined With Carotid Ultrasound on Major Adverse Cardiac Events Following Percutaneous Coronary Intervention","authors":"Jun Xue, Di Wu, Yudong Fan, Miaomiao Zhang, Xu Wang","doi":"10.1111/echo.70326","DOIUrl":"https://doi.org/10.1111/echo.70326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study sought to investigate the predictive effect of combining cardiac color Doppler ultrasound and carotid ultrasound for major adverse cardiac events (MACE) following percutaneous coronary intervention (PCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 475 coronary heart disease (CHD) patients who underwent PCI between May 2021 and April 2024. Cardiac ultrasound parameters (left atrial diameter [LAD], left ventricular diameter in diastole [LVDd]) and carotid ultrasound metrics (plaque score, intima-media thickness [IMT], total plaque area [TPA], and gray scale median [GSM]) were collected within 48 h post-PCI. Patients were monitored for a 12-month period to record MACE incidence. After 12 months of follow-up, patients were assigned to a Without MACE group (<i>n</i> = 324) and a With MACE group (<i>n</i> = 151). Correlation and multivariate logistic regression analyses were conducted to identify predictors, and receiver operating characteristic (ROC) curves evaluated predictive accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 151 patients (31.8%) who experienced MACE, significant predictors included diabetes requiring medication (OR = 1.80, <i>p</i> = 0.039), prior myocardial infarction (OR = 1.93, <i>p</i> = 0.009), elevated discharge heart rate (OR = 1.10, <i>p</i> = 0.013), Charlson Comorbidity Index (OR = 1.60, <i>p</i> = 0.002), maximum left ventricular thickness (OR = 1.181, <i>p</i> = 0.003), higher Tei index (OR = 1.386, <i>p</i> = 0.001), plaque score (OR = 5.032, <i>p</i> = 0.001), carotid IMT (OR = 2.216, <i>p</i> = 0.002), and TPA (OR = 1.039, <i>p</i> = 0.016). Protective factors included beta-blocker use (OR = 0.468, <i>p</i> = 0.027), higher LVEF (OR = 0.957, <i>p</i> = 0.009), and higher GSM (OR = 0.894, <i>p</i> = 0.045). The combined ultrasound model achieved an AUC of 0.833, demonstrating robust predictive accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cardiac color Doppler ultrasound combined with carotid ultrasound effectively predicts post-PCI MACE by integrating cardiac function and atherosclerotic plaque characteristics. These non-invasive imaging tools offer a valuable framework for early risk assessment and personalized treatment strategies in CHD patients following PCI.</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":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine W. Sun, Donald Glower, Angela Pollak, Madison Goldberger, Alina Nicoara
Introduction
Placement of a percutaneous coronary sinus catheter (CSC) for retrograde cardioplegia delivery in minimally invasive cardiac surgery has been implemented at various centers. While several techniques have been described for catheter placement, we present our experience utilizing transesophageal echocardiography (TEE) alone for guiding the successful placement and management of percutaneous CSC during robotic mitral valve repair (MVr).
Methods
We retrospectively studied all adult patients who underwent planned robotic MVr by a single surgeon at our institution from August 2013 to December 2021. Confirmation of successful CSC placement was made by review of electronic medical records and TEE data.
Results
Out of 144 patients in the study cohort, 135 (94%) patients had successful CSC placement. The median time from anesthesia start in the operating room to surgical incision was 93 min (interquartile range 82–103 min). Of the 135 patients with successful CSC placement, 122 patients (90%) had maintenance of cardiac arrest during cardiopulmonary bypass with retrograde cardioplegia only. Two patients (1.4%) had complications; one had an injury of the coronary sinus (unrelated to CSC placement) requiring sternotomy, and one had an episode of ventricular tachycardia requiring defibrillation.
Discussion
In our experience, TEE guidance offers an effective approach for percutaneous CSC placement without requiring fluoroscopic guidance. It allows the safe conduct of surgery with multidose administration of retrograde cardioplegia. The alternative to placing a percutaneous CSC is administration of antegrade cardioplegia only, which may not be feasible in all patients, and if feasible, may have limitations in robotic MVr.
{"title":"Percutaneous Coronary Sinus Catheter Placement and Management With Transesophageal Echocardiography for Robotic Mitral Valve Surgery","authors":"Katherine W. Sun, Donald Glower, Angela Pollak, Madison Goldberger, Alina Nicoara","doi":"10.1111/echo.70327","DOIUrl":"https://doi.org/10.1111/echo.70327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Placement of a percutaneous coronary sinus catheter (CSC) for retrograde cardioplegia delivery in minimally invasive cardiac surgery has been implemented at various centers. While several techniques have been described for catheter placement, we present our experience utilizing transesophageal echocardiography (TEE) alone for guiding the successful placement and management of percutaneous CSC during robotic mitral valve repair (MVr).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively studied all adult patients who underwent planned robotic MVr by a single surgeon at our institution from August 2013 to December 2021. Confirmation of successful CSC placement was made by review of electronic medical records and TEE data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 144 patients in the study cohort, 135 (94%) patients had successful CSC placement. The median time from anesthesia start in the operating room to surgical incision was 93 min (interquartile range 82–103 min). Of the 135 patients with successful CSC placement, 122 patients (90%) had maintenance of cardiac arrest during cardiopulmonary bypass with retrograde cardioplegia only. Two patients (1.4%) had complications; one had an injury of the coronary sinus (unrelated to CSC placement) requiring sternotomy, and one had an episode of ventricular tachycardia requiring defibrillation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In our experience, TEE guidance offers an effective approach for percutaneous CSC placement without requiring fluoroscopic guidance. It allows the safe conduct of surgery with multidose administration of retrograde cardioplegia. The alternative to placing a percutaneous CSC is administration of antegrade cardioplegia only, which may not be feasible in all patients, and if feasible, may have limitations in robotic MVr.</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":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145366956","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}
Mucahit Yetim, Macit Kalçık, Lütfü Bekar, Muhammet Cihat Çelik, Abdullah Sarıhan, Yusuf Karavelioğlu
Background
Essential hypertension is associated with structural and functional cardiac changes, including left ventricular hypertrophy (LVH), which significantly increases cardiovascular risk. Left anterior fascicular block (LAFB), historically considered benign, has recently been linked to adverse outcomes. Carotid intima-media thickness (CIMT) is a noninvasive marker of subclinical atherosclerosis. The interplay between LAFB, LVH, and CIMT in hypertensive patients remains poorly defined.
Methods
We conducted a cross-sectional study of 256 patients with essential hypertension, divided into LAFB (n = 60) and non-LAFB (n = 196) groups. All participants underwent 12-lead electrocardiography, echocardiography, and carotid ultrasonography. CIMT was measured as a surrogate of vascular remodeling. Echocardiographic indices of cardiac remodeling and CIMT were compared between groups. Logistic regression identified independent predictors of LAFB.
Results
Patients with LAFB had significantly higher left atrial diameter (LAD), left atrial volume index (LAVI), interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass (LVM), left ventricular mass index (LVMI), and prevalence of LVH compared with those without LAFB (all p < 0.001). Mean CIMT values were also greater in the LAFB group (0.82 ± 0.27 vs. 0.72 ± 0.19 mm, p = 0.003). ROC analysis identified LAD >35 mm and LVMI >81 g/m2 as useful predictors of LAFB. Multivariate logistic regression showed increased LAD (OR = 7.94, 95% CI: 2.24–28.10, p = 0.001) and LVM (OR = 3.37, 95% CI: 1.49–7.57, p = 0.003) as independent predictors of LAFB.
Conclusion
In essential hypertension, LAFB is associated with more advanced cardiac remodeling and increased CIMT. LAD and LVM were independent predictors of LAFB, suggesting that this ECG finding may serve as a simple marker of higher cardiovascular risk.
背景原发性高血压与心脏结构和功能改变相关，包括左心室肥厚（LVH），可显著增加心血管风险。左前束阻滞（LAFB）历来被认为是良性的，但最近与不良后果有关。颈动脉内膜-中膜厚度（CIMT）是亚临床动脉粥样硬化的无创指标。高血压患者LAFB、LVH和CIMT之间的相互作用仍不明确。方法对256例高血压患者进行横断面研究，分为LAFB组（n = 60）和非LAFB组（n = 196）。所有参与者都进行了12导联心电图、超声心动图和颈动脉超声检查。测量CIMT作为血管重构的替代指标。比较两组间心脏重构和CIMT的超声心动图指标。Logistic回归确定了LAFB的独立预测因子。结果LAFB患者左房内径（LAD）、左房容积指数（LAVI）、室间隔厚度（IVST）、后壁厚度（PWT）、左室质量（LVM）、左室质量指数（LVMI）、LVH患病率均显著高于无LAFB患者（p < 0.001）。LAFB组的平均CIMT值也更高（0.82±0.27 vs 0.72±0.19 mm, p = 0.003）。ROC分析确定LAD 35 mm和LVMI 81 g/m2是LAFB的有效预测因子。多因素logistic回归显示LAD （OR = 7.94, 95% CI: 2.24-28.10, p = 0.001）和LVM （OR = 3.37, 95% CI: 1.49-7.57, p = 0.003）升高是LAFB的独立预测因子。结论在原发性高血压患者中，LAFB与更晚期的心脏重构和增加的CIMT相关。LAD和LVM是LAFB的独立预测因子，这表明这一ECG发现可以作为心血管风险较高的简单标志。
{"title":"Association Between Left Anterior Fascicular Block, Cardiac Remodeling, and Carotid Intima Media Thickness in Hypertensive Patients","authors":"Mucahit Yetim, Macit Kalçık, Lütfü Bekar, Muhammet Cihat Çelik, Abdullah Sarıhan, Yusuf Karavelioğlu","doi":"10.1111/echo.70329","DOIUrl":"https://doi.org/10.1111/echo.70329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Essential hypertension is associated with structural and functional cardiac changes, including left ventricular hypertrophy (LVH), which significantly increases cardiovascular risk. Left anterior fascicular block (LAFB), historically considered benign, has recently been linked to adverse outcomes. Carotid intima-media thickness (CIMT) is a noninvasive marker of subclinical atherosclerosis. The interplay between LAFB, LVH, and CIMT in hypertensive patients remains poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study of 256 patients with essential hypertension, divided into LAFB (<i>n</i> = 60) and non-LAFB (<i>n</i> = 196) groups. All participants underwent 12-lead electrocardiography, echocardiography, and carotid ultrasonography. CIMT was measured as a surrogate of vascular remodeling. Echocardiographic indices of cardiac remodeling and CIMT were compared between groups. Logistic regression identified independent predictors of LAFB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with LAFB had significantly higher left atrial diameter (LAD), left atrial volume index (LAVI), interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass (LVM), left ventricular mass index (LVMI), and prevalence of LVH compared with those without LAFB (all <i>p</i> < 0.001). Mean CIMT values were also greater in the LAFB group (0.82 ± 0.27 vs. 0.72 ± 0.19 mm, <i>p</i> = 0.003). ROC analysis identified LAD >35 mm and LVMI >81 g/m<sup>2</sup> as useful predictors of LAFB. Multivariate logistic regression showed increased LAD (OR = 7.94, 95% CI: 2.24–28.10, <i>p</i> = 0.001) and LVM (OR = 3.37, 95% CI: 1.49–7.57, <i>p</i> = 0.003) as independent predictors of LAFB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In essential hypertension, LAFB is associated with more advanced cardiac remodeling and increased CIMT. LAD and LVM were independent predictors of LAFB, suggesting that this ECG finding may serve as a simple marker of higher cardiovascular risk.</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":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145366957","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}
Yuan Tian, Yutian Wang, Bo Jing, Xiaofang Chen, Kunhui Huang, Jiancheng Xiu, Maolong Su, Qiuxia Zhang, Xu Chen
Background
Atrial fibrillation (AF) is linked to tricuspid annulus (TA) and right heart (RH) remodeling. Despite advances in catheter ablation, data regarding its structural impact on the TA and RH chambers remain limited. Therefore, the impact of radiofrequency ablation (RFA) on TA and RH remodeling in persistent AF patients is less clear. Furthermore, the potential of three-dimensional echocardiography (3DE) for evaluating TA and RH remodeling following RFA requires further exploration. This study aimed to characterize TA and RH geometry and function in persistent AF patients before and after RFA via 3DE.
Methods
The 90 subjects included in this study were divided into three groups: the persistent AF group (n = 30); persistent AF patients who underwent successful RFA with sinus rhythm maintenance at the 3-month follow-up were assigned to the RFA group (n = 30); and the control group (n = 30). 3DE datasets were analyzed to measure TA and RH geometry and function via Tomtec 3D echocardiography analysis software.
Results
Compared with the AF group, the RFA group presented shorter linear dimensions of the right atrium (RA) (p < 0.05). The right atrial ejection fraction (EF) and right ventricular (RV) EF were significantly greater in the RFA group than in the AF group (RAEF: 45.56% vs. 28.57%, p = 0.003; RVEF: 45.94% vs. 38.45%, p < 0.001). However, there was no significant difference in the RV fractional area change (FAC) index (p > 0.05). The TA area, anteroposterior diameter, and circumference were significantly smaller in the RFA group than in the control group in all phases (all p < 0.05). After 3 months, RFA intervention (B = −0.440, p < 0.001) demonstrated significant inverse associations with the TA perimeter. Moreover, the non-planar angle and tricuspid leaflet tenting height were smaller in the RFA group than in the control group in the systolic phase (p < 0.05).
Conclusions
This study suggests that RFA may contribute to favorable TA and RH remodeling in patients with persistent AF, and that 3DE may provide more comprehensive and sensitive assessments with excellent feasibility, facilitating readily accessible evaluations for AF patients undergoing RFA.
{"title":"Evaluation of the Remodeling of the Tricuspid Annulus and Right Heart in Persistent Atrial Fibrillation Patients With or Without Radiofrequency Ablation via Three-Dimensional Echocardiography","authors":"Yuan Tian, Yutian Wang, Bo Jing, Xiaofang Chen, Kunhui Huang, Jiancheng Xiu, Maolong Su, Qiuxia Zhang, Xu Chen","doi":"10.1111/echo.70319","DOIUrl":"10.1111/echo.70319","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is linked to tricuspid annulus (TA) and right heart (RH) remodeling. Despite advances in catheter ablation, data regarding its structural impact on the TA and RH chambers remain limited. Therefore, the impact of radiofrequency ablation (RFA) on TA and RH remodeling in persistent AF patients is less clear. Furthermore, the potential of three-dimensional echocardiography (3DE) for evaluating TA and RH remodeling following RFA requires further exploration. This study aimed to characterize TA and RH geometry and function in persistent AF patients before and after RFA via 3DE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 90 subjects included in this study were divided into three groups: the persistent AF group (<i>n</i> = 30); persistent AF patients who underwent successful RFA with sinus rhythm maintenance at the 3-month follow-up were assigned to the RFA group (<i>n</i> = 30); and the control group (<i>n</i> = 30). 3DE datasets were analyzed to measure TA and RH geometry and function via Tomtec 3D echocardiography analysis software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with the AF group, the RFA group presented shorter linear dimensions of the right atrium (RA) (<i>p</i> < 0.05). The right atrial ejection fraction (EF) and right ventricular (RV) EF were significantly greater in the RFA group than in the AF group (RAEF: 45.56% vs. 28.57%, <i>p</i> = 0.003; RVEF: 45.94% vs. 38.45%, <i>p</i> < 0.001). However, there was no significant difference in the RV fractional area change (FAC) index (<i>p</i> > 0.05). The TA area, anteroposterior diameter, and circumference were significantly smaller in the RFA group than in the control group in all phases (all <i>p</i> < 0.05). After 3 months, RFA intervention (B = −0.440, <i>p</i> < 0.001) demonstrated significant inverse associations with the TA perimeter. Moreover, the non-planar angle and tricuspid leaflet tenting height were smaller in the RFA group than in the control group in the systolic phase (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study suggests that RFA may contribute to favorable TA and RH remodeling in patients with persistent AF, and that 3DE may provide more comprehensive and sensitive assessments with excellent feasibility, facilitating readily accessible evaluations for AF patients undergoing RFA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 10","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahmoud Shaaban, Amr Yosry Emam, Mohamed Elgouhary, Faisal Said, Nagwa Thabet, Soha Hekal, Hani Mahmoud-Elsayed
<div> <section> <h3> Background</h3> <p>Septal myectomy is a well-established surgical intervention for patients with hypertrophic obstructive cardiomyopathy (HOCM). However, mitral annulus dynamics in HOCM patients and the procedure's impact on them are not fully understood. This study aimed to evaluate the mitral valve annulus's dynamics and the effect of septal myectomy on its geometry and function using three-dimensional transesophageal echocardiography (3D TEE) in HOCM patients.</p> </section> <section> <h3> Methods</h3> <p>A single-site, prospective observational study was conducted at a tertiary-level hospital; 26 patients with HOCM who underwent septal myectomy were included. Intraoperative 3D TEE was performed before and after surgery to assess mitral annular dimensions, area, and motion. Clinical outcomes, including New York Heart Association (NYHA) functional class and left ventricular outflow tract (LVOT) gradient, were also evaluated. Preoperative and postoperative transesophageal images were analyzed offline to measure mitral annular dynamics across the cardiac cycle using dedicated software and Doppler-derived pressure gradients.</p> </section> <section> <h3> Results</h3> <p>Throughout the four phases of the cardiac cycle (late diastole, early systole, mid-systole, and late systole), there were no significant dynamic changes in mitral annulus dimensions, specifically, the anteroposterior (AP) diameter (<i>p</i> = 0.286), anterolateral–posteromedial (AL–PM) diameter (<i>p</i> = 0.922), sphericity index (<i>p</i> = 0.311), inter-trigonal diameter (<i>p</i> = 0.982), intercommissural diameter (<i>p</i> = 0.999), 3D saddle-shaped annulus area (<i>p</i> = 0.714), 3D saddle-shaped annulus perimeter (<i>p</i> = 0.754), annulus height (<i>p</i> = 0.981), nonplanar angle (<i>p</i> = 0.902), aorto-mitral angle (<i>p</i> = 0.949), and saddling (<i>p</i> = 0.231).</p> <p>Immediately after septal myectomy, despite significant LVOT gradient reduction (88.4 ± 45.6 mmHg preoperative vs. 9.3 ± 4.7 mmHg postoperative; <i>p</i> < 0.001), no significant improvements were detected in mitral annular parameters (<i>p</i> > 0.05 for all parameters).</p> </section> <section> <h3> Conclusion</h3> <p>3D TEE offers critical insights into the dynamics of the mitral valve annulus across various phases of the cardiac cycle. In patients with HOCM, the mitral valve annulus exhibits reduced dynamic motion, with a notable loss of normal systolic AP contraction and saddling. Immediate postoperative assessments did not demonstrate significant improvements in mitral annulus dynamics. Therefore, further longitudinal studies
{"title":"Dynamics of the Mitral Valve Annulus in Hypertrophic Obstructive Cardiomyopathy Patients Undergoing Septal Myectomy: Insights From 3D Transesophageal Echocardiography","authors":"Mahmoud Shaaban, Amr Yosry Emam, Mohamed Elgouhary, Faisal Said, Nagwa Thabet, Soha Hekal, Hani Mahmoud-Elsayed","doi":"10.1111/echo.70314","DOIUrl":"10.1111/echo.70314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Septal myectomy is a well-established surgical intervention for patients with hypertrophic obstructive cardiomyopathy (HOCM). However, mitral annulus dynamics in HOCM patients and the procedure's impact on them are not fully understood. This study aimed to evaluate the mitral valve annulus's dynamics and the effect of septal myectomy on its geometry and function using three-dimensional transesophageal echocardiography (3D TEE) in HOCM patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-site, prospective observational study was conducted at a tertiary-level hospital; 26 patients with HOCM who underwent septal myectomy were included. Intraoperative 3D TEE was performed before and after surgery to assess mitral annular dimensions, area, and motion. Clinical outcomes, including New York Heart Association (NYHA) functional class and left ventricular outflow tract (LVOT) gradient, were also evaluated. Preoperative and postoperative transesophageal images were analyzed offline to measure mitral annular dynamics across the cardiac cycle using dedicated software and Doppler-derived pressure gradients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Throughout the four phases of the cardiac cycle (late diastole, early systole, mid-systole, and late systole), there were no significant dynamic changes in mitral annulus dimensions, specifically, the anteroposterior (AP) diameter (<i>p</i> = 0.286), anterolateral–posteromedial (AL–PM) diameter (<i>p</i> = 0.922), sphericity index (<i>p</i> = 0.311), inter-trigonal diameter (<i>p</i> = 0.982), intercommissural diameter (<i>p</i> = 0.999), 3D saddle-shaped annulus area (<i>p</i> = 0.714), 3D saddle-shaped annulus perimeter (<i>p</i> = 0.754), annulus height (<i>p</i> = 0.981), nonplanar angle (<i>p</i> = 0.902), aorto-mitral angle (<i>p</i> = 0.949), and saddling (<i>p</i> = 0.231).</p>\u0000 \u0000 <p>Immediately after septal myectomy, despite significant LVOT gradient reduction (88.4 ± 45.6 mmHg preoperative vs. 9.3 ± 4.7 mmHg postoperative; <i>p</i> < 0.001), no significant improvements were detected in mitral annular parameters (<i>p</i> > 0.05 for all parameters).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>3D TEE offers critical insights into the dynamics of the mitral valve annulus across various phases of the cardiac cycle. In patients with HOCM, the mitral valve annulus exhibits reduced dynamic motion, with a notable loss of normal systolic AP contraction and saddling. Immediate postoperative assessments did not demonstrate significant improvements in mitral annulus dynamics. Therefore, further longitudinal studies","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 10","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337955","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}
Seda Tanyeri, Murat Karacam, Barkin Kultursay, Azmican Kaya, Deniz Mutlu, Suleyman Cagan Efe, Gulumser Sevgin Halil, Ozgur Yasar Akbal, Cem Dogan, Mehmet Kaan Kırali, Rezzan Deniz Acar
Background
Right ventricular (RV) dysfunction is a key determinant of prognosis in advanced heart failure (HF) patients, particularly those undergoing heart transplantation. Noninvasive RV–pulmonary arterial (PA) coupling indices, such as tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP), fractional area change (FAC)/PASP and strain-based parameters, offer potential in predicting clinical outcomes. However, their comparative prognostic value remains unclear.
Methods
A retrospective cohort of 247 patients evaluated for heart transplantation between 2021 and 2023 was included. Echocardiographic parameters, including TAPSE (mm), FAC (%), RV ejection fraction (RVEF, %), lateral tricuspid annular systolic velocity (s′ by tissue Doppler imaging, cm/s), RV free-wall strain (RVFWS, %), and global longitudinal strain (RVGLS, %) and PASP (mmHg), were measured. The primary composite outcome was heart transplantation, LV assist device implantation, or all-cause mortality. Cox regression (hazard ratios per 1-standard deviation [SD] change; for strain, per 1-SD decrease in absolute magnitude) and time-dependent receiver operating characteristic (ROC) analyses were performed to assess the prognostic value of RV–PA coupling indices.
Results
During a median follow-up of 452 days, 62 patients (25.1%) experienced the primary outcome. Patients with adverse outcomes had significantly lower TAPSE, FAC, s′ (TDI), and higher PASP. RV–PA coupling indices, including TAPSE/PASP, FAC/PASP, and RVGLS/PASP, were significantly lower in these patients. Among those parameters, RVEF/PASP and TAPSE/PASP showed numerically higher prognostic performance with C-index values of 0.827 and 0.826, respectively, while RV strain indices appeared to demonstrate relatively stronger prognostic capacity during longer follow-ups.
Conclusion
Noninvasive RV–PA coupling indices, particularly TAPSE/PASP, FAC/PASP, and RVEF/PASP, were associated with adverse outcomes in advanced HF patients and may provide useful information for early risk stratification. Strain-based indices, especially RVFWS/PASP, appeared to offer additional prognostic value during longer-term follow-up. These findings highlight the potential clinical relevance of RV–PA coupling; however, they should be regarded as descriptive and hypothesis-generating until validated in larger, prospective cohorts.
{"title":"Echocardiographic Assessment of RV–PA Coupling in Advanced Heart Failure: A Comparative Analysis of Volumetric and Strain-Based Measures","authors":"Seda Tanyeri, Murat Karacam, Barkin Kultursay, Azmican Kaya, Deniz Mutlu, Suleyman Cagan Efe, Gulumser Sevgin Halil, Ozgur Yasar Akbal, Cem Dogan, Mehmet Kaan Kırali, Rezzan Deniz Acar","doi":"10.1111/echo.70313","DOIUrl":"10.1111/echo.70313","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Right ventricular (RV) dysfunction is a key determinant of prognosis in advanced heart failure (HF) patients, particularly those undergoing heart transplantation. Noninvasive RV–pulmonary arterial (PA) coupling indices, such as tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP), fractional area change (FAC)/PASP and strain-based parameters, offer potential in predicting clinical outcomes. However, their comparative prognostic value remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort of 247 patients evaluated for heart transplantation between 2021 and 2023 was included. Echocardiographic parameters, including TAPSE (mm), FAC (%), RV ejection fraction (RVEF, %), lateral tricuspid annular systolic velocity (s′ by tissue Doppler imaging, cm/s), RV free-wall strain (RVFWS, %), and global longitudinal strain (RVGLS, %) and PASP (mmHg), were measured. The primary composite outcome was heart transplantation, LV assist device implantation, or all-cause mortality. Cox regression (hazard ratios per 1-standard deviation [SD] change; for strain, per 1-SD decrease in absolute magnitude) and time-dependent receiver operating characteristic (ROC) analyses were performed to assess the prognostic value of RV–PA coupling indices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a median follow-up of 452 days, 62 patients (25.1%) experienced the primary outcome. Patients with adverse outcomes had significantly lower TAPSE, FAC, s′ (TDI), and higher PASP. RV–PA coupling indices, including TAPSE/PASP, FAC/PASP, and RVGLS/PASP, were significantly lower in these patients. Among those parameters, RVEF/PASP and TAPSE/PASP showed numerically higher prognostic performance with C-index values of 0.827 and 0.826, respectively, while RV strain indices appeared to demonstrate relatively stronger prognostic capacity during longer follow-ups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Noninvasive RV–PA coupling indices, particularly TAPSE/PASP, FAC/PASP, and RVEF/PASP, were associated with adverse outcomes in advanced HF patients and may provide useful information for early risk stratification. Strain-based indices, especially RVFWS/PASP, appeared to offer additional prognostic value during longer-term follow-up. These findings highlight the potential clinical relevance of RV–PA coupling; however, they should be regarded as descriptive and hypothesis-generating until validated in larger, prospective cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 10","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338045","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}
<p>The management of moderate aortic stenosis (AS) has long been guided by the principle of surveillance until patients cross the diagnostic thresholds for severe disease or develop symptoms. This conventional paradigm is being challenged by emerging data demonstrating that moderate AS is not a uniform or benign stage. Rather, it represents a spectrum of biological and clinical trajectories, with some patients experiencing rapid progression and adverse outcomes rivaling those of severe disease [<span>1-3</span>]. The study by D'Amico et al., <i>“Clinical, echocardiographic, and socioeconomic predictors of progression and outcomes in patients with moderate aortic stenosis,”</i> adds critical insight into this debate. By integrating clinical, imaging, and socioeconomic predictors, their findings reinforce the paradigm shift toward risk-based surveillance and individualized management strategies. The implications extend beyond diagnostic refinement to potential early intervention, disease modification, and even health policy. This commentary will discuss the evolving understanding of moderate AS, highlight predictors of progression, and offer insight that may influence clinical practice.</p><p>Moderate AS is a heterogeneous stage. Moderate AS has been defined by echocardiographic parameters (cutoff values defined by current guidelines), followed up with repeat echocardiography every 1–2 years, and patients are otherwise managed conservatively until criteria for severe AS are met [<span>2, 3</span>]. However, contemporary cohort studies demonstrate that moderate AS is not a homogeneous state. Event rates in patients with moderate AS, particularly those with comorbidities or imaging evidence of rapid progression, can approach those of severe disease [<span>1, 3, 4</span>]. Some patients remain stable for years, whereas others deteriorate quickly, experiencing progression, hospitalizations, or death. This heterogeneity challenges the sufficiency of the “watchful waiting” strategy and underscores the importance of identifying high-risk subsets. Baseline hemodynamic severity remains a central determinant of outcomes. Patients with higher peak velocity, mean gradients, and smaller valve areas are more likely to cross into severe disease. An annual rise in peak velocity ≥0.3 m/s is a widely recognized marker of “rapid progression” and strongly correlates with adverse events [<span>2-4</span>]. However, these patients often fall through the cracks of standard surveillance intervals, as shown by D<sup>,</sup>Amico et al., underscoring the need for a tailored approach and risk stratification tools.</p><p>Beyond the valve, myocardial and extravalvular damage and the clinical consequences of AS are determined not only by the degree of valvular narrowing but also by the heart's capacity to adapt to chronic pressure overload. Recognition of this broader pathophysiology has reframed how disease staging is conceptualized. Impaired global longitudinal strain (GLS &l
{"title":"Time to Rethink the Road From Moderate to Severe Aortic Stenosis","authors":"Sandra Jaksic Jurinjak","doi":"10.1111/echo.70325","DOIUrl":"10.1111/echo.70325","url":null,"abstract":"<p>The management of moderate aortic stenosis (AS) has long been guided by the principle of surveillance until patients cross the diagnostic thresholds for severe disease or develop symptoms. This conventional paradigm is being challenged by emerging data demonstrating that moderate AS is not a uniform or benign stage. Rather, it represents a spectrum of biological and clinical trajectories, with some patients experiencing rapid progression and adverse outcomes rivaling those of severe disease [<span>1-3</span>]. The study by D'Amico et al., <i>“Clinical, echocardiographic, and socioeconomic predictors of progression and outcomes in patients with moderate aortic stenosis,”</i> adds critical insight into this debate. By integrating clinical, imaging, and socioeconomic predictors, their findings reinforce the paradigm shift toward risk-based surveillance and individualized management strategies. The implications extend beyond diagnostic refinement to potential early intervention, disease modification, and even health policy. This commentary will discuss the evolving understanding of moderate AS, highlight predictors of progression, and offer insight that may influence clinical practice.</p><p>Moderate AS is a heterogeneous stage. Moderate AS has been defined by echocardiographic parameters (cutoff values defined by current guidelines), followed up with repeat echocardiography every 1–2 years, and patients are otherwise managed conservatively until criteria for severe AS are met [<span>2, 3</span>]. However, contemporary cohort studies demonstrate that moderate AS is not a homogeneous state. Event rates in patients with moderate AS, particularly those with comorbidities or imaging evidence of rapid progression, can approach those of severe disease [<span>1, 3, 4</span>]. Some patients remain stable for years, whereas others deteriorate quickly, experiencing progression, hospitalizations, or death. This heterogeneity challenges the sufficiency of the “watchful waiting” strategy and underscores the importance of identifying high-risk subsets. Baseline hemodynamic severity remains a central determinant of outcomes. Patients with higher peak velocity, mean gradients, and smaller valve areas are more likely to cross into severe disease. An annual rise in peak velocity ≥0.3 m/s is a widely recognized marker of “rapid progression” and strongly correlates with adverse events [<span>2-4</span>]. However, these patients often fall through the cracks of standard surveillance intervals, as shown by D<sup>,</sup>Amico et al., underscoring the need for a tailored approach and risk stratification tools.</p><p>Beyond the valve, myocardial and extravalvular damage and the clinical consequences of AS are determined not only by the degree of valvular narrowing but also by the heart's capacity to adapt to chronic pressure overload. Recognition of this broader pathophysiology has reframed how disease staging is conceptualized. Impaired global longitudinal strain (GLS &l","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 10","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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