Jess Hatfield, Michael D. Woods, Alex Pham, Scott Mayo, Laith Wahab, Kendall Hammonds, Vinh Nguyen, Robert J. Widmer
Purpose
Regional wall motion abnormality (RWMA) on transthoracic echocardiography (TTE) is used as a clinical decision-making tool to assess systolic function, but there is limited data regarding the validity of this tool to predict obstructive coronary artery disease (CAD). This study evaluates the utility of RWMA on TTE for detecting obstructive CAD in patients with no prior CAD history.
Methods
We retrospectively reviewed charts of adults who underwent resting TTE and coronary angiography within 30 days, analyzing RWMA in relation to angiographic luminal stenosis.
Results
Among 754 patients (mean age 62, 60% male), TTE sensitivity varied with timing relative to angiography: 68.7% after angiography versus 49.5% before. In ST-elevation myocardial infarction (STEMI) patients (n = 126 after vs. n = 4 before), sensitivity was 89.8%. RWMA correlated with CAD severity, particularly in STEMI cases.
Conclusions
TTE specificity remains high, but sensitivity varies significantly by timing, with the highest sensitivity in STEMI patients. These findings could refine decision-making in uncertain STEMI cases, supporting TTE as a valuable adjunctive diagnostic tool.
{"title":"Diagnostic Value of Regional Wall Motion Abnormalities on Resting Transthoracic Echocardiography for Coronary Artery Disease","authors":"Jess Hatfield, Michael D. Woods, Alex Pham, Scott Mayo, Laith Wahab, Kendall Hammonds, Vinh Nguyen, Robert J. Widmer","doi":"10.1111/echo.70031","DOIUrl":"10.1111/echo.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Regional wall motion abnormality (RWMA) on transthoracic echocardiography (TTE) is used as a clinical decision-making tool to assess systolic function, but there is limited data regarding the validity of this tool to predict obstructive coronary artery disease (CAD). This study evaluates the utility of RWMA on TTE for detecting obstructive CAD in patients with no prior CAD history.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed charts of adults who underwent resting TTE and coronary angiography within 30 days, analyzing RWMA in relation to angiographic luminal stenosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 754 patients (mean age 62, 60% male), TTE sensitivity varied with timing relative to angiography: 68.7% after angiography versus 49.5% before. In ST-elevation myocardial infarction (STEMI) patients (<i>n</i> = 126 after vs. <i>n</i> = 4 before), sensitivity was 89.8%. RWMA correlated with CAD severity, particularly in STEMI cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TTE specificity remains high, but sensitivity varies significantly by timing, with the highest sensitivity in STEMI patients. These findings could refine decision-making in uncertain STEMI cases, supporting TTE as a valuable adjunctive diagnostic tool.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631958","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}
Sarah Hugelshofer, Bianca Giacomuzzi-Moore, Denise Auberson, Georgios Tzimas, Christel H. Kamani, Ambra Masi, Pierre Monney, Dimitri Arangalage, Nana K. Poku
Thanks to impressive advances in the field of oncology over the last 30 years, there has been a significant rise in cancer survivors. Nowadays, cardiovascular disease is one of the leading causes of death in this patient population. Coronary artery disease (CAD) is a major problem due to shared risk factors, an aging population and in many cases induced and/or accelerated atherosclerosis by antitumoral treatment during and even decades after the end of cancer therapy. Furthermore, the presence of CAD or valvular heart disease (VHD) at the time point of cancer diagnosis largely increases the risk of any cancer therapy-related cardiovascular toxicity (CTR-CVT). It is therefore of utmost importance to detect CAD and VHD before, during, and after certain types of chemotherapy, target therapies, and radiotherapy. Multimodality cardiovascular imaging plays a central role in this vulnerable population where individual risk stratification and multidisciplinary decision-making are critical.
{"title":"Multi-Modality Imaging to Detect Ischemic and Valvular Heart Disease in Adult Cancer Patients","authors":"Sarah Hugelshofer, Bianca Giacomuzzi-Moore, Denise Auberson, Georgios Tzimas, Christel H. Kamani, Ambra Masi, Pierre Monney, Dimitri Arangalage, Nana K. Poku","doi":"10.1111/echo.70030","DOIUrl":"10.1111/echo.70030","url":null,"abstract":"<p>Thanks to impressive advances in the field of oncology over the last 30 years, there has been a significant rise in cancer survivors. Nowadays, cardiovascular disease is one of the leading causes of death in this patient population. Coronary artery disease (CAD) is a major problem due to shared risk factors, an aging population and in many cases induced and/or accelerated atherosclerosis by antitumoral treatment during and even decades after the end of cancer therapy. Furthermore, the presence of CAD or valvular heart disease (VHD) at the time point of cancer diagnosis largely increases the risk of any cancer therapy-related cardiovascular toxicity (CTR-CVT). It is therefore of utmost importance to detect CAD and VHD before, during, and after certain types of chemotherapy, target therapies, and radiotherapy. Multimodality cardiovascular imaging plays a central role in this vulnerable population where individual risk stratification and multidisciplinary decision-making are critical.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631963","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}
{"title":"Cutting-Edge Echocardiographic Tools for Enhanced Understanding and Management of Atrial Functional Mitral Regurgitation","authors":"Julien Dreyfus, David Messika-Zeitoun","doi":"10.1111/echo.70038","DOIUrl":"10.1111/echo.70038","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631956","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}
Aortic stenosis (AS) is a common cardiovascular condition where early detection of left ventricular (LV) dysfunction is essential for timely intervention and optimal management. Current echocardiographic measurements, such as ejection fraction (EF), are insensitive to minor changes in LV function, and strain imaging is typically limited to the global longitudinal strain (GLS) parameter due to robustness issues. This study introduces a novel, fully automatic algorithm to enhance the detection of LV dysfunction in AS patients using multiple strain imaging parameters.
Methods
We applied supervised machine-learning techniques to classify data from 82 severe AS patients, 96 chest pain subjects, and 319 healthy volunteers.
Results
Our model significantly outperformed EF and GLS in distinguishing AS patients from healthy volunteers (area under the curve [AUC] = 0.97 vs. 0.88 and 0.82, respectively). It also surpassed EF and GLS in differentiating AS patients from chest pain subjects (AUC = 0.95 vs. 0.90 and 0.55, respectively).
Conclusion
This novel, clinically interpretable model leverages the potential of strain imaging to enhance diagnostic accuracy and guide clinical decision-making in LV dysfunction, thereby improving clinical practice.
目的：主动脉瓣狭窄（AS）是一种常见的心血管疾病，早期发现左心室（LV）功能障碍对于及时干预和优化治疗至关重要。目前的超声心动图测量，如射血分数（EF），对左心室功能的微小变化不敏感，而应变成像由于鲁棒性问题通常仅限于全局纵向应变（GLS）参数。本研究介绍了一种新颖的全自动算法，利用多种应变成像参数提高对强直性脊柱炎患者左心室功能障碍的检测能力：我们应用机器学习监督技术对来自 82 名严重 AS 患者、96 名胸痛受试者和 319 名健康志愿者的数据进行分类：结果：在区分 AS 患者和健康志愿者方面，我们的模型明显优于 EF 和 GLS（曲线下面积 [AUC] = 0.97 vs. 0.88 和 0.82）。在区分强直性脊柱炎患者和胸痛受试者方面，它也超过了 EF 和 GLS（AUC = 0.95 vs. 0.90 和 0.55）：结论：这一可在临床上解释的新型模型充分利用了应变成像的潜力，可提高诊断准确性并指导左心室功能障碍的临床决策，从而改善临床实践。
{"title":"Early Detection of Left Ventricular Dysfunction With Machine Learning-Based Strain Imaging in Aortic Stenosis Patients","authors":"Amir Yahav, Dan Adam","doi":"10.1111/echo.70007","DOIUrl":"10.1111/echo.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Aortic stenosis (AS) is a common cardiovascular condition where early detection of left ventricular (LV) dysfunction is essential for timely intervention and optimal management. Current echocardiographic measurements, such as ejection fraction (EF), are insensitive to minor changes in LV function, and strain imaging is typically limited to the global longitudinal strain (GLS) parameter due to robustness issues. This study introduces a novel, fully automatic algorithm to enhance the detection of LV dysfunction in AS patients using multiple strain imaging parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We applied supervised machine-learning techniques to classify data from 82 severe AS patients, 96 chest pain subjects, and 319 healthy volunteers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our model significantly outperformed EF and GLS in distinguishing AS patients from healthy volunteers (area under the curve [AUC] = 0.97 vs. 0.88 and 0.82, respectively). It also surpassed EF and GLS in differentiating AS patients from chest pain subjects (AUC = 0.95 vs. 0.90 and 0.55, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This novel, clinically interpretable model leverages the potential of strain imaging to enhance diagnostic accuracy and guide clinical decision-making in LV dysfunction, thereby improving clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631959","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}
<div> <section> <h3> Background</h3> <p>The transesophageal echocardiogram (TEE) is the standard imaging modality for confirming the presence or absence of patent foramen ovale. PFO is a flap valve depending on the pressure change between the left and right atrium, which can help determine whether to open. 3D-TEE was shown to optimize the visualization of PFO. There is a causal association between PFO and unexplained stroke. It seems that 3D-TEE can present a high-risk PFO morphological feature, which seems to show more than just being easier to open.</p> </section> <section> <h3> Methods</h3> <p>In total, 134 consecutive patients with cryptogenic stroke or migraine who had suspected PFO and underwent c-TCD, TTE, and c-TEE were included in this study. TEE confirmed the PFO. The right-to-left shunt (RLS) grade of PFO at rest and abdominal compression Valsalva maneuver was detected by c-TEE.</p> </section> <section> <h3> Results</h3> <p>The long diameter of FO (1.74 ± 0.3 vs. 1.60 ± 0.4, <i>p</i> = 0.039), the short diameter of FO (1.12 ± 0.3 vs. 1.00 ± 0.3, <i>p</i> = 0.036), perimeter of FO (4.62 ± 0.7 vs. 4.22 ± 1.0, <i>p</i> = 0.026), and area (1.80 ± 0.8 vs. 1.35 ± 0.8, <i>p</i> = 0.05) of the FO were significantly larger in the larger RLS group. In group of CS, a larger proportion of Eustachian valve or a Chiari's network (14.3% vs. 3.5%, <i>p</i> = 0.036), a larger proportion of in the left funnelform (55.1% vs. 16.3%, <i>p</i> < 0.001), a longer length of the PFO tunnel (13.4 ± 4.4 vs. 7.8 ± 2.5, <i>p</i> < 0.001), a lower IVC-PFO angle (16.4 ± 3.4 vs. 20.3 ± 7.7, <i>p</i> = 0.001), a higher proportion of LA multiple exits of the tunnel (46.9% vs. 14.3%, <i>p</i> < 0.001). Multivariate regression analysis showed that male gender (HR: 4.026, 95% CI: 0.883–18.361, <i>p</i> = 0.072), age (HR: 1.076, 95% CI: 1.002–1.155, <i>p</i> = 0.045), the left funnelform (HR: 7.299, 95% CI: 1.585–33.618, <i>p</i> = 0.011), a longer length of the PFO tunnel (HR: 1.843, 95% CI: 1.404–2.418, <i>p</i> < 0.001) and multiple exits of the tunnel of LA (HR: 8.544, 95% CI: 1.595–45.754, <i>p</i> = 0.012) increased the risk of cerebral infarction. The cut-off value calculated by ROC for the diagnosis of high-risk PFO was that the length of the PFO tunnel was 12 mm and the left funnelform combined with multiple exits of the left atrial (sensitivity was 92%, specificity was 90%). The area under the curve of the combined index versus PoPE score (0.932 vs. 0.736) relative to the RoPE score was statistically significant.</p> </section> <section> <h3> Conclusions</h3>
{"title":"Anatomical Significance of the Patent Foramen Ovale by Real-Time 3D TEE in Cryptogenic Stroke and Migraine","authors":"Li Wang, Haibo Sun, Han Shen","doi":"10.1111/echo.70018","DOIUrl":"10.1111/echo.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The transesophageal echocardiogram (TEE) is the standard imaging modality for confirming the presence or absence of patent foramen ovale. PFO is a flap valve depending on the pressure change between the left and right atrium, which can help determine whether to open. 3D-TEE was shown to optimize the visualization of PFO. There is a causal association between PFO and unexplained stroke. It seems that 3D-TEE can present a high-risk PFO morphological feature, which seems to show more than just being easier to open.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 134 consecutive patients with cryptogenic stroke or migraine who had suspected PFO and underwent c-TCD, TTE, and c-TEE were included in this study. TEE confirmed the PFO. The right-to-left shunt (RLS) grade of PFO at rest and abdominal compression Valsalva maneuver was detected by c-TEE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The long diameter of FO (1.74 ± 0.3 vs. 1.60 ± 0.4, <i>p</i> = 0.039), the short diameter of FO (1.12 ± 0.3 vs. 1.00 ± 0.3, <i>p</i> = 0.036), perimeter of FO (4.62 ± 0.7 vs. 4.22 ± 1.0, <i>p</i> = 0.026), and area (1.80 ± 0.8 vs. 1.35 ± 0.8, <i>p</i> = 0.05) of the FO were significantly larger in the larger RLS group. In group of CS, a larger proportion of Eustachian valve or a Chiari's network (14.3% vs. 3.5%, <i>p</i> = 0.036), a larger proportion of in the left funnelform (55.1% vs. 16.3%, <i>p</i> < 0.001), a longer length of the PFO tunnel (13.4 ± 4.4 vs. 7.8 ± 2.5, <i>p</i> < 0.001), a lower IVC-PFO angle (16.4 ± 3.4 vs. 20.3 ± 7.7, <i>p</i> = 0.001), a higher proportion of LA multiple exits of the tunnel (46.9% vs. 14.3%, <i>p</i> < 0.001). Multivariate regression analysis showed that male gender (HR: 4.026, 95% CI: 0.883–18.361, <i>p</i> = 0.072), age (HR: 1.076, 95% CI: 1.002–1.155, <i>p</i> = 0.045), the left funnelform (HR: 7.299, 95% CI: 1.585–33.618, <i>p</i> = 0.011), a longer length of the PFO tunnel (HR: 1.843, 95% CI: 1.404–2.418, <i>p</i> < 0.001) and multiple exits of the tunnel of LA (HR: 8.544, 95% CI: 1.595–45.754, <i>p</i> = 0.012) increased the risk of cerebral infarction. The cut-off value calculated by ROC for the diagnosis of high-risk PFO was that the length of the PFO tunnel was 12 mm and the left funnelform combined with multiple exits of the left atrial (sensitivity was 92%, specificity was 90%). The area under the curve of the combined index versus PoPE score (0.932 vs. 0.736) relative to the RoPE score was statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 ","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631954","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}
Atrial fibrillation (AF) is among the most prevalent forms of clinically significant arrhythmia, and stroke incidence is among the most serious AF-related complications, causing high rates of morbidity and mortality among affected patients. The European Society of Cardiology guidelines recommend a thromboembolic event risk assessment based on the CHA2DS2-VASC score. However, stroke also occurs in some patients with a low CHA2DS2-VASC score. Therefore, it is necessary to improve thromboembolic risk stratification in AF patients. The left atrial appendage (LAA) is considered to be the most frequent site of thrombus formation. Approximately 47% of thrombi in valvular AF and 91% of thrombi in nonvalvular AF are localized in the LAA. Therefore, identification or exclusion of LAA thrombi is critical in many clinical situations. It is essential to assess LAA morphology and function using imaging modalities (particularly echocardiography) before, during, and after interventional procedures such as AF ablation and LAA occlusion. This review article describes the anatomical, physiological, and LAA assessment in daily practice.
{"title":"Morphology and Function Assessment of Left Atrial Appendage in Patients With Atrial Fibrillation","authors":"Ruizhong Liu, Ying Li","doi":"10.1111/echo.70013","DOIUrl":"10.1111/echo.70013","url":null,"abstract":"<div>\u0000 \u0000 <p>Atrial fibrillation (AF) is among the most prevalent forms of clinically significant arrhythmia, and stroke incidence is among the most serious AF-related complications, causing high rates of morbidity and mortality among affected patients. The European Society of Cardiology guidelines recommend a thromboembolic event risk assessment based on the CHA<sub>2</sub>DS<sub>2</sub>-VAS<sub>C</sub> score. However, stroke also occurs in some patients with a low CHA<sub>2</sub>DS<sub>2</sub>-VAS<sub>C</sub> score. Therefore, it is necessary to improve thromboembolic risk stratification in AF patients. The left atrial appendage (LAA) is considered to be the most frequent site of thrombus formation. Approximately 47% of thrombi in valvular AF and 91% of thrombi in nonvalvular AF are localized in the LAA. Therefore, identification or exclusion of LAA thrombi is critical in many clinical situations. It is essential to assess LAA morphology and function using imaging modalities (particularly echocardiography) before, during, and after interventional procedures such as AF ablation and LAA occlusion. This review article describes the anatomical, physiological, and LAA assessment in daily practice.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631961","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}
Sadaf Agahi, Mehdi Yaseri, Mohammad Reza Eftekhari, Babak Geraiely, Akram Sardari, Roya Sattarzadeh Badkoubeh, Farnoosh Larti
Purpose
Defining normative aortic echocardiographic values in each geographical district is crucial as aortic valve area (AVA) may vary across races, genders, and ages. Notably, variations in normal values can have implications for clinical decision-making, and available data on the Middle East population is also scarce. We sought to establish normal ranges for aortic valve echocardiographic parameters in the Iranian population and assess the effect of age, gender, weight, height, BMI, BSA, and blood pressure on them.
Methods
Our data were provided from the web-based echocardiographic data registry of Imam Khomeini Hospital Complex (IKHC). A total of 3251 healthy subjects older than 18 years old without any valvular stenosis were included in our study.
Results
AVA's normal range was estimated at 1.92–4.52 and 1.67–3.80 cm2 in men and women, respectively. The annulus, AVA, AV VTI, and LVOT VTI were significantly larger in males, and this association remained significant after indexing AVA for weight, height, BMI, and BSA. Also, smaller AVA was associated with lower height, weight, BMI, and BSA in both men and women. Obese and hypertensive subjects had significantly larger AVA and annulus diameters.
Conclusion
Our study provided region-specific normal reference values for AV echocardiographic parameters and compared them across genders, ages, BMI, and blood pressure groups in the Iranian population.
目的：确定每个地区的主动脉超声心动图正常值至关重要，因为主动脉瓣面积（AVA）会因种族、性别和年龄而异。值得注意的是，正常值的变化会对临床决策产生影响，而且中东地区人口的可用数据也很少。我们试图确定伊朗人群主动脉瓣超声心动图参数的正常范围，并评估年龄、性别、体重、身高、体重指数、BSA 和血压对这些参数的影响：我们的数据来自伊玛目霍梅尼综合医院（IKHC）的网络超声心动图数据登记。我们的研究共纳入了 3251 名 18 岁以上、无任何瓣膜狭窄的健康受试者：男性和女性的 AVA 正常范围分别为 1.92-4.52 和 1.67-3.80 平方厘米。男性的瓣环、AVA、AV VTI 和 LVOT VTI 明显更大，在将 AVA 与体重、身高、体重指数和 BSA 进行指数化后，这种关联仍然显著。此外，在男性和女性中，较小的 AVA 与较低的身高、体重、BMI 和 BSA 相关。肥胖和高血压受试者的 AVA 和瓣环直径明显更大：我们的研究为伊朗人口提供了特定地区的房室超声心动图参数正常参考值，并对不同性别、年龄、体重指数和血压组进行了比较。
{"title":"Revisiting the Normal Ranges of Aortic Valve Area in 2D Echocardiography and Its Association With Age, Sex, and Anthropometric Characteristics","authors":"Sadaf Agahi, Mehdi Yaseri, Mohammad Reza Eftekhari, Babak Geraiely, Akram Sardari, Roya Sattarzadeh Badkoubeh, Farnoosh Larti","doi":"10.1111/echo.70029","DOIUrl":"10.1111/echo.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Defining normative aortic echocardiographic values in each geographical district is crucial as aortic valve area (AVA) may vary across races, genders, and ages. Notably, variations in normal values can have implications for clinical decision-making, and available data on the Middle East population is also scarce. We sought to establish normal ranges for aortic valve echocardiographic parameters in the Iranian population and assess the effect of age, gender, weight, height, BMI, BSA, and blood pressure on them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our data were provided from the web-based echocardiographic data registry of Imam Khomeini Hospital Complex (IKHC). A total of 3251 healthy subjects older than 18 years old without any valvular stenosis were included in our study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AVA's normal range was estimated at 1.92–4.52 and 1.67–3.80 cm<sup>2</sup> in men and women, respectively. The annulus, AVA, AV VTI, and LVOT VTI were significantly larger in males, and this association remained significant after indexing AVA for weight, height, BMI, and BSA. Also, smaller AVA was associated with lower height, weight, BMI, and BSA in both men and women. Obese and hypertensive subjects had significantly larger AVA and annulus diameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study provided region-specific normal reference values for AV echocardiographic parameters and compared them across genders, ages, BMI, and blood pressure groups in the Iranian population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607451","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}
Sara Fässler, Mariana B. L. Falcão, Stefano F. de Marchi, Christopher W. Roy, Tobias Rutz
Aim
Two-dimensional phase-contrast magnetic resonance imaging (2D flow MRI) and its multidimensional alternatives, 4D and 5D flow MRI, measure blood flow in the heart and great vessels. While 2D flow MRI is the standard technique, it has limitations regarding need for precise image plane prescribing and long scan time. In contrast, 4D and 5D flow MRI acquire 3D volumes, enabling retrospective assessment of all vessels. This review evaluates these three techniques for quantification of blood flow of the aortic and pulmonary valves in congenital heart disease.
Methods
A systematic literature search was conducted in August 2024 using the PUBMED database, including articles comparing 2D, 4D, and 5D flow MRI.
Results
Fifteen articles comparing 2D and 4D, one comparing 2D and 5D and three articles comparing 4D and 5D flow MRI were included. No study compared all three techniques. 2D, 4D and 5D flow MRI demonstrated a good agreement for flow quantification. 4D flow MRI, however, tends to present a better accuracy and internal consistency than 2D flow MRI for determination of peak velocities and flow in stenotic lesions, particularly when comparing velocities to echocardiography. 4D and 5D flow MRI are associated with shorter scan times than 2D flow MRI.
Conclusions
4D and 5D flow MRI appear to offer promising alternatives to 2D flow MRI with the advantage of reduced scan times. Larger and prospective studies including echocardiography are needed to evaluate the potential of 4D and 5D to replace 2D flow MRI for flow quantification and peak velocity determination.
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As right heart catheterization (RHC) is invasive and not always accessible, this study developed a noninvasive model (P-echo) to predict shunt closure feasibility in adult congenital heart disease (ACHD) patients with post-tricuspid valve shunt defects (PTD), specifically isolated ventricular septal defects (VSD) and patent ductus arteriosus (PDA).
Methods
A retrospective analysis of 1474 VSD or PDA patients from 2012 to 2022 was conducted. Echocardiographic parameters were assessed, and key variables identified via LASSO regression. The P-echo model incorporated left to right velocity (LRv), right to left velocity (RLv), tricuspid regurgitation (TR), pulmonary artery diameter (PA), and RV/LV ratio. Its predictive performance was evaluated using ROC curve analysis.
Results
The P-echo model demonstrated excellent predictive performance with AUC values of 0.975 (95% CI: 0.965–0.984) in the derivation set, 0.963 (95% CI: 0.937–0.989) in the validation set, and high accuracy in both PDA (AUC 0.975, 95% CI: 0.965–0.984) and VSD (AUC 0.958, 95% CI: 0.936–0.980) subsets. In the derivation set, the model categorized patients into low (9.1% closure rate), medium (70.9% closure rate), and high-risk groups (99.7% closure rate) for shunt closure feasibility. Calibration plots confirmed the model's accuracy. Decision curve analysis showed a higher net benefit across a range of threshold probabilities, indicating the clinical usefulness of the model.
Conclusions
The P-echo model is a robust and reliable tool for predicting the feasibility of shunt closure in patients with PTD, offering a noninvasive alternative to RHC. This model can guide clinical decision-making and support individualized treatment strategies in ACHD management.
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