European heart journal. Imaging methods and practice最新文献

The congenital heart disease (CHD) population has seen substantial growth due to advancements in paediatric cardiac care, cardiothoracic surgery, anaesthesia, and intensive care. Although improved surgical interventions have enhanced survival rates for even the most severe defects, such as hypoplastic left heart syndrome, most CHD patients remain palliated rather than cured, requiring lifelong expert care. With increasing survival, new challenges emerge in managing the ageing CHD population, particularly regarding changing medical, psychosocial needs, and the evolving epidemiology of CHD. Imaging plays a pivotal role in CHD care, offering precise anatomical and physiological insights necessary for effective management and risk stratification. The European Association of Cardiovascular Imaging (EACVI) established a shared interest group (SIG) to improve imaging standardization, promote education, and foster research for CHD patients. Multimodality imaging, including echocardiography, cardiovascular magnetic resonance (CMR), and computed tomography (CT), is critical in guiding interventions and improving outcomes. The SIG also addresses gaps in education, research, and global healthcare disparities, ensuring a collaborative and systematic approach to CHD care. Advances in imaging technology, genetic research, and tissue engineering hold promise for further improving the longevity and quality of life for CHD patients in the future.

Aims: Peak oxygen uptake (VO₂peak) is closely related to total heart volume (THV) in healthy individuals. This study aimed to investigate (i) the association between VO₂peak and THV in subjects with sub-clinical diastolic dysfunction, athletes, healthy controls, and patients with established heart failure with and without preserved ejection fraction (HFpEF and HFrEF), and (ii) whether VO₂peak/THV-index can distinguish between subjects with sub-clinical diastolic dysfunction, HFpEF, HFrEF, and healthy controls.

Methods and results: Seventy participants were included: 15 with sub-clinical diastolic dysfunction (defined as showing only 1-2 echocardiographic signs of diastolic dysfunction, not meeting clinical diagnostic criteria), 10 athletes, 15 healthy controls, and 30 heart failure patients (15 HFpEF and 15 HFrEF). VO₂peak was assessed by cardiopulmonary exercise testing and THV by cardiovascular magnetic resonance imaging. In sub-clinical diastolic dysfunction, THV was a weak determinant of VO₂peak (R ² = 0.41, P = 0.01), and even weaker in heart failure (R ² = 0.16, P = 0.03). However, THV strongly predicted VO₂peak in athletes and controls combined (R ² = 0.87, P < 0.0001). VO₂peak/THV did not distinguish healthy controls from sub-clinical diastolic dysfunction but could reliably discriminate between healthy controls and patients with heart failure.

Conclusion: Subjects with sub-clinical diastolic dysfunction may have an altered relationship between VO₂peak and THV, approaching that of patients with established heart failure. Thus, this proof-of-concept study indicates that sub-clinical diastolic dysfunction constitutes a group of patients that may be of interest to follow over time to prevent continued deterioration of cardiac function. Furthermore, the VO₂peak/THV ratio can be used to distinguish between healthy controls and overt heart failure.

Aims: Left ventricular (LV) global longitudinal strain (GLS) is a sensitive marker for detection of subclinical LV systolic dysfunction, but variability in acquisition and analysis may limit its clinical utility. We studied the accuracy, variability, and correlation of LV GLS across different 2D and 3D echocardiographic acquisition methods and post-processing platforms.

Methods and results: In this prospective study, we analyzed 254 consecutive patients (mean age 55 ± 16 years, 60% female) undergoing clinically indicated echo. GLS was measured using multiple 2D acquisition methods (three beats and single beat) and 3D. Analyses were performed using both vendor-specific (EchoPac) and vendor-neutral (TomTec-Arena) software. Correlations and agreement between methods were assessed using Pearson correlation, intraclass correlation coefficients (ICCs), and Bland-Altman analyses.GLS values were highly consistent across the acquisition methods and between software platforms. Mean GLS values were -19.4 ± 3.3 (2D-A), -19.2 ± 3.3 (2D-B), -19.1 ± 3.5 (3P), and -14.8 ± 4.1 (3D). Intra- and interobserver variability for 2D GLS was low (ICC >0.9), indicating excellent reproducibility. However, 3D GLS values were significantly lower than 2D (mean difference -4.3%), with only moderate correlation (r = 0.66), suggesting that 2D and 3D GLS values are not interchangeable.

Conclusion: The LV GLS is a reliable method for assessment of LV function with strong reproducibility across differing acquisition and analysis methods. However, 3D GLS is consistently lower and should not be used interchangeably with 2D measurements. These findings underscore the need for ongoing standardization and caution in comparing GLS values across 2D and 3D methods.

Aims: Transoesophageal echocardiography (TEE) is widely used for cardiac assessment and requires moderate sedation due to its semi-invasive nature, carrying potential risks. Music is a non-pharmacological strategy shown to reduce anxiety in various clinical settings. We prospectively investigated whether music could reduce anxiety and/or sedation dosage in patients undergoing TEE.

Methods and results: Sixty-three patients (>18 years) referred for TEE were randomized into a music group (n = 31) or control group (n = 32). All completed an anxiety questionnaire and had haemodynamic parameters (blood pressure, heart rate, oxygen saturation) assessed prior to transthoracic echocardiography (TTE). Music was played before TTE and continued throughout TEE in the intervention group. Anxiety and haemodynamic measurements were repeated after TTE, before sedation. Groups were compared for baseline characteristics, anxiety levels, haemodynamic changes, and midazolam dosage. There was no difference between the groups regarding age or sex; control group had more comorbidities. Anxiety levels did not differ between groups at baseline or pre-sedation (P > 0.05). A significant reduction over time was observed only in the music group (P = 0.032 vs. P = 0.069), but group-by-time interaction was not significant (P = 0.347). Regarding anxiety level, it decreased in both groups, more markedly in the music group (P < 0.008 vs. P = 0.04). Diastolic blood pressure also decreased after music exposure (P = 0.024). Midazolam dosage did not differ between groups but was inversely correlated with age.

Conclusion: Although music did not reduce sedation requirements, it significantly decreased anxiety levels and blood pressure; music may be a valuable adjunct to sedation in patients undergoing TEE.

Aims: The Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women (PRESAP) is a registry designed for the echocardiographic screening of structural heart disease (SHD). It offers a unique opportunity to compare the effectiveness of point-of-care ultrasound (POCUS) vs. routine transthoracic echocardiography (TTE) in this population. This sub-study of the PRESAP registry aimed to compare the detection of SHD in asymptomatic pregnant women using POCUS vs. routine TTE.

Methods and results: Between February 2023 and March 2024, pregnant women without known heart disease were enrolled in the PRESAP registry. Participants underwent a limited echocardiogram, using either POCUS or TTE. The primary outcome was the detection of abnormal findings, including left ventricular systolic dysfunction (LVSD), valvular heart disease (VHD), and congenital heart disease (CHD). Matching cohorts were created using propensity score matching, based on demographic factors, comorbid conditions, and gestational history. Among 18 401 patients, 9681 (52.6%) underwent POCUS. The 1:1 propensity-matched cohort included 4177 patients in each arm. Abnormal echocardiographic findings were detected in 4.4% (185) of the TTE group and 3% (124) of the POCUS group (P < 0.001). VHD (1.3% vs. 1.1%; P = 0.416) and CHD (0.4% vs. 0.6%; P = 0.093) were detected at similar rates by both methods, while LVSD was more frequently identified by TTE compared with POCUS (2.8% vs. 1.5%; P < 0.001).

Conclusion: POCUS may be considered as an alternative to TTE for screening for SHD in asymptomatic pregnant women, particularly in resource-limited settings. TTE was superior for LVSD, and POCUS was equally effective in identifying valvular and congenital heart disease.

The 2019 ESC guidelines redefined stable coronary artery disease as chronic coronary syndrome (CCS), highlighting the dynamic nature of this disease. This condition is characterized by the gradual accumulation of atherosclerotic plaques in the epicardial coronary arteries. CCS can result in myocardial ischaemia due to supply-demand mismatch, often triggered by physical or emotional stress. The clinical course may be abruptly interrupted by plaque rupture or erosion, leading to acute coronary syndromes. Revolutionary advances in non-invasive imaging have transformed the chronic coronary syndrome diagnosis algorithm and management. Coronary computed tomography angiography provides detailed anatomical insights, identifying high-risk plaques with features like low attenuation and positive remodelling, as evidenced by SCOT-HEART, which reported reduced coronary events (HR: 0.59, P = 0.004). Stress echocardiography may detect ischaemia-induced wall motion abnormalities (sensitivity, 85-95%), while cardiovascular magnetic resonance is paramount in functional assessment, offering 81-86% sensitivity/specificity and detecting microvascular dysfunction via perfusion and late gadolinium enhancement. Nuclear imaging (SPECT/PET) enhances ischaemia detection, with PET's myocardial flow reserve improving prognostic accuracy (sensitivity 90%, specificity 88%). AI-driven innovations, such as CT-derived fractional flow reserve, automate plaque quantification and may reduce in the future unnecessary invasive angiographies by 19-25% (P = 0.01), while dynamic CT myocardial perfusion integrates anatomical and hemodynamic data, boosting diagnostic accuracy (87%). These advancements enable precise risk stratification and a personalized multimodal imaging approach, based on pre-test likelihood. It also increases the risk of unsustainable costs for society, repeated radiation exposure throughout a patient's life, and raises the question of actual limited benefits from revascularization in low-risk patients.

Aims: We assessed the readability level of online patient education materials (PEMs) for cardiac MRI (CMRI) to determine whether they meet the standard health literacy needs as determined by the US National Institutes of Health and the American Medical Association guidelines.

Methods and results: We evaluated the readability of CMRI PEMs from 5 websites using the Flesch-Kincaid Reading Ease (FKRE), Flesch-Kincaid grade level (FKGL), Gunning-Fog Index (GFI), Simple Measure of Gobbledygook index (SMOGI), Coleman-Liau Index (CLI), and Automated Readability Index (ARI). PEMs on the British Heart Foundation (BHF) website yielded the highest mean FKRE score, while the RadiologyInfo.org (RadInfo) website yielded the highest mean score on the CLI compared to all the other websites. Statistical analysis of individual predictors revealed that average words per sentence (P < 0.001) and average syllables per word (P < 0.001) were strong determinants of FKRE for the RadInfo PEMs. In contrast, sentences (P = 0.044), words (P = 0.046), average words per sentence (P = <0.001), and average syllables per word (P = <0.001) were significant predictors of FKRE for the InsideRadiology (InsRad) PEMs. The sensitivity analysis consistently confirmed the robustness and primary influence of average words per sentence and average syllables per word.

Conclusion: The BHF and American Heart Association emphasize accessible CMRI communication, whereas RadInfo, InsRad, and the European Society of Cardiology PEMs may be less suitable for low-health-literacy audiences. Strategies aimed at enhancing the comprehensibility of patient education materials should primarily focus on reducing the average complexity of words and shortening average sentence lengths.