Cardiovascular Ultrasound最新文献

Background: Coronary microvascular disease (CMVD) is a major cause of hospitalization for a considerable number of patients with ischemia with non-obstructive coronary arteries (INOCA), with coronary flow reserve (CFR) reduction being the main feature of CMVD. However, imaging methods for CMVD evaluation are still lacking. This study aimed to investigate associations among epicardial fat thickness (EFT), endothelial function assessed by flow-mediated dilation (FMD), and CFR in patients with CMVD, and to evaluate their predictive value for CMVD diagnosis.

Methods: CFR was measured by regadenoson stress echocardiography, while EFT and FMD were measured by transthoracic echocardiography and brachial artery vascular ultrasound in 66 subjects with INOCA. Multivariable logistic regression and receiver operating characteristic analysis were performed.

Results: Twenty-nine patients were categorized into the CFR decreased group (CFR < 2.0), and thirty-seven patients were separated into the CFR normal group (CFR ≥ 2.0). EFT was significantly higher in the CFR decreased group (6.063 ± 1.732 mm vs. 5.95 ± 1.718 mm, P = 0.003), while FMD was significantly lower in the CFR decreased group [4.05 (3.10, 5.40) vs. 5.30 (4.85, 7.30), P = 0.011]. EFT was an independent predictor for CMVD [odds ratio: 5.084, 95% confidence interval: 1.498-17.251, P = 0.009]. A cut-off value of EFT > 5.51 mm predicted CMVD with 90% sensitivity and 71% specificity. FMD was not an independent predictor for CMVD, but when FMD < 4.65%, it predicted CMVD with 60% sensitivity and 83% specificity.

Conclusions: EFT and FMD may serve as potential evaluation methods for CMVD in patients with INOCA. EFT was independently associated with the presence of CMVD in this cohort, offering significant clinical diagnostic insights. EFT is a novel independent predictor of CMVD in this specific population, while FMD provides complementary diagnostic value for risk stratification. These non-invasive markers may help to improve risk stratification in patients with microvascular dysfunction.

Background: Right ventricular (RV) dysfunction is a critical predictor of adverse outcomes in cardiac surgery patients. The assessment of right ventricular global longitudinal strain (GLS) echo has emerged as a promising tool for detecting early RV dysfunction. This meta-analysis evaluates the predictive value of RV GLS in these patients.

Methods: A comprehensive literature search was conducted. The primary outcomes included pooled diagnostic performance measures, including sensitivity, specificity, and the diagnostic odds ratio (DOR). A multiple-cutoff model was employed to determine the optimal RV-GLS threshold.

Results: Ten observational studies involving 583 patients were included. RV-GLS demonstrated strong diagnostic accuracy, with a pooled area under the summary receiver operating characteristic curve (AUC) of 0.90 (95% CI: 0.82-1.00). The pooled DOR was 6.34 (95% CI: 3.20-12.57) with no heterogeneity (I² = 0%). Sensitivity was 0.79 (95% CI: 0.69-0.86; I² = 57.2%) and specificity was 0.78 (95% CI: 0.71-0.84; I² = 20.8%). The risk of publication bias was low (LFK index = 0.6). A multiple-threshold model identified - 15.25% as the optimal RV-GLS cutoff, achieving balanced sensitivity and specificity of 0.7423.

Conclusions: RV-GLS demonstrates excellent predictive value for RV dysfunction in cardiac surgery patients.

Background: The prevalence and prognostic implications of low-flow (LF) aetiologies in aortic stenosis (AS) are unknown. This study aimed to characterize the specific causes of LF, their prevalence, and prognostic significance.

Methods: In 408 patients with severe LFAS included, the aetiology of LF was identified. The primary endpoint was the composite of all-cause death and hospitalizations for heart failure (HF) up to 36 months. Secondary endpoints included individual components of the primary endpoint and cardiovascular mortality.

Results: The most common LF cause was reduced LVEF (n = 228, 55.9%), while preserved LVEF included five aetiologies: (1)mixed aetiologies (n = 65, 36.1%), (2)small LV cavity (n = 58, 32.2%), (3)significant isolated mitral regurgitation (n = 39, 21.7%), (4)significant isolated tricuspid regurgitation (n = 13, 7.2%), (5)significant isolated mitral stenosis (n = 5, 2.8%). Over a median follow-up of 15 (IQR 6 - 36) months obtained in 302 patients, 159 (52.6%) reached the primary composite endpoint, 108 (35.8%) died and 91 (30.8%) were hospitalized due to HF. LF aetiology was not associated with outcomes. Independent predictors of the primary endpoint were severe MR (adj.HR 1.71, p = 0.04) and TR (adj.HR 1.47, p = 0.04). Aortic valve replacement (adj.HR 0.76, p < 0.001) and mean transvalvular gradient ≥ 40 mmHg (adj.HR 0.39, p < 0.001) were protective.

Conclusions: The main cause of LFAS is reduced LVEF, while in preserved LVEF mixed causes and small LV volume prevailed, without association with the outcome. Severe mitral and tricuspid regurgitation were strongly associated with worse outcomes, while valve replacement and mean transvalvular gradient ≥ 40 mmHg emerged as protective factors.

Background: Determining the severity of aortic stenosis (AS) with low-flow (LF) status remains challenging because conventional echocardiographic indicators often yield discordant results. The velocity ratio (VR), in addition to the aortic valve calcium (AVC) score, has been proposed as a supplemental parameter that is less influenced by flow status. This study evaluates the relationship between the VR and the AVC burden, and determines whether the VR serves as a better predictor of the AVC burden than conventional echocardiographic parameters, particularly in patients with LF.

Methods: We retrospectively analyzed the data of 405 patients with at least mild AS who underwent multidetector computed tomography and Doppler echocardiography. Patients were categorized into four groups: LF, normal flow (NF)-low, NF-high and high flow (HF) status. We investigated the relationship between AVC and three echocardiographic indicators (VR, transvalvular mean pressure gradient [MPG], and aortic valve area indexed to body surface area [AVAi]) within each group. Multiple regression models were constructed to predict AVC, incorporating all possible combinations of echocardiographic indicators and relevant covariates. Model performance was assessed by comparing the ranking of the models that included a given echocardiographic indicator with those that excluded it.

Results: The study included 59 patients with LF, 161 with NF-low, 136 with NF-high, and 49 with HF. In all groups, VR, MPG, and AVAi were significantly associated with AVC in the simple linear regression analysis. Notably, in the LF group, the VR was included in all three of the top-ranking multiple regression models for AVC, and models containing the VR ranked significantly higher than those without it. By contrast, the inclusion of the MPG or AVAi did not significantly affect the model ranking in the LF group. No significant differences in model ranking were noted with versus without the VR in the HF group.

Conclusions: In patients with LF AS, the VR was a reliable marker for assessing the AVC burden, underscoring its value for clinical decision making in severe AS. Its superior predictive performance compared to conventional echocardiographic parameters highlights its potential to refine diagnostic accuracy in this population.

Objective: Exercise-induced premature ventricular complexes (EI-PVCs) are key indicators of subclinical cardiac dysfunction and elevated cardiovascular risk. However, their clinical significance and prognostic value remain unclear, particularly in asymptomatic individuals without structural heart disease. This study uses advanced echocardiographic techniques to investigate the relationship between EI-PVCs and subclinical myocardial dysfunction.

Methods: An observational case-control study was conducted with 141 participants (82 controls and 59 cases). Two-dimensional speckle tracking echocardiography (2D-STE) was utilized to assess myocardial function, including global longitudinal strain (GLS).

Results: Participants with exerciseinduced PVCs exhibited significantly greater left ventricular mass index (80.1 ± 15.7 vs. 74.3 ± 12.7 g/m²; p = 0.035), markedly reduced global longitudinal strain (-19.6 ± 2.0% vs. - 22.2 ± 1.4%; p < 0.001), and elevated myocardial performance index (0.42 ± 0.07 vs. 0.38 ± 0.06; p = 0.002) compared to controls, despite similar conventional systolic parameters.

Conclusion: This study highlights EI-PVCs as early markers of subclinical myocardial dysfunction, warranting detailed echocardiographic evaluation in affected individuals. The findings. underscore the need for further research into the burden, morphology, and patterns of EI-PVCs to refine cardiovascular risk stratification and management strategies.

Background: The prognostic value of functional echocardiographic parameters for risk stratification in chronic coronary syndrome (CCS) remains incompletely understood. This study aimed to integrate resting and stress echocardiographic parameters to identify sensitive non-invasive predictors of major adverse cardiovascular events (MACEs).

Methods: A total of 754 CCS patients with a resting left ventricular ejection fraction (LVEF) ≥ 50% undergoing adenosine stress echocardiography were prospectively enrolled. Parameters including myocardial perfusion, coronary flow velocity reserve (CFVR), and myocardial work were assessed. Resting and stress values were compared within groups, while dynamic changes were analyzed between CFVR-normal and impaired subgroups. Cox regression was used to identify independent predictors.

Results: The incidence of MACEs was significantly higher in patients with impaired CFVR compared to those with normal CFVR (71.4% vs. 6.2%, P < 0.0001). After stress, the impaired CFVR group exhibited myocardial perfusion defects, mechanical dyssynchrony, and reduced myocardial work efficiency, in contrast to the normal CFVR group. Patients with impaired CFVR combined with regional wall motion and perfusion abnormalities had the worst prognosis. Multivariate Cox model integrating CFVR and stress-derived dynamic parameters demonstrated superior predictive performance for MACEs, significantly exceeding that of the stress-substitution and base models (C-index: 0.867 vs. 0.841 vs. 0.709).

Conclusion: In CCS patients with preserved LVEF, reduced CFVR indicates early myocardial dysfunction and predicts the worst prognosis when combined with wall motion and perfusion abnormalities. An integrated functional model combining CFVR and dynamic stress parameters enhances risk stratification for MACEs and supports individualized therapy.

Background: Infective endocarditis is a common medical complication in patients with intravenous drug use (IVDU). staphylococcal infection is the predominant pathogen in left-sided endocarditis. Cardiac abscesses are more common in prosthetic valves. Should they rupture, they often create fistulous tracts in addition to prosthetic valve dehiscence, conduction abnormalities, and acute coronary syndrome.

Case presentation: A 51-year-old man with history of IV drug use, methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis, and bovine aortic valve replacement was treated for MSSA bacteremia and was discharged on dalbavancin. The transesophageal echocardiogram (TEE) was negative for abscess or vegetation. Three days later, he presented with fever, worsening mental status, and neurologic deficits with infarcts in the brain, lungs, spleen on imaging. TEE was negative for vegetation or abscess. After transfer to a quaternary care center four days later, TEE showed a large aortic root abscess that eroded the membranous ventricular septum resulting in a Gerbode defect. Then, he sustained a non-shockable rhythm cardiac arrest. The patient was transferred to the cardiac ICU where emergent TEE showed complete dehiscence of the septum and a loosely attached prosthetic aortic valve. After a second cardiac arrest and resuscitative efforts, the patient expired.

Conclusion: This case highlights that inadequately treated infective endocarditis can rapidly progress and cause serious complications. If patients with prosthetic valves develop bacteremia and have negative TEEs, retrospectively-gated CTs should be obtained to evaluate for perivalvular extensions. Currently, there have been no published studies demonstrating patients with infective endocarditis who were treated with Dalbavancin that progressed to fistulous tracts. Further research is required to investigate the effectiveness of long-acting lipoglycopeptides, such as Dalbavancin, in treating infective endocarditis. This case demonstrates a rare, but a serious medical emergency that can arise in patients with prosthetic heart valves and positive blood cultures when not detected early and treated promptly.