Cardiovascular Ultrasound最新文献

Purpose: Left atrial (LA) volume and strain parameters have been associated with cardiovascular outcomes in several cardiac pathologies, yet their role in predicting major adverse cardiovascular events (MACE) in kidney transplant (KT) recipients has not been explored.

Methods: We retrospectively reviewed the records of adult KT recipients from our institution (2015-2024). We utilized baseline echocardiograms routinely acquired during KT workup to measure LA volumetrics and strain. MACE was the study's primary endpoint, defined as cardiovascular death, nonfatal myocardial infarction, stroke, major arrhythmias or heart failure hospitalization. Logistic regression, Kaplan-Meier and Cox proportional hazards regression were performed to evaluate the association between LA parameters and MACE.

Results: Of 518 patients who underwent kidney transplant, 377 were in sinus rhythm with an acceptable quality echocardiogram (male, 56.7%; mean age 53.7 ± 13.1 years). Over a median follow up duration of 5.3 ± 2.3 years from KT, 82 patients reached the study endpoint. Kaplan-Meier analysis showed significantly lower MACE-free survival in patients with abnormal LA strain. After adjusting for confounding variables in the Cox Proportional Hazards model, of all LA parameters, lower LAScd (HR 0.94, 95% CI 0.89-0.98, p = 0.003), and LASr (HR 0.97, 95% CI 0.94-0.995, p = 0.02) were independently associated with MACE.

Conclusion: In this retrospective single center study, LA strain parameters particularly LASr and LAScd were independently associated with MACE after KT. LA strain might have a role in risk stratification in this population.

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.