Cardiovascular Ultrasound最新文献

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.

Vulnerable plaques are significant risk factors for acute ischemic events, and intraplaque neovascularization (IPN) is an important indicator for evaluating plaque vulnerability. This review summarizes the importance of IPN in the assessment of carotid plaque vulnerability, the current status of ultrasound examination of IPN, and the technical advancements in ultrasound imaging of IPN, These techniques include: Superb micro-vascular imaging; Contrast-enhanced ultrasound; Plane wave ultra-sensitive blood flow imaging; Ultrasound-targeted microbubble destruction; Ultrasound Super-Resolution Imaging. Aiming to provide a reference for the prevention and treatment of ischemic cardiovascular and cerebrovascular events.

A 35-year-old male, without significant cardiovascular history, presented with recurrent palpitations. Initial echocardiographic evaluation demonstrated eccentric left ventricular hypertrophy, mild systolic dysfunction, suspicion of a ventricular septal defect, bicuspid aortic valve, and right ventricular dilation. Transesophageal echocardiography revealed an aneurysmal dilation of the right coronary sinus with an aorto-atrial/ventricular fistula, further confirmed by contrast-enhanced computed tomography angiography. Coronary angiography identified a single anomalous coronary artery with left dominance and absence of the right coronary artery. Surgical repair successfully closed the fistula, with mild post-operative aortic regurgitation. Follow-up at one year indicated normalization of cardiac dimensions and function, with stable moderate aortic valve regurgitation. Genetic sequencing found no identifiable mutations. Regular monitoring was recommended due to the potential risk of complications related to the bicuspid aortic valve and coronary anomaly.

With the growing complexity of structural heart disease procedures, the need for advanced intraprocedural imaging has become increasingly critical. Transesophageal echocardiography remains the gold standard for procedural guidance but is associated with risks such as upper gastrointestinal tract injury and the need for general anesthesia for patient comfort and safety. Miniaturized three-dimensional transesophageal echocardiography (miniTEE) probes offer a promising solution by providing high-resolution imaging which could be performed under conscious sedation. Studies evaluating the miniTEE probe for safety, image quality, and ability to guide specific structural and non-structural heart disease procedures will be reviewed. The limitations and future developments will be discussed.

Background: Although the left atrium (LA) plays a key role in diastolic function, LA dysfunction in patients with repaired tetralogy of Fallot (rTOF) remains unclear. Recently, LA strains assessed using a speckle tracking system have been used as novel sensitive indicators of LA function. Therefore, we aimed to evaluate LA function and investigate changes with age in patients with rTOF using speckle-tracking echocardiography.

Methods: We analyzed three age-based subgroups of patients with rTOF (T1, T2, T3) and their corresponding healthy control groups (C1, C2, C3) to assess phasic left atrial function: T1 and C1 (3-9 years [children]), T2 and C2 (10-19 years [adolescents and young adults]), and T3 and C3 (20-44 years [adults]). LA strain was assessed by two-dimensional speckle-tracking echocardiography and defined according to its three distinct phases, with the LA serving as a reservoir during systole, a conduit during early diastole, and a booster pump at the end of diastole. Furthermore, we examined the correlations between LA strains and left ventricular longitudinal strain (LVLS) as well as conventional echocardiographic parameters.

Results: LA reservoir and pump strains were lower in the T3 group than in the C3 group (35.5 (30.1/41.3) vs. 42.9 (41.1/48.1), P = 0.010; 8.3 (7.4/10.6) vs. 11.4 (10.7/13.5), P = 0.025, respectively). In the T1 and T2 groups, no significant differences in LA strains were reported. LA functions based on LA volume did not show any difference between rTOF and controls among all age groups. All LA strains only moderately or weakly correlated with LVLS and mitral E/A, but not with left ventricular (LV) lateral e' nor E/e'. Reservoir strain-LVLS (ρ = 0.476, P < 0.001), conduit strain-LVLS (r = 0.382, P < 0.001), pump strain-LVLS (ρ = 0.337, P < 0.001), reservoir strain-E/A (ρ = 0.200, P = 0.026), conduit strain-E/A (ρ = 0.282, P = 0.002), and pump strain-E/A (ρ = -0.209, P = 0.02).

Conclusions: LA phasic function decreases in adult patients with rTOF. LA reservoir and pump strains may serve as sensitive indicators of diastolic dysfunction in these patients.

Background: The reliability of the recommended echocardiographic methods for assessing RV diastolic function has been questioned. We aimed to validate noninvasive indices of RV diastolic function, derived from tricuspid Doppler and myocardial deformation metrics, against intrinsic diastolic chamber properties and filling pressures.

Methods: We obtained simultaneous high-fidelity pressure-volume loops and echocardiographic data in separate animal and clinical settings: (1) a porcine model of acute hemodynamic interventions (n = 13), and (2) patients with Fallot tetralogy and pulmonary hypertension (n = 9). These designs allow for within- and between-subject validation. From the PV loops data, we obtained the reference values of RV stiffness (S₊), elastic recoil (S_-) and relaxation (τ) constants, as well as the contribution of passive properties to instantaneous diastolic pressures.

Results: In the animal setting, only the tricuspid E/A ratio and e' velocity weakly correlated with S₊ (R_rm:0.36 and 0.28 respectively, p < 0.01 for both). In the clinical group, no correlation was found between the echocardiographic indices and the intrinsic diastolic properties. Isovolumic relaxation time and early diastolic global strain-rate (GSR) correlated with mean right atrial pressure (RAP) (Spearman r: -0.73 and 0.85, respectively, p < 0.05 for both). E/e' and E/GSR ratio were not associated with RAP. Tricuspid e' and GSR negatively correlated with passive pressure component (only due to) at valve opening (R_rm -0.27 and - 0.33, respectively, p < 0.01 for both).

Conclusions: Recommended echocardiographic indices of RV diastolic function do not reflect intrinsic RV diastolic properties. Therefore, the application of these indices for inferring RV diastolic function and filling pressures is limited.

Background: The evaluation of left ventricular (LV) flow dynamics is a novel approach to assessing LV function that goes beyond traditional metrics. This approach has been applied to patients with heart failure (HF), providing valuable insights that are discussed in this review, with the aim of enhancing our understanding of LV function in the context of the HF syndrome.

Methods: The analysis of LV flow dynamics is typically conducted using ultrasound and magnetic resonance imaging (MRI) techniques, primarily including particle image velocimetry echocardiography, Vector Flow Imaging, HyperDoppler, and four-dimensional flow MRI. A variety of parameters can be obtained that describe the geometry of the LV vortex, vorticity, kinetic energy, energy dispersion, as well as the amplitude and direction of the hemodynamic forces within the LV cavity.

Results: In normal subjects, vortex formation plays a crucial role in optimizing LV filling, diastolic-systolic coupling, and energy transfer during systolic ejection. In patients with HF, alterations in vortex structure and dynamics have been associated with both systolic and diastolic LV dysfunction, demonstrating the potential to diagnose early LV dysfunction. Furthermore, these alterations have been linked to LV remodeling and thrombus formation. Several studies have also explored intracardiac flow metrics as biomarkers for guiding HF treatments, including pharmacological interventions, cardiac resynchronization therapy, and LV assist devices.

Conclusions: Currently available data suggest that the evaluation of LV flow dynamics can have diagnostic and prognostic utility in HF. However, large-scale, multicenter, and prospective studies are needed, particularly to validate therapeutic implications.

Conduction system pacing (CSP), encompassing His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), revolutionizes cardiac pacing, allowing a more physiological left ventricular activation than conventional right ventricular (RV) pacing through electrode placed in RV apex, interventricular septum or right ventricular outflow tract. Echocardiography plays a pivotal role in patient assessment, primarily by measuring left ventricular ejection fraction (LVEF) to determine the pacing strategy in alignment with current guidelines. Clinical data, simulations and ongoing trials on CSP explore CSP viability across various LVEF conditions. CSP is supposed to defer pacing-induced cardiomyopathy (PiCM) associated with conventional right ventricular pacing (RVP). This paper aims to review the current literature regarding the use of echocardiography in CSP. Images from our experience in the echocardiographic lab were used throughout this document to show our proposals of imaging in CSP. Echocardiography may help to determine lead localization within the interventricular septum (IVS), customizing pacing to individual anatomy and electromechanical indices (like atro-ventricular delay) and evaluates often-overlooked valvular function, a potential PiCM contributor. Three-dimensional (3-D) echocardiography widens the knowledge of lead localization and valvular dysfunction, as well as dyssynchrony assessment. Dyssynchrony, crucial both to resynchronization per se and physiological stimulation is quantified via echocardiography, especially using speckle-tracking imaging. Baseline LVEF and follow-up observation of CSP effects: early in Global Longitudinal Strain (GLS), afterwards in LV volumes and LVEF may improve the future proper qualification of patients. Limited left atrial (LA) and right atrial (RA) strain assessments hold potential in the CSP qualification and response assessment context. Echocardiography complements other imaging modalities for comprehensive patient evaluation. Echocardiography is integral in the CSP clinical use, from patient selection (by showing subtle changes in myocardial function) to post-procedure follow-up (tricuspid regurgitation, LV and RV function, leads and synchrony assessment). GLS, assessed by speckle tracking imaging and profound 2D and 3D (lead placement, septum morphology and global heart function under CSP) analyses show promise in CSP outcome assessment, though standardization is needed.