Cardiovascular Ultrasound最新文献

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.

Background: Early identification of subclinical left ventricular (LV) systolic dysfunction (LVSD) in patients with isolated left bundle branch block (LBBB) and preserved LV ejection fraction (LVEF), termed LBBB_pEF, is clinically important. Electrocardiography (ECG) has been proposed as a potential screening tool for detecting subclinical LVSD in LBBB_pEF patients, but its effectiveness has not been fully validated. This study investigated the relationships between specific ECG characteristics and subclinical LVSD in LBBB_pEF patients.

Methods: The study included 111 patients with LBBB_pEF. Two-dimensional speckle-tracking echocardiography was used to derive the LV global longitudinal strain (LV GLS), with LV GLS>-20% indicating subclinical LVSD. The recorded ECG characteristics included heart rate, QRS duration, P-R duration, QRS morphology, T-wave morphology, the presence of QS patterns, and discordant LBBB, among others. The presence of QS patterns was defined as the absence of R-waves in lead V1 (or R-waves < 1 mm with a scale of 10 mm/mV). Discordant LBBB was defined as an inconsistency between the T wave and QRS complex in leads I, V5, and V6.

Results: Among the patients, 52 exhibited subclinical LVSD. Compared with those with normal LV systolic function, patients with subclinical LVSD had longer QRS durations, a higher frequency of QS patterns, and more instances of discordant LBBB. A QRS duration of 153 ms was identified as the optimal cut-off for detecting subclinical LVSD, with a sensitivity of 75.00% and specificity of 72.88%. The combination of QRS duration, the presence of QS patterns, and discordant LBBB produced the highest area under the curve of 0.82. Incorporating the presence of QS patterns and discordant LBBB into the QRS duration model increased the integrated discriminant index from 0.07 to 0.15.

Conclusions: QRS duration, the presence of QS patterns, and discordant LBBB are independent predictors of subclinical LVSD in patients with LBBB_pEF. An integrated ECG assessment may offer a straightforward screening method for identifying subclinical LVSD in this population.

Objectives: To evaluate the efficacy of prenatal ultrasound in diagnosing pulmonary atresia with intact ventricular septum (PA/IVS).

Methods: This retrospective study analyzed 48 cases of PA/IVS at the Fujian Maternity and Child Health Hospital between January 2013 and December 2023. Prenatal ultrasound was used to characterize and classify the features of PA/IVS. Pregnancy outcomes were followed up, and the results were compared with post-termination pathological anatomical findings or postnatal imaging. This study aims to enhance the understanding of PA/IVS and improve the accuracy of its prenatal diagnosis.

Results: Among the 48 PA/IVS cases, four were diagnosed during early pregnancy and 44 during mid-to-late pregnancy. In the mid-to-late pregnancy group, there were 29 cases of type I (TV-Z scores ranging from - 1.77 to 5.22), 10 cases of type II (TV-Z scores ranging from - 3.50 to -2.06), and five cases of type III (TV-Z scores ranging from - 4.29 to -7.41). The cohort included 41 singleton pregnancies and seven twin pregnancies. Ventriculo-coronary artery communication (VCAC) was observed in 19 cases. Additional abnormalities included Ebstein's anomaly (EA) in three cases, restricted opening of the foramen ovale in one case, increased inner diameter of the foramen ovale in one case, reversal or deepening of the a-wave of the ductus venosus in six cases, and umbilical vein pulsation in one case. Genetic testing (amniocentesis, NIPT, or SNP-array) was performed in 19 cases, with one case revealing a genomic copy number deletion in the q22.3 region of chromosome 21. Pregnancy outcomes included 41 terminations (five with pathologic dissection or vascular casting), five live births, one selective reduction, and one intrauterine death.

Conclusion: Fetal echocardiography is an effective tool for diagnosing PA/IVS. While PA/IVS can be diagnosed in early gestation, it remains diagnostical challenging. Given the progressive nature of PA/IVS in utero, sequential ultrasound examinations during the second and third trimesters are essential for monitoring disease progression and hemodynamic changes. Additionally, a comprehensive evaluation for associated intracardiac and extracardiac anomalies should be systematically conducted throughout the pregnancy.

Background: The assessment of left ventricular (LV) diastolic function based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines requires measurement of several echocardiographic indices. However, these assessments often yield inconclusive results owing to the absence of measurable parameters. Multiple B-lines on lung ultrasound have been proposed as a method for evaluating pulmonary congestion. We aimed to evaluate the association between B-lines and LV diastolic function and to examine whether B-lines show potential as an alternative to conventional indices for assessing LV diastolic function.

Methods: This prospective study included 172 patients with pre-heart failure (HF) or HF. We investigated (i) the relationship between B-lines and LV diastolic function using echocardiography, (ii) the diagnostic accuracy of B-lines compared to echocardiography indices for estimating LV filling pressures and (iii) the relationship between B-lines and risk of hospitalisation for HF.

Results: Among patients for whom the ASE/EACVI guideline algorithm for LV diastolic dysfunction was available (n = 89), the number of B-lines typically increased with the severity of diastolic dysfunction grade. In patients who underwent left heart catheterisation (n = 20), the LV filling pressure was significantly correlated with B-lines (r = 0.690, P < 0.001). The diagnostic accuracy of B-lines for detecting high LV filling pressure was comparable to that of tricuspid regurgitation peak gradient (TRPG). When TRPG was replaced with B-lines to diagnose grade II or III diastolic dysfunction using the ASE/ESCVI algorithm, sensitivity remained comparable (0.80); however, specificity improved (0.80 vs. 0.50). In patients who underwent lung ultrasound while they were hemodynamically stable and were followed up for prognosis (median, 730 days; n = 75), 14 hospitalisations for HF were observed. Kaplan-Meier analysis revealed that the high B-line group had a significantly higher incidence of hospitalisation events for HF (P = 0.036, log-rank test).

Conclusion: B-lines have shown potential as an alternative to conventional indices for assessing LV diastolic dysfunction.

Objective: To analyze the echocardiography characteristics of pulmonary artery sling (PAS) and explore the diagnostic value of the distance between the bifurcation of the left and right pulmonary arteries and the pulmonary artery valve annulus (DBP) in diagnosing PAS in children.

Methods: This retrospective study analyzed echocardiographic data from 27 children diagnosed with PAS at our hospital from March 2014 to December 2022. The data were compared with those from 77 normal children. The study examined statistical differences between the two groups in the diameters of the left and right pulmonary arteries, the main pulmonary artery valve annulus diameter, and the DBP, both uncorrected and corrected for body surface area (BSA). The diagnostic utility of these measurements for distinguishing children with PAS from those without was assessed using receiver operating characteristic (ROC) curves.

Results: The DBP and the corrected DBP values were significantly higher in the PAS group than in the normal group, with areas under the ROC curve of 0.909 for DBP and 0.951 for DBP/BSA (P < 0.05). A DBP of 1.87 cm as the diagnostic threshold yielded a sensitivity of 98.9% and specificity of 84.4%. A DBP/BSA of 7.68 cm/m² had a sensitivity of 98.3% and specificity of 92.2%. The diagnostic odds ratios (OR) were 76.38% and 79.99%, respectively.

Conclusion: The pivotal element in echocardiography diagnosis of PAS is the identification of the spatial relationship between the left pulmonary artery (LPA) and the trachea. The use of quantitative indices such as DBP and DBP/BSA for adjunctive diagnosis can positively impact the early detection of PAS.

Background: Several predictors of atrial fibrillation (AF) onset in patients with hypertrophic cardiomyopathy (HCM) have been proposed, however, all of them showed limited accuracy. This study aims to assess the role of new echographic parameters in predicting AF onset and major adverse cardiovascular outcomes (cardiovascular death or heart transplantation).

Methods: Clinical and imaging data from 141 patients with HCM and without a history of AF were retrospectively analyzed over a 5-year period. Patients who developed AF during the study were compared to those who did not. The analysis focused on key atrial parameters, including the Left Atrial Contraction Index (LACI) and Left Atrial Ejection Fraction (LAEF). LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Echocardiographic measurements were standardized using cardiac magnetic resonance (CMR) as the reference. Regarding statistical analysis, each significant continuous variable was categorized by identifying a cut-off value using the Youden index. Independent associations with outcomes and cumulative survival were assessed using Cox regression analysis.

Results: Thirty-five patients developed AF, at a mean time of 4 years. The HCM-AF group had significantly higher values of LACI, left atrial diameter (LAD), and left atrial minimum volume (LAVmin). A LACI > 43% on echocardiography and LACI > 44% on CMR showed the best performance in identifying patients at risk for AF. In multivariate analysis, an echocardiographic LAEF < 43% was independently associated with the occurrence of AF (HR 2.9, 95% CI: 1.2-6.9). Additionally, a LAD > 40.5 mm was independently associated with AF onset, with a hazard ratio of 2.5 (95% CI 1.1-5.5). Eleven patients experienced the composite outcome of cardiovascular death or heart transplant, and a LACI > 60% was associated with this outcome.

Conclusion: In patients with HCM, both LACI and LAEF were significantly associated with the occurrence of AF over a 4-year period, demonstrating higher sensitivity and specificity compared to other parameters. A LACI > 60% was also found to be associated with cardiovascular death or heart transplant in this population.