Cardiovascular Ultrasound最新文献

Background: The echocardiography is the first-line imaging modality in detecting the cardiac lipoma. Contrast-enhanced echocardiography improves its structural definition and characteristics of blood supply to exclude thrombus and malignant tumors.

Case presentation: We introduced a case that large cardiac mass involving nearly the whole left ventricular cavity and papillary muscles without any complications. Multimodal imaging has confirmed lipoma before surgery. However, rather than recommending conservative treatment in accordance with guidelines, surgical intervention was performed to prevent future hemodynamic abnormalities.

Conclusion: Combined with multimodal imaging, we showed a rare case on comprehensive evaluation of left ventricular silent lipoma and provided new clues for surgical strategy, which were different from guideline recommendations.

Background: Left ventricular (LV) long-axis shortening at the cardiac base is a determinant of left atrial (LA) reservoir function. Cardiac amyloidosis (CA) is characteristic of amyloid deposition predominantly in the LV basal wall. We investigated the relationship between LV basal strain and LA reservoir strain among patients with pathological LV hypertrophy and subsequently evaluated the diagnostic ability of LA reservoir strain to identify CA etiology and its predictive value for heart failure hospitalization.

Methods: We retrospectively analyzed 341 patients with LV hypertrophy. Cardiac etiologies were diagnosed by tissue biopsy, cardiac magnetic resonance imaging or ^99mTc-PYP scintigraphy. LV basal strain and LA reservoir strain were analyzed.

Results: Patients were diagnosed with CA (n = 75) and other etiologies (n = 266). LV basal strain was correlated with LA reservoir strain in the CA group (r = 0.58, p < 0.01) and the non-CA group (r = 0.44, p < 0.01). A binary logistic regression analysis showed that relative apical sparing of longitudinal strain, septal E/e' and LA reservoir strain had the ability to discriminate between the CA and non-CA groups (p < 0.01 for all). The area under the curve for relative apical sparing of longitudinal strain had a stronger ability than LA reservoir strain to discriminate CA from non-CA etiologies (0.90 versus 0.81, respectively; p < 0.01). During the follow-up period (median 2.7 years), the incidence of heart failure hospitalization was higher in the CA group than the non-CA group (35% versus 14%, respectively; p < 0.01). According to univariate Cox regression analysis, three LA factors (LA reservoir strain, E/e' and LA volume index) were associated with heart failure hospitalization in the non-CA group (p < 0.05 for all).

Conclusions: LA reservoir strain was associated with LV basal strain among patients with pathological LV hypertrophy. Echocardiographic assessment of LA reservoir strain might add diagnostic value to identify CA etiology in these patients.

Background: Functional single ventricle represents a complex congenital cardiac malformation where ventricular function directly impacts patients' quality of life and prognosis. Accurate assessment of ventricular function in FSV patients is crucial for treatment planning, surgical intervention, and monitoring therapeutic efficacy.

Main text: Echocardiography, as a non-invasive, readily available, and real-time cardiac imaging modality, has emerged as the preferred method for evaluating functional single ventricle ventricular function. With continuous advancement and innovation in echocardiographic technology, methods for evaluating functional single ventricle ventricular function have become increasingly diverse and refined. This review synthesizes recent research developments in echocardiographic assessment of functional single ventricle ventricular function and analyzes the advantages, limitations, and future applications of various techniques.

Conclusion: Strain and strain rate derived from two-dimensional speckle tracking imaging have progressively entered clinical application, demonstrating substantial potential as crucial parameters for evaluating single ventricular function. Emerging technologies, including three-dimensional speckle tracking imaging and non-invasive pressure-strain loops, show promise for contributing to multi-dimensional, integrated assessment as research continues to advance.

Background and aim: Pulmonary thromboembolism (PTE) is a common cause of cardiovascular death worldwide. Due to its nonspecific clinical symptoms, PTE is easy to be missed or misdiagnosed. Pulmonary transit time (PTT) is a noninvasive cardiopulmonary hemodynamic index, which is the time required for a blood sample to pass through pulmonary circulation. This study is aim to establish a rabbit PTE model using auto-thrombus, evaluating the dynamic changes in a rabbit's heart structure and function at multiple time points before and after modeling by echocardiography and exploring the application value of PTT obtained by contrast enhanced ultrasound (CEUS) in evaluating a PTE model.

Methods: Twenty-four healthy rabbits were intubated by femoral vein puncture to establish the PTE model. Echocardiography was performed before embolization, 2 h, 24 h, 3 days, 5 days, and 7 days after embolization to obtain conventional ultrasonic parameters. Then, CEUS was performed to obtain the PTT.

Results: Seventh day after modeling, nineteen rabbits were alive. Compared with pre-modeling, right heart parameters and heart rate in echocardiography were significantly impaired in the acute phase (2 and 24 h after modeling) and gradually returned to normal in the compensatory phase (3, 5, and 7 days after modeling). In contrast with conventional ultrasound parameters, PTT and nPTT revealed a gradually increasing trend at each time point. Receiver operating characteristic (ROC) curve analysis revealed with an extension of molding time, the area under the curve (AUC) of (n)PTT is larger and larger.

Conclusions: Right heart parameters obtained using conventional echocardiography can accurately indicate changes in the structure and function of the right heart during the acute phase of PTE, while (n)PTT measured by CEUS continues to extend during the acute and compensatory phases of PTE. Therefore, PTT (nPTT) obtained by CEUS is a useful clinical indicator for the diagnosis of PTE and can be utilized as a supplement to conventional echocardiography parameters.

Background: The incorporation of artificial intelligence (AI) into point-of-care ultrasound (POCUS) platforms has rapidly increased. The number of B-lines present on lung ultrasound (LUS) serve as a useful tool for the assessment of pulmonary congestion. Interpretation, however, requires experience and therefore AI automation has been pursued. This study aimed to test the agreement between the AI software embedded in a major vendor POCUS system and visual expert assessment.

Methods: This single-center prospective study included 55 patients hospitalized for various respiratory symptoms, predominantly acutely decompensated heart failure. A 12-zone protocol was used. Two experts in LUS independently categorized B-lines into 0, 1-2, 3-4, and ≥ 5. The intraclass correlation coefficient (ICC) was used to determine agreement.

Results: A total of 672 LUS zones were obtained, with 584 (87%) eligible for analysis. Compared with expert reviewers, the AI significantly overcounted number of B-lines per patient (23.5 vs. 2.8, p < 0.001). A greater proportion of zones with > 5 B-lines was found by the AI than by the reviewers (38% vs. 4%, p < 0.001). The ICC between the AI and reviewers was 0.28 for the total sum of B-lines and 0.37 for the zone-by-zone method. The interreviewer agreement was excellent, with ICCs of 0.92 and 0.91, respectively.

Conclusion: This study demonstrated excellent interrater reliability of B-line counts from experts but poor agreement with the AI software embedded in a major vendor system, primarily due to overcounting. Our findings indicate that further development is needed to increase the accuracy of AI tools in LUS.

Mitral valve prolapse (MVP) is a common condition affecting approximately 3% of the population, typically with a benign clinical course. However, a small subset of patients (5-10%) may develop severe mitral regurgitation or arrhythmias, which can lead to sudden cardiac death (SCD). Among the morphological features of MVP, mitral annular disjunction (MAD) has emerged as a potential marker of malignant MVP, with some studies suggesting an association with ventricular arrhythmias and SCD. MAD refers to a structural abnormality where there is a separation between the posterior mitral annulus and the ventricular myocardium, particularly during systole. Initially described in the 1980s, MAD has been primarily studied through echocardiography, although its dynamic nature during the cardiac cycle has complicated its diagnosis. The clinical significance of MAD has been debated, as its presence is not exclusive to pathological MVP, being observed in structurally normal mitral valves as well. Recent research, using advanced imaging techniques such as three-dimensional echocardiography, cardiac magnetic resonance and computed tomography, has provided a more refined understanding of MAD. These studies suggest that MAD can be found in normal hearts, particularly in the posterior mitral annulus, and is often considered a benign anatomical variant. However, the occurrence of MAD in patients with MVP, especially those with leaflet redundancy, has been linked to an increased risk of arrhythmias and SCD. The exact role of MAD in arrhythmogenesis remains unclear, but it is hypothesized that MAD may contribute to electrical instability by altering the mechanical properties of the mitral valve, potentially promoting fibrosis in the surrounding myocardium. Despite these associations, the direct causal role of MAD in SCD requires further investigation, and it may ultimately prove to be an innocent bystander rather than the primary cause of fatal arrhythmias.

Background: Left atrial (LA) and ventricular (LV) functional impairment often co-exist in patients with heart failure (HF). However, some patients with HF have a disproportionate LA or LV dysfunction. We aimed to characterize patients with predominant LA and LV myopathy in a cohort of patients with chronic HF across the spectrum of LV ejection fraction (LVEF).

Methods: From a nationwide, prospective, multi-center, observational HF cohort, transthoracic echocardiographic examination was performed on each patient. LA reservoir strain and LV global longitudinal strain (LVGLS) were measured using dedicated software of the two-dimensional speckle tracking analysis to evaluate LA and LV function and to define the myopathy.

Results: A total of 374 patients with chronic HF (mean age 58.9±11.5 years, 20% female, mean LVEF 39±17%) were included. By calculating the residuals from the linear regression between LA reservoir and LVGLS, we identified 47 patients with predominant LA myopathy, 271 patients with balanced LA/LV and 56 patients with predominant LV myopathy. Patients with predominant LA myopathy were older, had a higher prevalence of atrial fibrillation (AF), diabetes, higher plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), Growth differential factor 15(GDF15), high sensitivity Troponin T (hs-TNT) as well as more dilated left and right atria, and worse right atrial function compared to other groups (all p-values < 0.05). Using multivariable logistic regression adjusted for LVEF and LA size, independent predictors of predominant LA myopathy were the presence of AF, diabetes, and higher GDF15, whereas absence of diabetes independently predicted predominant LV myopathy. Patients with predominant LA myopathy group had a lower probability of survival than the other groups (Log rank p-value = 0.01).

Conclusion: While most patients with HF have balanced LA/LV myopathy, those with predominant LA myopathy are characterized by older age, more AF, more diabetes, higher circulating biomarkers of cardiac stress and injury, and worse outcomes.

Background: Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study the right ventricular (RV) function using RV pressure-strain loops. The assessment of these novel indexes of RVMW has not yet been exten sively studied, namely in pre-capillary pulmonary hypertension (PH) population.

Objectives: to evaluate the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with group I and group IV PH and to compare with a control group without PH.

Methods: A prospective registry of pre-capillary PH patients was used and compared with a control group without PH. In both groups, patients underwent same day RHC and echocardiographic assessment. Dedicated software for left ventricle myocardial work was used for the RV. RV global work index (RVGWI) was calculated as the area of the RV pressure-strain loops. From RVGWI, RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were estimated.

Results: 25 pts were included: 17 pts with PH were compared with 8 pts without PH. RVGWI, RVGCW and RVGWW were significantly higher in PH patients than in controls (p < 0,05), while RVGWE was significantly lower (p < 0,05). Significant correlations were found between mean pulmonary artery pressure, cardiac index, venous oxygen saturation, NT-proBNP and RVGCW, RVGWW and RVGWE; between pulmonary vascular resistance, cardiac output, right ventricular stroke work and RVGWI, RVGCW, RVGWW and RVGWE; between stroke volume and RVGWW and RVGWE; between pulmonary artery pulsatility index and RVGWI, RVGCW and RVGWW; between RA pressure and RVGWE.

Conclusions: Patients with pre-capillary PH present significantly higher RVGWI, RVGCW and RVGWW and lower RVGWE than patients without PH. Echocardiographic RVMW-derived indexes show significant correlation with invasive measurements and NT-proBNP. Larger studies are needed to assess the prognostic value of these novel indexes.

Background: Left atrium (LA) is far from simply being a passive connection chamber between left ventricle and the pulmonary circulation. In patients affected by mitral regurgitation (MR) an impairment in LA compliance and reservoir function, which can be evaluated using Speckle Tracking echocardiography, lead to elevated atrial pressure, resulting in increased pulmonary capillary pressures and the onset of dyspnea. Our study aims to evaluate the correlation between left atrial dysfunction and symptoms onset in patients with severe degenerative MR. Identifying left atrial dysfunction as a predictor of symptoms could be helpful to guide management strategy of asymptomatic patients with severe degenerative MR.

Methods: In a retrospective analysis, we examined all patients diagnosed with severe degenerative MR who underwent evaluation for potential cardiac surgery using transthoracic and transesophageal echocardiogram between May 2019 and July 2022 at IRCCS San Raffaele Hospital. The cohort was stratified into two groups: symptomatic patients (NYHA > I) and asymptomatic (NYHA = I) patients. A comprehensive assessment of LA function and compliance was performed including: LA fractional atrial change, LA reservoir strain (LASr), LASr/E/e', and LA reservoir work.

Results: The final study cohort comprised 401 patients. There were no significant differences observed in terms of left ventricle size, function, and mitral regurgitation volume between the two groups. Atrial dysfunction and dilatation were significantly associated with symptoms. Among the atrial functional indexes LASr, a marker of LA compliance, showed the strongest association with symptoms (AUC: 0.85, OR: 7.45, p < 0.001). A LASr value below 22% emerged as an effective threshold, identifying symptomatic patients with 86% specificity and 68% sensitivity.

Conclusions: The onset of symptoms in severe degenerative mitral regurgitation (MR) is closely associated with left atrial dysfunction. LASr < 22% identified symptomatic patients with 86% specificity and 68% sensitivity.

Background: Despite its proven prognostic value in different contexts, the precise implications of left atrial strain (LAS) assessment throughout different phases of the atrial cycle remain uncertain. A direct correlation between left atrial reservoir strain (LARS) and left ventricular global longitudinal strain (GLS) has been consistently demonstrated in several studies involving patients with various heart diseases. The objective of our study is to identify factors directly associated with LARS, left atrial conduction strain (LACS) and left atrial booster strain (LABS) in patients without cardiovascular (CV) disease.

Methods: Transthoracic echocardiographic examinations in patients without CV disease were prospectively selected in two tertiary hospitals echocardiography labs for clinical purposes. LAS, maximal and minimal left atrial (LA) volumes and left atrial ejection fraction (LAEF) were measured using the two-dimensional strain analysis package provided by the EchoPAC Plugging workstation (AFI LA).

Results: A total of 196 cases were included, median age of 54 (45-62) with 85 (43%) being men. The mean left ventricular ejection fraction (LVEF) was 61% ± 5, and the median GLS was - 18% (-17 to -20). Median indexed maximum volume of left atrium (LAVI) was 27 ml/m² (22-31), and LAEF was 64% (58-70). The mean LARS biplane was 35,1% ± 8. Notably, LARS was greater in the 2-chamber view (36,1% ± 10) compared to the 4-chamber view (34,1% ± 8 p < 0,05). The multivariate analysis of LARS revealed that sex, GLS, LAEF and e'_mean are independently correlated with LARS. Multivariate analysis of LACS showed independent correlations between LACS and age, GLS, LAEF, E/A ratio and e'_mean. Conversely, the multivariate analysis of LABS demonstrated significant correlations among A wave, e'_mean, and left atrial stiffness index (LASI).

Conclusions: In patients without CV disease, GLS emerges as a crucial determinant of LARS and LACS. LAEF and e'_mean are directly and independently related to both LARS and LACS. LARS (univariate) and LACS (multivariate) exhibited a decline with older age in individuals without CV disease.