Echo Research and Practice最新文献

{"title":"Trajectories and determinants of echocardiographic myocardial work indices after acute myocardial infarction: a pilot study.","authors":"Haitham Ballo, Wail Nammas, Christian Paunonen, Jarmo Teuho, Reetta Siekkinen, Xiang-Guo Li, Anne Roivainen, Juhani Knuuti, Antti Saraste","doi":"10.1186/s44156-026-00131-5","DOIUrl":"10.1186/s44156-026-00131-5","url":null,"abstract":"<p><strong>Introduction: </strong>We evaluated the trajectories of echocardiographic myocardial work (MW) indices and their associations with left ventricle (LV) functional recovery, myocardial viability, and perfusion in patients with reperfused acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>Thirty-one patients with a first ST-elevation AMI treated with percutaneous coronary intervention were prospectively enrolled. Transthoracic echocardiography and [¹⁵O]-water positron emission tomography (PET) were performed at a median of 7.7 ± 3.8 days post- intervention (baseline). Global and segmental absolute myocardial blood flow (MBF) were assessed using PET, and myocardial segments were graded as viable or non-viable based on perfusable tissue fraction (PTF). Echocardiographic parameters, including LV ejection fraction (LVEF), global longitudinal strain (GLS), myocardial work index (MWI), constructive work (MCW), wasted work (MWW), and work efficiency (MWE), were measured at baseline and at the 6-month follow-up. The myocardial area at risk (AAR) and the remote myocardium were defined based on the culprit coronary artery segment.</p><p><strong>Results: </strong>LVEF and GLS remained unchanged between baseline and follow-up. However, global MWI, MCW, and MWE significantly increased, while MWW decreased at the 6 months (all p < 0.05). An increase in MWI, but not MWE, was associated with improvement of LVEF. Neither global MWI nor MWE correlated with global MBF, but were inversely associated with peak levels of troponin T and NT-proBNP. In the AAR, regional MWI and MWE were significantly correlated with regional MBF (r = 0.53, p = 0.003, and r = 0.59, p < 0.001, respectively) and PTF (r = 0.41, p = 0.03, and r = 0.65, p < 0.001, respectively). At baseline, segmental MWI and MWE were higher in viable compared to non-viable segments. At 6 months, MWI and MWE increased in viable, but not in non-viable segments.</p><p><strong>Conclusions: </strong>Echocardiographic myocardial work indices reflect the severity of myocardial injury early after AMI and may serve as non-invasive markers of functional recovery and myocardial viability.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiography in duchenne muscular dystrophy: a call for consistency and standardisation of reporting.","authors":"Lynne Williams, Sadie Bennett, Charlotte Atkinson, Daniel X Augustine, Maria Bland, Hatty Grant, Jade Hobday, Anna Johnson, Kadhim Kadhim, Lisa Kuhwald, Chiara Marini Bettolo, Adam Kerr, David Oxborough, Liam Ring, Shaun Robinson, Jo Sopala, Cathy Turner, Chet Villa, Michela Guglieri, John Bourke, Caroline Coats","doi":"10.1186/s44156-026-00130-6","DOIUrl":"10.1186/s44156-026-00130-6","url":null,"abstract":"<p><p>Duchenne muscular dystrophy (DMD) is a genetically determined, neuromuscular disorder occurring predominantly in males with a prevalence of 1:3,500 to 1:5,000 live male births. It is a life limiting condition with average life expectancy of only 28.1 years in the United Kingdom. A dilated cardiomyopathy occurs in all patients with DMD, and cardio-respiratory causes now account for about 80% of all deaths in adult patients. Transthoracic echocardiography (TTE) is a widely used non-invasive imaging modality to assess cardiac structure, chamber dimensions, and myocardial function, and so plays a central role in guiding the timely initiation and adjustment of 'heart failure' medications. However, obtaining high quality images in patients with DMD can be challenging, particularly after patients lose ambulation, become wheelchair reliant, and require non-invasive ventilatory support. We review the current literature and evidence pertaining to echocardiography and the assessment of cardiac function in this patient group. This article seeks to discuss the strengths and limitations of TTE in patients with DMD, recommends a standard set of the measures to be reported at all assessments, and offers consensus guidance, based on expert opinion, to allow valid comparisons of serial assessments even when performed by different TTE services.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive validation of BSE-2024 vs. BSE-2013 using LVEDP and LV pre-A pressure in patients undergoing cardiac catheterization: a multicenter study with a complementary algorithm.","authors":"Amer Barakat, Ali Khaddam, Mhd Ameen Alkhatib, Rami Alsaadi, Ahmad Rasheed Alsaadi","doi":"10.1186/s44156-026-00132-4","DOIUrl":"10.1186/s44156-026-00132-4","url":null,"abstract":"<p><strong>Objective: </strong>To invasively validate the 2024 and 2013 British Society of Echocardiography (BSE) recommendations for diastolic function (DF) and left ventricular filling pressure (LVFP) detection using LV end-diastolic pressure (LVEDP) ≥ 16 mmHg and LV pre-A > 15 mmHg in patients undergoing left heart catheterization (LHC) and to propose a complementary algorithm to improve diagnostic performance.</p><p><strong>Methods: </strong>In this prospective multicenter study, 716 patients in sinus rhythm underwent echocardiography within 120 min before clinically indicated LHC (401 derivations and 315 temporally independent validation cohort). Patients with conditions that could interfere with the reliability of the algorithms were excluded. Both guidelines and proposed algorithms estimated DF and LVFP. The diagnostic classifications were compared with invasively-measured LVEDP and LV pre-A pressure.</p><p><strong>Results: </strong>BSE-2024 classified patients as (0.7%) indeterminate, (49.1%) normal and (50.1%) impaired DF, compared with (60.6%), (14.2%) and (25.2%), respectively, using BSE-2013. After excluding indeterminate cases, area under the curve (AUC) for detecting LVFP was comparable (e.g. for LVEDP, BSE-2024: 0.602 vs. BSE-2013: 0.630, P = 0.459). Updated guidelines achieved higher specificity for LVEDP (93.5% vs. 81.9%) but substantially lower sensitivity (27.8% vs. 44.2%), similar to that for LV pre-A (specificity: 92.1% vs. 79.4% and sensitivity 38.2% vs. 50.8%). BSE-2024 reclassified (82.3%) of indeterminate cases and (60.8%) of elevated LVFP under BSE-2013 as normal, with no significant change in overall reclassification (NRI: -0.056, P = 0.41; IDI: -0.056, P = 0.40). The proposed algorithm performance results were {LVEDP: (78.8%) sensitivity and (79.8%) specificity, while LV pre-A: (85.5%) sensitivity and (67.3%) specificity}. The independent validation cohort confirmed the robustness and reproducibility of the complementary algorithm {LVEDP: (88.3%) sensitivity and (87.9%) specificity and LV pre-A: (95.7%) sensitivity and (64.3%) specificity}.</p><p><strong>Conclusions: </strong>BSE-2024 markedly reduced indeterminate classifications but showed reduced sensitivity and modest diagnostic discrimination against invasive reference standards. Comparisons should be interpreted cautiously because BSE-2013 excludes many indeterminate cases from performance analyses, whereas BSE-2024 retains nearly all patients. The complementary algorithm provided a more balanced diagnostic profile and warrants further external validation.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in echocardiography: a position statement from the British Society of Echocardiography.","authors":"Sadie Bennett, Christopher Wild, Maria F Paton, Kelly Victor, Sitara Khan, John Kirkham, George Gaye, Claire Peacock, Shaun Robinson, Charlotte Manisty, Denisa Muraru, Paul Leeson, Partho P Sengupta, Daniel X Augustine","doi":"10.1186/s44156-026-00124-4","DOIUrl":"10.1186/s44156-026-00124-4","url":null,"abstract":"<p><p>Echocardiography is a foundational imaging modality for assessing cardiac structure and function, with a long history of technological advancement. As artificial intelligence (AI) becomes increasingly embedded across healthcare, its potential to enhance the echocardiography workflow, from image acquisition and analysis to reporting and risk stratification, has expanded rapidly. Research activity in this field has grown substantially, yet clinical adoption remains variable and often limited by practical, technical, and governance challenges. In response, the British Society of Echocardiography has developed this position statement to provide a structured, consensus‑driven evaluation of the opportunities, limitations, and requirements for the safe, equitable, and effective integration of AI into echocardiography services. Although centred on the UK context, the principles outlined may be relevant to other healthcare systems with similar models of echocardiography delivery.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reported safety events from ultrasound enhancing agents: a critical reappraisal.","authors":"Jordan B Strom, Nicholas Spetko, Constance E M Angell-James, Madeline A Cassidy, Jessica L Stout, Morgan L Winburn, Rebecca Lee, Alecia Bradley, Kevin Moreau, Venkateshwar Polsani, Cosby A Stone","doi":"10.1186/s44156-026-00127-1","DOIUrl":"10.1186/s44156-026-00127-1","url":null,"abstract":"<p><strong>Background: </strong>Reported adverse events (AEs) to the Food and Drug Administration Adverse Event Reporting System (FAERS) have suggested an increased rate of serious AEs (SAEs) during the COVID-19 pandemic, but the extent to which this may be related to overall changes in reporting during this time period is uncertain. Accordingly, we aimed to evaluate trends in SAE reporting across commercially available ultrasound enhancing agent (UEA) brands as a function of overall trends in AE reporting.</p><p><strong>Methods: </strong>We retrospectively analyzed the FAERS public database, 2014-2024, to evaluate risks of UEAs overall and by brand, compared to similar contrast media.</p><p><strong>Results: </strong>Between 2014 and 2024, 21,960,760 AEs were reported to FAERS, of which 11,450,891 (52.1%) were categorized as SAEs. Overall SAE reports to FAERS increased from 678,953 in 2014 to 1,368,393 in 2021 before subsequently declining to 1,065,845 in 2024 (-7.9% change from 2021 to 2024). During the same period, overall death reports to FAERS increased from 124,055 in 2014 to 195,207 in 2018 before declining to 147,046 in 2024. During this period of decline, there was a 23.9% relative increase in SAEs to UEAs which peaked in 2023 at 350 before declining to 326 in 2024. Deaths attributed to SAEs increased from 1 in 2014 to 19 in 2023 before declining to 9 in 2024. Overall, these data suggest that 11.2% of the observed increase in SAEs to UEAs can be attributed to reporting changes. Despite changes in relative risks for SAEs, absolute SAE rates remained small and lower than other types of contrast media.</p><p><strong>Conclusions: </strong>In this analysis of the FAERS dataset, 2014-2024, 11.2% of SAEs to UEAs were attributable to temporal changes in AE reporting. Absolute risks are small and declining, suggesting broad safety of UEAs as a class. Collectively, these results support continued use of UEAs, but motivate improved safety screening and preparedness to mitigate small but existing risks.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial strain on 2D-STE in pediatric dilated cardiomyopathy.","authors":"Yi Wu, Qiu-Qin Xu, Wei Liu, Cui Hou, Hui Wang, Jie Shen, Yao-Wen Sun, Pei-Pei Gu, Xue-Ying Si, Hai-Tao Lv, Ling Sun, Yue-Yue Ding","doi":"10.1186/s44156-026-00126-2","DOIUrl":"10.1186/s44156-026-00126-2","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the left atrial (LA) strain of pediatric dilated cardiomyopathy (DCM) on two-dimensional speckle tracking echocardiography (2D-STE), and elucidate the progression of LA strain with long-term medical therapy in such patients.</p><p><strong>Methods: </strong>Children with DCM who received standardized medical treatment for > 1 year at Children's Hospital of Soochow University between January 2018 - January 2021 were retrospectively reviewed. Age- and sex-matched patients with normal echocardiography were included as controls. Routine echocardiography was performed. 2D-STE was applied to obtain LA strain and tissue mitral annular displacement (TMAD) parameters. Echocardiographic images at baseline, 1-year post-treatment (Period 1), and > 2-year post-treatment (Period 2) were analyzed.</p><p><strong>Results: </strong>A total of 33 DCM patients were included, among whom 19 had isolated DCM, while 14 had DCM associated with left ventricular (LV) hypertrabeculation. At baseline, the age range of these children was 1 month to 144 months, and significantly lower left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) (P < 0.05) were observed among the patients compared to controls. Among the LA strain parameters, significantly lower reservoir strain (LASr) and conduit strain (LAScd) (P < 0.05) were also demonstrated. And significantly higher LVEF, LVFS, LASr and LAScd and significantly lower IVSd-Z and LVEDd-Z were observed in DCM associated with LV hypertrabeculation patients compared to isolated DCM patients. Between Period 1 and 2, significant increase in LVEF, LVFS, LASr, and LAScd were observed (P < 0.05).</p><p><strong>Conclusions: </strong>Following long-term standardized medication treatment, children with DCM exhibited significant improvements in left atrial reservoir and conduit functions. LAScd carries the potential as a sensitive imaging modality for LA strain in pediatric DCM.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic assessment in arterial hypertension: a contemporary narrative review.","authors":"Hafiz Naderi, Kelly Victor, Lynne Williams, Pauline A Swift, Ian Wilkinson, Sanjeev Bhattacharyya","doi":"10.1186/s44156-026-00125-3","DOIUrl":"10.1186/s44156-026-00125-3","url":null,"abstract":"<p><p>Arterial hypertension remains the leading modifiable cause of cardiovascular morbidity and mortality resulting in characteristic changes in cardiac structure and function. Contemporary hypertension clinical guidelines increasingly emphasise prevention and early detection of hypertension-mediated organ damage, yet they differ in how blood pressure is categorised and when further investigation is recommended. Within this prevention-focused landscape and alongside a broader cardio-renal-metabolic framework, this review provides a practical overview on the role of echocardiography in arterial hypertension by integrating contemporary hypertension guidelines with imaging consensus documents. We outline when echocardiography is most likely to add value in hypertension and review echocardiographic assessment of left ventricular structure and geometry, systolic and diastolic function and filling pressures, atrial remodelling, right ventricular assessment, valvular heart disease and the aorta. Practical indications for scanning and transoesophageal echocardiography considerations are discussed. Finally, we highlight future directions including prevention-focused pathways, scalable echocardiography strategies, routine inclusion of contemporaneous blood pressure in reports, artificial intelligence-enabled quantification and selective multimodality imaging within specialist hypertension services.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling the grey zone: submaximal-to-peak stress echocardiography enhances diagnostic accuracy in differentiating early dilated cardiomyopathy from physiological adaptation.","authors":"Sarandeep K Marwaha, Joyee Basu, Raghav Bhatia, Hamish Maclachlan, Saad Fyyaz, Maria Teresa Tome Esteban, Elijah R Behr, Gherardo Finocchiaro, Aneil Malhotra, Sanjay Prasad, Sabiha Gati, Michael Papadakis, Sanjay Sharma","doi":"10.1186/s44156-026-00123-5","DOIUrl":"10.1186/s44156-026-00123-5","url":null,"abstract":"<p><strong>Background: </strong>Participation in regular endurance exercise may be associated with physiological left ventricular (LV) dilatation and concomitant low resting LV ejection fraction (LVEF), a phenotype indistinguishable from early dilated cardiomyopathy (DCM) on resting imaging alone and termed the \"grey zone\". Stress echocardiography has emerged as a potential arbiter and has been proposed to resolve this dilemma.</p><p><strong>Objectives: </strong>We evaluated the diagnostic accuracy of stress echocardiography in distinguishing physiological from pathological LV dilatation and assessed whether incorporating submaximal-to-peak contractile reserve improved discriminatory value in athletes in the grey zone.</p><p><strong>Methods: </strong>Of the 182 athletic individuals, 62 control athletes with an enlarged LV and normal LVEF, 58 athletic DCM individuals, and 62 grey zone athletes underwent stress echocardiography using a semi-supine bicycle. In addition to the ability to augment LVEF ≥ 10% from rest to maximal exercise, we evaluated the ability to augment LVEF from submaximal exercise (80% of maximal heart rate) to peak exercise.</p><p><strong>Results: </strong>Resting LV dimensions did not differ significantly amongst the groups. Control athletes had higher resting LVEF than grey zone athletes and DCM individuals (62.1% vs 52.1% and 53.1%; p=<0.001). Control and grey zone athletes showed greater ΔLVEF from rest to peak exercise than DCM individuals (21% and 19.2% vs 4.9%; p < 0.001). Most control (98.3%) and grey-zone athletes (90.3%) achieved a ΔLVEF ≥ 10% from rest to peak exercise compared with 20.6% of athletic DCM individuals. Control and grey zone athletes also revealed a mean increase in LVEF from submaximal to peak exercise of 7.5% and 3.8%, respectively, whereas DCM individuals showed a mean LVEF decline of -4.3% (p < 0.001). Although 20.6% of DCM individuals demonstrated a ΔLVEF ≥ 10% from rest to peak, only a single DCM individual augmented LVEF from submaximal to peak exercise. Failure to increase LVEF ≥ 10% from rest to peak exercise identified DCM with 79.4% sensitivity and 98.3% specificity. Combining this inability with a failure to augment LVEF from submaximal to peak exercise improved the sensitivity to 98.2% and specificity to 98.4%.</p><p><strong>Conclusion: </strong>Reliance on rest-to-peak augmentation of ≥10% alone risks misclassification. Introducing submaximal-to-peak augmentation enhances diagnostic precision by identifying virtually all individuals with DCM while preserving specificity.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic characterization of combined postcapillary and precapillary pulmonary hypertension in systemic sclerosis with preserved ejection fraction.","authors":"Ahmad Daoud, Garrett Goldin, Lea Goren, Arindam Bagga, Hoda Mombeini, Ryan Osgueritchian, Vivek P Jani, Steven Hsu, Fredrick M Wigley, Matthew R Lammi, Paul M Hassoun, Ami A Shah, Stephen C Mathai, Monica Mukherjee","doi":"10.1186/s44156-026-00116-4","DOIUrl":"10.1186/s44156-026-00116-4","url":null,"abstract":"<p><p>BACKGROUND: Systemic sclerosis (SSc) is a multisystem autoimmune disease frequently complicated by pre- and post-capillary pulmonary hypertension (PH). Within SSc, progressive diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF) are key contributors, often presenting as isolated postcapillary PH (Ipc-PH) or combined pre- and postcapillary PH (Cpc-PH). The ability to differentiate these hemodynamic phenotypes is critical for risk stratification, yet echocardiographic markers specific to each subtype in SSc-HFpEF are poorly defined. METHODS: We investigated 147 adults with SSc-HFpEF with echocardiograms and right heart catheterization (RHC) assessments performed within one year. Patients were classified as Ipc-PH (n = 46) or Cpc-PH (n = 101) based on guideline-defined hemodynamic criteria. Echocardiographic parameters, including conventional measures, strain indices, and coupling metrics were analyzed. A random forest (RF) classifier was used to identify top echocardiographic predictors of Cpc-PH, and further assessed using multivariable logistic regression. Separate RF models and Cox regression analyses were used to determine echocardiographic predictors of mortality within each group. Survival was assessed using Kaplan-Meier analysis. RESULTS: Patients with Cpc-PH exhibited significantly greater right heart remodeling, higher pulmonary pressures, and impaired right ventricle (RV)-pulmonary artery (PA) coupling. The top echocardiographic predictors of Cpc-PH included reduced RV free wall strain (RVFWS), decreased RVFWS/PA systolic pressure (PASP) and fractional area change (FAC)/PASP ratios, elevated PASP, lower septal e′ velocity, and higher systolic LV eccentricity index (LV EI). In adjusted Cox models, elevated LVEI (HR 1.39), increased RV internal diastolic diameter (HR 2.15), and reduced left and right atrial strain (HR 0.91 and 0.94, respectively) were independently associated with mortality in Cpc-PH. In Ipc-PH, mortality was linked to reduced FAC/PASP, lower left ventricular global longitudinal strain (LVGLS), increased LV mass index, elevated PASP, and lower RVFWS. CONCLUSION: In the present study, we demonstrate key echocardiographic differences between Ipc-PH and Cpc-PH within the SSc-HFpEF population, emphasizing the central role of right heart remodeling, RV-PA coupling, atrial and septal mechanics in phenotypic differentiation and prognostication. Strain-based parameters and RV-PA coupling indices offer incremental value for risk stratification and may guide more tailored therapeutic strategies in this heterogeneous population. </p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International practices and variability in right heart echocardiography: results from the RVNet(Work) international survey.","authors":"Harry Magunia, Daniel X Augustine, Attila Kovács, Alina Nicoara, Marius Keller, Dick Thijssen, Rebecca T Hahn, Denisa Muraru, Lawrence Rudski, Karima Addetia, Monica Mukherjee, Arie van Dijk, Andre Denault, Elena Surkova, Francois Haddad, David Oxborough","doi":"10.1186/s44156-026-00121-7","DOIUrl":"10.1186/s44156-026-00121-7","url":null,"abstract":"<p><p>BACKGROUND: The assessment of the right heart (RH) plays a central role in the diagnosis and management of cardiovascular and pulmonary diseases. Although current guidelines have improved standardization, there is anecdotal evidence suggesting that there is significant variability in clinical practice regarding acquisition and reporting persist. OBJECTIVES: This international survey evaluated the extent of variability in echocardiographic assessment of the RH. A simple method for the standardization of RH measurements is proposed. METHODS: The international anonymous survey consisted of 68 questions with a primary focus on routine methods and measurements of RH echocardiography by transthoracic (TTE) and transesophageal (TEE) modalities. The questions were developed using a standardization framework, focused on six key areas: views and settings, phase, orientation, interface, timing and selection, as well as scaling and indexing (V-POINTS). RESULTS: The survey was available from November 2024 to February 2025. A total of 588 international respondents from various disciplines and professions responded. The majority of respondents had certification in echocardiography (74%), 34% reported 10 to 20 years of experience, 22% reported more than 20 years of experience. The 4-chamber (80%) and right ventricular (RV) focused (67%) views were most commonly used in TTE. The functional parameters included tricuspid annular plane systolic excursion (TAPSE) (80%), visual assessment (66%), RV S’ (50%), and fractional area change (FAC) (42%). RV strain and 3D metrics were less frequently used. Using TEE the mid-esophageal 4-chamber view was most commonly used (80%), RV function was mostly assessed visually, and quantification playing a secondary role (TAPSE 44% and RVFAC 34%). There was considerable variability in the definition of cardiac phases across both modalities. RV dimensions and areas were measured at the compacted region by 58% of the respondents. Scaling and indexing were not routinely used in practice. CONCLUSIONS: The survey identified significant variability in the practice of RH echocardiography. We propose a simple system (V-POINTS) which may improve standardization of image acquisition and corresponding measurements. </p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"13 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}