Journal of the American Society of Echocardiography最新文献

{"title":"Exercise Echocardiography for Risk Stratification in Unexplained Dyspnea: the Incremental Value of the mPAP/CO slope.","authors":"Maarten Falter, Youri Bekhuis, Wouter L'Hoyes, Mauricio Milani, Sarah Hoedemakers, Lucie Soens, Sara Moura-Ferreira, Sebastiaan Dhont, Rik Pauwels, Annemie Jacobs, Stephanie De Schutter, Boris Delpire, Johan Verbeeck, Jan Stassen, Andreas B Gevaert, Philippe Debonnaire, Alexander Van de Bruaene, Philippe B Bertrand, Lieven Herbots, Ruta Jasaityte, Frederik H Verbrugge, Guido Claessen, Jan Verwerft","doi":"10.1016/j.echo.2025.06.007","DOIUrl":"10.1016/j.echo.2025.06.007","url":null,"abstract":"<p><strong>Background: </strong>Patients with unexplained dyspnea and an elevated mean pulmonary artery pressure over cardiac output (mPAP/CO) slope on invasive hemodynamic assessment during exercise have worse clinical outcomes.</p><p><strong>Objectives: </strong>To evaluate the incremental prognostic value of the non-invasive mPAP/CO slope on top of heart failure with preserved ejection fraction (HFpEF) probability scores and diastolic stress testing in patients with unexplained dyspnea.</p><p><strong>Methods: </strong>In a multicenter cohort study involving 6 Belgian dyspnea clinics, patients with unexplained dyspnea underwent exercise echocardiography for mPAP/CO slope assessment. Positive HFpEF scores were defined as HFA-PEFF score ≥5 or H₂FPEF score ≥6 and negative otherwise. The outcome evaluated was a composite of all-cause mortality or heart failure hospitalization.</p><p><strong>Results: </strong>Among 2452 patients (age 63±15 years, 53% women), a mPAP/CO slope >3.5 mmHg.L^-1.min best predicted adverse outcomes. The prognostic value of the mPAP/CO slope was greater in patients with negative HFpEF scores than in those with positive scores (interaction p=0.02). The mPAP/CO slope remained independently prognostic after adjustment for NT-proBNP (HR 2.26, 95% CI: 1.33-3.82) and for HFpEF scores and diastolic stress testing (HR 1.99, 95% CI: 1.37-2.88), whereas exercise tricuspid regurgitant velocity did not. Both HFpEF scores-negative patients with a slope >3.5 mmHg.L^-1.min (HR 2.99 [95%CI 1.81-4.95]) and HFpEF score-positive patients (HR 6.29 [95%CI 4.25-9.31]) showed significantly higher risk compared to HFpEF score-negative patients with a slope ≤3.5 mmHg.L^-1.min CONCLUSIONS: The mPAP/CO slope-unlike exercise tricuspid regurgitant velocity-adds prognostic value beyond natriuretic peptides, HFpEF scores, and diastolic stress testing, identifying high-risk patients with exercise-induced hemodynamic abnormalities who may benefit from invasive confirmation and closer follow-up.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Mitral Annular Calcification with Echocardiography: Comparison to Calcium Score with Computed Tomography.","authors":"Jon R Peacock, Connor P Craig, William K Harvey, Sheldon E Litwin","doi":"10.1016/j.echo.2025.06.010","DOIUrl":"10.1016/j.echo.2025.06.010","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of a Clinical Support Tool to Increase Value in Transthoracic Echocardiography.","authors":"Nisha Raiker, Aditya Nagori, Karunakar Dirisala, Patrick Hong Msce, Katy Lonergan, Susan Matulevicius, Gail Peterson, Ambarish Pandey, Rebecca Vigen","doi":"10.1016/j.echo.2025.06.011","DOIUrl":"10.1016/j.echo.2025.06.011","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Detection of Subclinical Atherosclerosis on Carotid Ultrasound on Cardiovascular Events in A Primary Prevention Clinical Setting.","authors":"Tasneem Z Naqvi, Chieh-Ju Chao, Duke Butterfield, Songnan Wen, Nan Zhang","doi":"10.1016/j.echo.2025.06.009","DOIUrl":"10.1016/j.echo.2025.06.009","url":null,"abstract":"<p><strong>Background: </strong>The relative contribution of common carotid artery (CCA) intimal medial thickness (IMT), carotid bifurcation plaque presence and its burden in predicting cardiovascular disease (CVD) events in a primary prevention clinical cohort remain unclear.</p><p><strong>Aims: </strong>To assess the usefulness of distal far wall of right (R) and left (L) CCA IMT assessment (in the absence of carotid bifurcation plaque), and plaque presence and plaque number on incident CVD in a primary prevention clinical setting.</p><p><strong>Methods: </strong>Observational study of consecutive 1903 patients free of known CVD clinically referred for R and L carotid bifurcation 2D ultrasound for SA assessment between 2007-2014 at a single center. Incident composite CVD (cardiac death, myocardial infarction, unstable angina and ischemic stroke) was compared between patients with and without plaque (defined as focal or diffuse medial-adventitial border to luminal border thickening of >1.5 mm), with increasing plaque number and with increasing CCA IMT percentiles (<25^th, 25-49, 50-74 and >75^th centile adjusted for atherosclerotic CVD scores using Pooled Cohort Equation (PCE) and Framingham Risk Score (FRS) in the absence of bifurcation plaque RESULTS: Final study cohort was 1569 (mean age 55.1±8.6; female 36%) after study exclusions with mean follow-up of 9.8±5.5 years. 859 (54.7%) had carotid plaque and 710 (45.3%) had no plaque. Incident composite CVD occurred in 90 (5.7%) patients, with no difference in patients with and without plaque (HR 1.19, 95% CI 0.78-1.82, P=0.425) or with >75th vs. < 75^th IMT percentile in the absence of plaque (HR 1.35, 95% CI 0.64-2.85, P=0.431). Increased incident CVD events occurred in patient with 3 or more plaques vs. no plaque (HR 2.9, 95% CI 1.48-5.65, p=0.002) which remained significant after adjusting for PCE (HR 2.45, 95% CI 1.13-5.3, p=0.023) and FRS. Patients with IMT centile >75% and presence of carotid plaque received increasing new statin prescriptions after carotid ultrasound result. Significant LDL-c reduction (19.3±25.7mg/dl, p<0.001) on follow up occurred only in patients in whom plaque was identified.</p><p><strong>Conclusions: </strong>Number of carotid bifurcation plaques on carotid ultrasound is associated with incident CVD in a primary prevention cohort. Given referral nature of study cohort, evaluation of only carotid vascular bed and increased statin prescriptions after carotid ultrasound result, our findings regarding lack of prognostic value of CCA IMT or of any plaque should be interpreted with caution. Presence of plaque on carotid ultrasound led to increased statin prescriptions and greater LDL-c reduction on follow up. This clinically useful and simple method can be adopted in clinical practice for CVD risk stratification.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Postoperative Atrial Fibrillation in Patients Undergoing Stress Echocardiography Prior to Noncardiac Surgery.","authors":"Kevin M Stanko, Toby N Weingarten, Garvan C Kane, Patricia A Pellikka, Robert B McCully, Karen F Mauck, Darrell R Schroeder, Michael W Cullen","doi":"10.1016/j.echo.2025.06.008","DOIUrl":"10.1016/j.echo.2025.06.008","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Utility of Routine Surveillance Echocardiograms After Arterial Switch Operation in Adults with Transposition of the Great Arteries.","authors":"Karl K Lundin, Sori K Lundin, Wilson W Lam, Katherine B Salciccioli","doi":"10.1016/j.echo.2025.06.006","DOIUrl":"10.1016/j.echo.2025.06.006","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend annual or biennial transthoracic echocardiograms for patients with d-transposition of the great arteries (d-TGA) who have undergone an arterial switch operation (ASO), but optimal imaging frequency is unknown. We sought to determine the utility of annual surveillance echocardiograms for asymptomatic patients.</p><p><strong>Methods: </strong>Clinical documentation from 2011-2023 for asymptomatic patients > 18 years old with history of d-TGA and ASO at a single large tertiary care center was reviewed to determine if routine surveillance echocardiograms resulted in changes in clinical management (ΔMGMT), categorized as procedures (surgery or catheterization) or noninvasive changes (medication changes, additional imaging, etc.). Echocardiograms obtained for symptoms or completed before age 18 were excluded from analysis. Data was evaluated with chi-square and Kruskal-Wallis tests, Kaplan-Meier analysis, and Cox proportional hazard analysis.</p><p><strong>Results: </strong>Of 416 echocardiograms from 127 patients, the median time from ASO to final echocardiogram was 22.2 years (IQR 19.1-25.7 years; range 15.2-34.1 years). Eighteen echocardiograms (4.32%) resulted in ΔMGMT for 12 patients including 8 (1.92%) medication changes, 7 (1.68%) cardiac CT or MRI studies, and 1 (0.24%) each for cardiac catheterization and surgery. A significantly larger proportion of patients with ΔMGMT underwent ASO at age >1 year compared to patients without ΔMGMT (36.36% vs 6.14%, P<0.01). Patients with a history of hypertension, arrhythmia, >2 sternotomies, or neo-aortic valve replacement had a significantly greater risk of ΔMGMT, as did those with neo-aortic root dilation >4.5cm and/or moderate or greater neo-aortic insufficiency.</p><p><strong>Conclusions: </strong>Routine surveillance echocardiograms are low yield in asymptomatic adults up to 30 years after ASO for d-TGA, suggesting it may be reasonable to increase the time interval between routine echocardiograms without adversely impacting care. Higher risk sub-populations including those with ASO at older ages, >2 sternotomies, neo-aortic valve replacement, and/or neo-aortic valve/root pathology may benefit from continued frequent surveillance.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in Residual Left Atrial Appendage Anatomy After Surgical Exclusion.","authors":"Blair Tilkens, Patrycja Galazka, Nicholas Beaudrie, Stacie Kroboth, Scott Johnson, Priscilla Wessly, Renuka Jain","doi":"10.1016/j.echo.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.echo.2025.06.004","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular and Atrial Function in Patients with Isolated Mitral Annular Calcification.","authors":"Kyu Kim, Seo-Yeon Gwak, Hyun-Jung Lee, Iksung Cho, Geu-Ru Hong, Jong-Won Ha, Chi Young Shim","doi":"10.1016/j.echo.2025.06.003","DOIUrl":"https://doi.org/10.1016/j.echo.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of left ventricular (LV) and left atrial (LA) function using Doppler echocardiography in patients with mitral annular calcification (MAC) is challenging. This study aimed to determine the clinical significance of LV and LA function using speckle-tracking echocardiography in patients with isolated MAC.</p><p><strong>Methods: </strong>Among 537 patients with MAC identified by echocardiography during 2012-2016, 275 (73.7 ± 11.0 years, 63.6% women) without atrial fibrillation, other severe valve disease, or mitral regurgitation were retrospectively analyzed. The LV global longitudinal strain (GLS) and LA strain were measured using vendor-independent software. The primary outcome was the composite of cardiovascular death and heart failure admission.</p><p><strong>Results: </strong>During a median follow-up of 42.0 (interquartile range, 7.6-87.9) months, 34 events occurred. Patients with events had lower absolute values of LV-GLS and LA reservoir strain than those without events. LV-GLS and LA reservoir strain worsened as MAC increased in severity. When patients were stratified into four groups according to LV-GLS and LA reservoir strain, the numbers of events were significantly different (log-rank P = 0.005). Following multivariable adjustment, LV-GLS (adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.12-1.38; P < 0.001) and LA reservoir strain (adjusted HR, 0.86; 95% CI, 0.80-0.92; P < 0.001) were independently associated with higher incidence of composite outcomes. LV-GLS and LA reservoir strain had incremental value for predicting composite outcomes over clinical variables and the mitral E to A ratio.</p><p><strong>Conclusion: </strong>Assessing LV-GLS and LA reservoir strain in patients with MAC is useful for predicting adverse outcomes.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodality Imaging in Presurgical Evaluation of Total Anomalous Pulmonary Venous Connection: Single Center Practice Variability and a Systematic Review of Diagnostic Error.","authors":"Helen M Stanley, Danish Vaiyani, Meryl S Cohen, Shobha Natarajan, Brian R White","doi":"10.1016/j.echo.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.echo.2025.05.020","url":null,"abstract":"<p><p>Pulmonary vein anatomy varies widely in total anomalous pulmonary venous connection (TAPVC), with diagnostic accuracy affecting surgical planning and prognosis. Echocardiography is the preferred screening modality. Cross-sectional imaging (cardiac computed tomography (CT) or magnetic resonance (MR)) may offer added value. As the first step in a quality improvement initiative, we sought to describe practice patterns in presurgical imaging in TAPVC with attention to diagnostic error. We also evaluated available literature on diagnostic accuracy of imaging in TAPVC. Patients with TAPVC who underwent repair at our center (1/1/06-9/15/22) were included. Thirty-three of 167 patients (20%) underwent presurgical CT or MR. Initial echocardiogram incorrectly diagnosed the subtype of TAPVC in 9% (15/167). Patients with birth weight under 3 kilograms, born preterm, or an initial diagnosis of mixed-type TAPVC were more likely to have misdiagnosis by initial echocardiogram. CT or MR miscategorized 3/33 patients. Systematic literature review revealed 10 studies that evaluated CT imaging diagnostic accuracy in TAPVC, one of which also included MR studies. Among 171 total patients, there were no patients with inaccurate anatomic diagnosis by CT or MR. Cross-sectional angiography is used increasingly in this population and with diagnostic excellence, though it is not infallible. Efforts to improve echocardiographic quality as well as multimodality imaging in high-risk patients may improve diagnostic accuracy and surgical planning.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1016/j.echo.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.echo.2025.03.004","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}