Journal of the American Society of Echocardiography最新文献

{"title":"Echocardiographic Predictors of Readiness for Double Switch Operation and Postoperative Ejection Fraction in Patients With Congenitally Corrected Transposition of the Great Arteries Undergoing Left Ventricular Retraining","authors":"Son Q. Duong MD, MS , Deborah Ho MD , Rajesh Punn MD , Danielle Sganga MD , Richard Mainwaring MD , Michael Ma MD , Frank L. Hanley MD , Kyong-Jin Lee MD , Shiraz A. Maskatia MD","doi":"10.1016/j.echo.2024.08.011","DOIUrl":"10.1016/j.echo.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>In patients with congenitally corrected transposition of the great arteries (ccTGA), assessment of readiness for the double switch operation (DSO) after pulmonary arterial band (PAB) placement involves cardiac magnetic resonance imaging (cMRI) to measure left ventricular ejection fraction (LVEF) and mass and cardiac catheterization (catheterization) to assess the ratio of left ventricular to right ventricular pressure (LV:RVp). The aims of this study were to describe the relationships between echocardiographic and catheterization and cMRI measures of readiness for DSO and to develop risk factors for left ventricular (LV) dysfunction after DSO on the basis of echocardiographic measures of ventricular-arterial coupling (VAC).</div></div><div><h3>Methods</h3><div>Patients with ccTGA undergoing LV retraining at a DSO referral center were reviewed. LVEF measured by echocardiography was compared with that measured by cMRI, and LV:RVp measured by echocardiography was compared with that measured by catheterization using Bland-Altman analysis. The relationship between preoperative VAC markers and postoperative echocardiography was analyzed using ventricular end-systolic elastance (EES) and a novel marker consisting of the product of LVEF and LV:RVp (EFPR).</div></div><div><h3>Results</h3><div>Thirty-one patients with 56 evaluations for DSO were included, 24 of whom underwent DSO. Echocardiographic LVEF correlated well with cMRI LVEF (<em>r</em> = 0.79), and Bland-Altman analysis slightly overestimated cMRI LVEF (mean difference, +3%). Echocardiographic LVEF had a moderate ability to identify normal cMRI LVEF (area under the curve, 0.80) and at an optimal cut point of echocardiographic LVEF threshold of 61%, there was 71% sensitivity and 76% specificity to detect cMRI LVEF ≥ 55%. Echocardiographic LV:RVp correlated well with LV/RVp by catheterization (<em>r</em> = 0.77) and slightly underestimated the catheterization value (mean difference, −0.11). Echocardiographic LV:RVp had a good ability to identify adequate LV:RVp by catheterization (area under the curve, 0.95) and at an optimal echocardiography cut point of 0.75 had 100% sensitivity and 85% specificity to detect a catheterization LV:RVp >0.9. Echocardiography-based criteria for DSO readiness (echocardiographic LVEF of 61% and LV:RVp of 0.75) demonstrated specificity of 97% and positive predictive value of 96% for published criteria of DSO readiness (cMRI LVEF of 55% and catheterization LV:RVp of 0.9). EES and EFPR correlated with post-DSO LVEF (ρ = 0.72 and ρ = 0.60, respectively). EFPR of 0.51 demonstrated 78% sensitivity and 100% specificity for post-DSO LV dysfunction (LVEF < 55%). Age at first PAB also strongly correlated with post-DSO LVEF (ρ = 0.75). No patient with first PAB at <1 year of age exhibited post-DSO LV dysfunction.</div></div><div><h3>Conclusions</h3><div>Echocardiographic measures of LVEF and LV:RVp are reliable indicators of reference standar","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages 1136-1144"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114233","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":"Early Heart Checks: Harnessing Fetal Echocardiography, Genetic Insights, and the Role of Transvaginal Cardiac Imaging in Clinical Practice","authors":"Flora Nuñez Gallegos MD, MPH, Anita J. Moon-Grady MD","doi":"10.1016/j.echo.2024.10.003","DOIUrl":"10.1016/j.echo.2024.10.003","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages 1133-1135"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479303","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":"Lowering Mechanical Index Reduces B-Lines: Balancing Safety With Accuracy in Lung Ultrasound","authors":"David Reza Mittelstein MD, PhD, Keshav R. Nayak MD, Pamela M. Resnikoff MD, MPH, Samantha R. Spierling Bagsic PhD, MSE, Bruce J. Kimura MD","doi":"10.1016/j.echo.2024.08.008","DOIUrl":"10.1016/j.echo.2024.08.008","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages 1184-1186"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114236","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":"Continuing Education and Meeting Calendar","authors":"","doi":"10.1016/j.echo.2024.09.009","DOIUrl":"10.1016/j.echo.2024.09.009","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Page A15"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154704","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":"Improving Prenatal Detection of Congenital Heart Disease With a Scalable Composite Analysis of 6 Fetal Cardiac Ultrasound Biometrics","authors":"Aneela Reddy MD, Sara Rizvi MS, Anita J. Moon-Grady MD, Rima Arnaout MD","doi":"10.1016/j.echo.2024.08.007","DOIUrl":"10.1016/j.echo.2024.08.007","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages 1186-1188"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114235","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":"Author Response to Unraveling the Impact of Perivascular Amyloid Deposition on Cardiac Remodeling in AL Amyloidosis","authors":"Jeremy Slivnick MD, Karima Addetia MD","doi":"10.1016/j.echo.2024.08.015","DOIUrl":"10.1016/j.echo.2024.08.015","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages 1191-1192"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134293","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":"Clinical Implications of Left Ventricular Apex Mechanics in Patients With Apical Hypertrophic Cardiomyopathy","authors":"Chenyang Wang MD, PhD ,&nbsp;Wei Zhou MD, PhD ,&nbsp;Jeffrey B. Geske MD ,&nbsp;Ying Zhu MD, PhD ,&nbsp;Jie Tian MD ,&nbsp;Shiliang Liu MD ,&nbsp;Hui Wang MD ,&nbsp;Xueqing Chen MD ,&nbsp;Qiaoying Tang MD, PhD ,&nbsp;Youbin Deng MD, PhD ,&nbsp;Yani Liu MD, PhD","doi":"10.1016/j.echo.2024.08.016","DOIUrl":"10.1016/j.echo.2024.08.016","url":null,"abstract":"<div><h3>Background</h3><div>Apical hypertrophic cardiomyopathy (ApHCM) is a unique disease with pathologic hypertrophy mainly at the left ventricular (LV) apex. Although previous studies have indicated apical dysfunction in ApHCM, how apical mechanics change during disease progression has not been thoroughly examined. The aims of this study were to characterize the mechanics of the LV apex in patients with ApHCM at different disease stages and to explore the clinical significance of these alterations.</div></div><div><h3>Methods</h3><div>One hundred four patients with ApHCM were divided into three subtypes on the basis of LV apical maximum wall thickness (AMWT) and extent of hypertrophy: relative type (isolated apical hypertrophy with AMWT &lt; 15 mm), pure type (isolated apical hypertrophy with AMWT ≥ 15 mm), and mixed type (both apical and midventricular hypertrophy with AMWT ≥ 15 mm). Two-dimensional speckle-tracking echocardiography was used to analyze LV segmental strain, global strain, and twist. Comparisons of these parameters were performed among ApHCM subtypes and 30 healthy control subjects. Logistic regression and Cox proportional-hazards regression analyses were used to explore associations between myocardial mechanics and clinical indicators. A composite outcome of new-onset atrial fibrillation, heart failure hospitalization, myectomy, and all-cause mortality was assessed.</div></div><div><h3>Results</h3><div>Even in relative ApHCM patients, apical longitudinal strain (LS), circumferential strain, and radial strain (RS) were significantly impaired compared with control subjects (LS: −14.6 ± 4.1% vs −20.0 ± 1.7% [<em>P</em> = .001]; circumferential strain: −19.6 ± 2.5% vs −25.6 ± 3.7% [<em>P</em> = .002]; RS: 26.6 ±7.4% vs 35.6 ± 11.1% [<em>P</em> = .026]), while apical rotation and LV twist remained unchanged. In patients with greater apical hypertrophy (mixed and pure patients), apical LS and RS were more abnormal. Moreover, apical rotation showed significant reductions compared with relative-type patients. After adjusting for clinical and myocardial mechanical parameters, apical rotation was independently associated with New York Heart Association functional class ≥ II (odds ratio, 0.81; 95% CI, 0.66-0.99; <em>P</em> = .036) and the composite outcome (hazard ratio, 0.82; 95% CI, 0.73-0.91; <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>Relative ApHCM demonstrates apical dysfunction but sparing of apical rotation, which was abnormal in more extensive phenotypes. LV apex mechanics were closely related to clinical patterns, with apical rotation correlated with both New York Heart Association functional class ≥ II and clinical events.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages 1145-1155"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remember to Put Yourself on the Holiday List","authors":"Theodore P. Abraham MD, FASE","doi":"10.1016/j.echo.2024.10.011","DOIUrl":"10.1016/j.echo.2024.10.011","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 12","pages":"Pages A13-A14"},"PeriodicalIF":5.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787545","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":"Exercise-Induced Reduction in Left Ventricular Ejection Fraction in the Absence of Coronary Artery Disease: Clinical Characteristics and Outcomes.","authors":"Luca Fazzini, Scott A Hubers, Jenny J Cao, Christopher G Scott, Robert B McCully, Matteo Castrichini, Marta Figueiral, Akanksha Mohananey, Li Wang, Rajiv Gulati, Roberta Montisci, Patricia A Pellikka, Naveen L Pereira","doi":"10.1016/j.echo.2024.11.008","DOIUrl":"10.1016/j.echo.2024.11.008","url":null,"abstract":"<p><strong>Background: </strong>During exercise stress echocardiography (ESE), there are patients with normal left ventricular ejection fraction (LVEF) who paradoxically develop reduced LVEF during exercise despite absence of coronary artery disease (CAD) and a significant hypertensive response. This study sought to describe the clinical features and outcomes of this population.</p><p><strong>Methods: </strong>Among ESEs performed between 2003 and 2022, patients without CAD by angiogram within 90 days of ESE and resting LVEF ≥50% with a ≥5% LVEF decrease during ESE were included. Outcomes assessed were all-cause mortality, heart failure (HF) hospitalization, and atrial fibrillation (AF). Kaplan-Meier and Cox regression methods were used to analyze time-to-event outcomes.</p><p><strong>Results: </strong>Among 213,643 ESE, 134 patients met the eligibility criteria. The mean age of the population was 66 ± 10 years, 76% were women, and 16% had AF at baseline. Mean LVEF was 58% ± 4% at rest and 43% ± 4% at peak stress. Stress ECG met the criteria for ischemia in 14% of these patients. The 10-year estimated incidence of HF hospitalization was 17.6% (95% CI, 9.0%-26.2%). Among the subgroup without AF at baseline, the 10-year estimated incidence of developing AF was 23.4% (95% CI, 13.4%-33.4%). The 10-year estimated incidence of all-cause mortality was 12.9% (95% CI, 5.5%-20.3%), with 89% of deaths occurring due to noncardiovascular causes.</p><p><strong>Conclusion: </strong>Patients with exercise-induced reduction in LVEF in the absence of obstructive CAD have a high incidence of HF hospitalizations and AF. The underlying pathophysiology of this disease process needs to be further investigated.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755777","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":"Machine Learning Identifies Clinically Distinct Phenotypes in Patients With Aortic Regurgitation.","authors":"Brototo Deb, Christopher G Scott, Hector I Michelena, Sorin V Pislaru, Vuyisile T Nkomo, Garvan C Kane, Juan A Crestanello, Patricia A Pellikka, Vidhu Anand","doi":"10.1016/j.echo.2024.10.019","DOIUrl":"10.1016/j.echo.2024.10.019","url":null,"abstract":"<p><strong>Background: </strong>Aortic regurgitation (AR) is a prevalent valve disease with a long latent period before symptoms appear. Recent data has suggested the role of novel markers of myocardial overload in assessing onset of decompensation.</p><p><strong>Methods: </strong>The aim of this study was to evaluate the role of unsupervised cluster analyses in identifying different clinical clusters, including clinical status, and a large number of echocardiographic variables including left ventricular volumes, and their associations with mortality. Patients with moderate to severe or greater chronic AR identified using echocardiography at the Mayo Clinic in Rochester, Minnesota, were retrospectively analyzed. The primary outcome was all-cause mortality censored at aortic valve surgery. Uniform manifold approximation and projection with the k-means algorithm was used to cluster patients using clinical and echocardiographic variables at the time of presentation. Missing data were imputed using the multiple imputation by chained equations method. A supervised approach trained on the training set was used to find cluster membership in a hold-out validation set. Log-rank tests were used to assess differences in mortality rates among the clusters in both the training and validation sets.</p><p><strong>Results: </strong>Three distinct clusters were identified among 1,100 patients (log-rank P for survival < .001). Cluster 1 (n = 337), which included younger males with severe AR but fewer symptoms, showed the best survival at 75.6% (95% CI, 69.5%-82.3%). Cluster 2 (n = 235), including older patients and more females with elevated filling pressures, showed intermediate survival of 64.2% (95% CI, 56.8%-72.5%). Cluster 3 (n = 253), characterized by severe symptomatic AR, demonstrated the lowest survival of 45.3% (95% CI, 34.4%-59.8%) at 5 years. Similar clusters were identified in the internal validation cohort.</p><p><strong>Conclusions: </strong>Distinct clusters with variable echocardiographic features and mortality differences exist within patients with chronic moderate to severe or greater AR. Recognizing these clusters can refine individual risk stratification and clinical decision-making after verification in future prospective studies.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683162","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}