Journal of the American Society of Echocardiography最新文献

{"title":"Dobutamine Stress Echocardiography in Low-Gradient Aortic Stenosis","authors":"","doi":"10.1016/j.echo.2024.06.017","DOIUrl":"10.1016/j.echo.2024.06.017","url":null,"abstract":"<div><h3>Importance</h3><div>Guidelines recommend the use of dobutamine stress echocardiography (DSE) in patients with low-gradient aortic stenosis (AS) and left ventricular ejection fraction (LVEF) &lt;50%. However, a paucity of DSE data exists when LVEF &gt;35%.</div></div><div><h3>Objective</h3><div>To examine the diagnostic accuracy of DSE in patients with low-gradient AS with a wide range of LVEF and to examine the interaction between the diagnostic accuracy of DSE and LVEF.</div></div><div><h3>Design, Setting, and Participants</h3><div>Patients with mean gradient &lt;40 mm Hg, aortic valve area &lt;1.0 cm², and stroke volume index ≤35 mL/m² undergoing DSE and cardiac computer tomography (C-CT) were identified from 3 prospectively collected patient cohorts and stratified according to LVEF: LVEF&lt;35%, LVEF 35% to 50%, and LVEF&gt;50%.</div></div><div><h3>Exposure</h3><div>Dobutamine stress echocardiography and C-CT were performed on patients with low-gradient AS.</div></div><div><h3>Main Outcomes and Measures</h3><div>Severe AS was defined as aortic valve calcification score ≥2,000 arbitrary units (AU) among men and ≥1,200 AU for women on C-CT.</div></div><div><h3>Results</h3><div>Of 221 patients included in the study, 78 (35%) presented with LVEF &lt;35%, 67 (30%) with LVEF 35% to 50%, and 76 (34%) with LVEF &gt;50%. Mean-gradient and aortic valve peak velocity during DSE showed significant diagnostic heterogeneity between LVEF groups, being most precise when LVEF &lt;35% (both areas under the curve [AUC] = 0.90), albeit with optimal thresholds of 30 mm Hg and 377 cm/sec and a limited diagnostic yield in patients with LVEF ≥35% (AUC = 0.67 and 0.66 in LVEF 35% to 50% and AUC = 0.65 and 0.60 in LVEF ≥50%). Using guideline thresholds led to a sensitivity/specificity of 49%/84% for all patients with LVEF &lt;50%.</div></div><div><h3>Conclusion and Relevance</h3><div>While DSE is safe and leads to an increase in stroke volume in patients with low-gradient AS regardless of LVEF, the association between DSE gradients and AS severity assessed by C-CT demonstrates important heterogeneity depending on LVEF, with the highest accuracy in patients with LVEF &lt;35%.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1023-1033"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555752","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":"Evaluating Discrepancies in Mitral Valve Area and Pressure Gradient: Implications for Diagnosing Severe Mitral Stenosis Under the 2023 Revised American Society of Echocardiography Recommendations","authors":"","doi":"10.1016/j.echo.2024.06.015","DOIUrl":"10.1016/j.echo.2024.06.015","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1103-1105"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499491","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":"Guidelines Reinforce Treatment Disparities for Patients with Aortic Stenosis","authors":"","doi":"10.1016/j.echo.2024.07.002","DOIUrl":"10.1016/j.echo.2024.07.002","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1119-1120"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581360","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":"The Areas and Gradients in Rheumatic Mitral Stenosis: A Tale of Highs and Lows","authors":"Jin Kyung Kim MD, PhD ,&nbsp;Anita Sadeghpour MD ,&nbsp;Natesa G. Pandian MD","doi":"10.1016/j.echo.2024.09.004","DOIUrl":"10.1016/j.echo.2024.09.004","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1106-1108"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299723","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":"Effectiveness of Negative Pressure Booths in Mitigating Airborne Infection Risk During Transesophageal Echocardiography","authors":"","doi":"10.1016/j.echo.2024.07.005","DOIUrl":"10.1016/j.echo.2024.07.005","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1111-1113"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601997","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":"Evolution of Natural Myocardial Shear Wave Behavior in Young Hearts: Determinant Factors and Reproducibility Analysis","authors":"Ahmed S. Youssef MD ,&nbsp;Aniela Petrescu MD, PhD ,&nbsp;Thomas Salaets MD ,&nbsp;Stéphanie Bézy MSc, PhD ,&nbsp;Laurine Wouters MSc ,&nbsp;Marta Orlowska MSc, PhD ,&nbsp;Annette Caenen MSc, PhD ,&nbsp;Jürgen Duchenne MSc, PhD ,&nbsp;Alexis Puvrez MD ,&nbsp;Bjorn Cools MD, PhD ,&nbsp;Ruth Heying MD, PhD ,&nbsp;Jan D’hooge MSc, PhD ,&nbsp;Marc Gewillig MD, PhD ,&nbsp;Jens-Uwe Voigt MD, PhD","doi":"10.1016/j.echo.2024.07.004","DOIUrl":"10.1016/j.echo.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial diastolic function assessment in children by conventional echocardiography is challenging. High–frame rate echocardiography facilitates the assessment of myocardial stiffness, a key factor in diastolic function, by measuring the propagation velocities of myocardial shear waves (SWs). However, normal values of natural SWs in children are currently lacking. The aim of this study was to explore the behavior of natural SWs among children and adolescents, their reproducibility, and the factors affecting SW velocities from childhood into adulthood.</div></div><div><h3>Methods</h3><div>One hundred six healthy children (2-18 years of age) and 62 adults (19-80 years of age) were recruited. High–frame rate images were acquired using a modified commercial scanner. An anatomic M-mode line was drawn along the ventricular septum, and propagation velocities of natural SWs after mitral valve closure were measured in the tissue acceleration–coded M-mode display.</div></div><div><h3>Results</h3><div>Throughout life, SW velocities after mitral valve closure exhibited pronounced age dependency (<em>r</em> = 0.73; <em>P</em> &lt; .001). Among the pediatric population, SW velocities correlated significantly with measures of cardiac geometry (septal thickness and left ventricular end-diastolic dimension), local hemodynamics (systolic blood pressure), and echocardiographic parameters of systolic and diastolic function (global longitudinal strain, mitral E/e′ ratio, isovolumic relaxation time, and mitral deceleration time) (<em>P</em> &lt; .001). In a multivariate analysis including all these factors, the predictors of SW velocities were age, mitral E/e′, and global longitudinal strain (<em>r</em> = 0.81).</div></div><div><h3>Conclusions</h3><div>Natural myocardial SW velocities in children can be detected and measured. SW velocities showed significant dependence on age and diastolic function. Natural SWs could be a promising additive tool for the assessment of diastolic function among children.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1051-1061"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604411","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":"Refining the Prothrombotic State in Atrial Fibrillation with Left Atrial Appendage 3D Echocardiography.","authors":"Laurie Soulat-Dufour, Sylvie Lang, Maharajah Ponnaiah, Théo Simon, Stephane Ederhy, Saroumadi Adavane-Scheuble, Marion Chauvet-Droit, Elodie Capderou, Camille Arnaud, Eleonore Sotto, Raphael Cohen, Thibault d'Izarny Gargas, Aliocha Scheuble, Nadjib Hammoudi, Anne-Sophie Beraud, Karima Addetia, Franck Boccara, Roberto M Lang, Ariel Cohen","doi":"10.1016/j.echo.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.echo.2024.10.014","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569583","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":"Perinatal Cardiac Functional Adaptation in Hypoplastic Left Heart Syndrome: A Longitudinal Analysis","authors":"","doi":"10.1016/j.echo.2024.06.020","DOIUrl":"10.1016/j.echo.2024.06.020","url":null,"abstract":"<div><h3>Background</h3><div>The perinatal transition is characterized by acute changes in cardiac loading. Compared with normal newborn combined cardiac output (CCO), single right ventricular (RV) output of neonates with hypoplastic left heart syndrome (HLHS) is markedly greater. The aim of this study was to examine the mechanisms of cardiac adaptation that facilitate this perinatal transition from late fetal to early neonatal life in HLHS.</div></div><div><h3>Methods</h3><div>Prospectively recruited pregnancies complicated by fetal HLHS (<em>n</em> = 35) and healthy control subjects (Ctrl; <em>n</em> = 17) underwent serial echocardiography in late gestation (38 ± 1 weeks) and 6, 24, and 48 hours after birth. Cardiac function was assessed using conventional, Doppler tissue, and speckle-tracking echocardiography.</div></div><div><h3>Results</h3><div>Term fetuses with HLHS had RV output comparable with Ctrl CCO via higher stroke volume. Compared with both left ventricular and RV indices of Ctrl, they exhibited globular and dilated right ventricles with reduced relative wall thickness (0.40 ± 0.08 vs 0.49 ± 0.10, <em>P</em> &lt; .01), increased Tei index′ (HLHS vs Ctrl left ventricle/Ctrl right ventricle: sphericity index, 0.9 ± 0.25 vs 0.5 ± 0.10/0.6 ± 0.11; RV area index, 28 ± 6 vs 15 ± 3/17 ± 5 cm²/m²; Tei index′, 0.65 ± 0.11 vs 0.43 ± 0.07/0.45 ± 0.09; <em>P</em> &lt; .0001 for all). Neonates with HLHS generated elevated RV cardiac output compared with Ctrl CCO via higher heart rate and stroke volume, with further RV dilatation, increased longitudinal systolic strain at 48 hours (−17 ± 4% vs −14 ± 3%/ 14 ± 5%) with reduced circumferential and rotational myocardial deformation and altered diastolic function. Neonates with HLHS also demonstrated right atrial enlargement with increased longitudinal strain: 6 hours (33 ± 12% vs 26 ± 6%), 24 hours (37 ± 15% vs 26 ± 13%), and 48 hours (38 ± 11% vs 24 ± 13%) (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Term fetuses with HLHS exhibit altered RV geometry and RV systolic and diastolic functional parameters. After birth, further alterations in these cardiac parameters likely reflect adaptation to acutely altered RV loading from increasing cardiac output and pulmonary artery flow demands.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1062-1072"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601998","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":"A Comparison of Perinatal Circulatory Transition in Critical Right and Left Heart Obstructive Lesions","authors":"Proscovia M. Mugaba MD ,&nbsp;Lisa K. Hornberger MD ,&nbsp;Angela McBrien MBBCh, MD ,&nbsp;Lindsay Mills MD ,&nbsp;Luke G. Eckersley MBBS, PhD","doi":"10.1016/j.echo.2024.07.007","DOIUrl":"10.1016/j.echo.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>During perinatal transition in hypoplastic left heart syndrome (HLHS), reduced systemic blood flow (Qs) and cerebral blood flow and increased pulmonary blood flow (Qp) are observed, contributing to hemodynamic instability. The aim of the present study was to explore whether similar or discordant perinatal changes occur in critical pulmonary outflow tract obstruction (POFO) compared with HLHS and healthy control subjects.</div></div><div><h3>Methods</h3><div>Echocardiography was prospectively performed at 36 to 39 gestational weeks and then serially from 6 to 96 hours after birth, before cardiac intervention. Combined cardiac output (CCO), superior vena cava (SVC) flow rate, Qs and Qp, and resistance indices (RIs) in the middle cerebral artery (MCA), celiac artery, and superior mesenteric artery were compared among the three groups.</div></div><div><h3>Results</h3><div>In fetal POFO (<em>n</em> = 19) and HLHS (<em>n</em> = 31), CCO was comparable with that in control subjects (<em>n</em> = 21) because of elevated stroke volume, but CCO in POFO was lower compared with HLHS (<em>P</em> &lt; .01). Compared with control subjects, POFO CCO was lower at 6 hours after delivery but comparable at 24 to 96 hours. In contrast, from 6 to 96 hours, the HLHS group had higher CCO than POFO and control subjects. Compared with control subjects, both neonates with POFO and those with HLHS had lower Qs and SVC flow (POFO at 24 hours, <em>P</em> &lt; .001; HLHS 6-hour Qs and 6- to 24-hour SVC flow). Compared with control subjects, Qp was increased in POFO at 48 to 96 hours (<em>P</em> &lt; .05) and in HLHS at all time points (<em>P</em> &lt; .001). Compared with fetal MCA RI, postnatal MCA RI was acutely higher in both POFO and HLHS, whereas in control subjects, it tended to decrease postnatally. Celiac artery RI and superior mesenteric artery pulsatility index were higher in POFO and HLHS from 6 to 48 hours vs control subjects.</div></div><div><h3>Conclusions</h3><div>POFO and HLHS demonstrate divergent acute hemodynamic changes in the early neonatal period, with early decreased CCO in POFO and increased CCO in HLHS. Both demonstrate early compromise in Qs and SVC (cerebral flow) and ongoing altered splanchnic flow.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1073-1082"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635558","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":"Diastolic Myocardial Stiffness Assessed by Shear Wave Elastography in Children With a Fontan Circulation","authors":"Thomas Salaets MD, PhD,&nbsp;Maëlys Venet MD,&nbsp;Aimen Malik MSc,&nbsp;Jerome Baranger PhD,&nbsp;Luc Mertens MD, PhD,&nbsp;Olivier Villemain MD, PhD","doi":"10.1016/j.echo.2024.07.010","DOIUrl":"10.1016/j.echo.2024.07.010","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"37 11","pages":"Pages 1116-1118"},"PeriodicalIF":5.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749537","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}