Journal of the American Society of Echocardiography最新文献

{"title":"Dapagliflozin Effects on Left Ventricular Remodeling and Filling Pressures in Heart Failure With Reduced Ejection Fraction","authors":"Mauro Acquaro MD ,&nbsp;Laura Scelsi MD ,&nbsp;Camilla Mascolo MD ,&nbsp;Costantino Pelosi MD ,&nbsp;Alessandra Greco MD ,&nbsp;Annalisa Turco MD ,&nbsp;Sandra Schirinzi MD ,&nbsp;Mariangela Lattanzio MD ,&nbsp;Tullia Resasco MD ,&nbsp;Valentina Mercurio MD, PhD ,&nbsp;Claudio Di Lorenzo MD ,&nbsp;Edoardo Marovino PharmD ,&nbsp;Leonardo De Luca MD, PhD ,&nbsp;Stefano Ghio MD","doi":"10.1016/j.echo.2024.10.009","DOIUrl":"10.1016/j.echo.2024.10.009","url":null,"abstract":"<div><h3>Aims</h3><div>The benefits of sodium glucose cotransporter 2 inhibitors in patients with heart failure with reduced ejection fraction (HFrEF) have been clearly demonstrated in randomized clinical trials. However, the mechanisms of the observed beneficial effects remain incompletely understood. This study aimed to assess morphofunctional cardiac changes following dapagliflozin introduction in stable outpatients with HFrEF and to investigate whether these changes were determinants of the improved clinical outcome.</div></div><div><h3>Methods</h3><div>In this multicenter, prospective observational study, 300 consecutive HFrEF patients ≥18 years old on optimized medical therapy and eligible for dapagliflozin therapy were enrolled between April 2022 and January 2023. Laboratory and echocardiographic assessments were performed at baseline and after a median of 6 months.</div></div><div><h3>Results</h3><div>Following dapagliflozin initiation, 47% of patients achieved a target of improvement in left ventricular end-diastolic volume (Δ EDVi &lt; −10%) and/or end-systolic volume (Δ ESVi &lt; –15%) and/or ejection fraction (Δ EF% &gt; 10%) at 6 months. The proportion of patients with elevated left ventricular filling pressures decreased from 26% to 3% at 6 months (<em>P</em> &lt; .001). The combination of left ventricular remodeling and filling pressures improvements was associated with absence of heart failure–related hospitalizations and significant natriuretic peptide reduction at 12 months.</div></div><div><h3>Conclusions</h3><div>Dapagliflozin determined left ventricular remodeling and improved left ventricular filling pressures in a high proportion of patients with stable HFrEF patients already on optimized medical therapy. These improvements were associated with absence of heart failure–related hospitalizations and a significant natriuretic peptide reduction at 12 months.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages 395-403"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569572","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":"Diastolic Dysfunction and Survival in Patients With Preserved or Mildly Reduced Left Ventricular Ejection Fraction Following Myocardial Infarction","authors":"Nicole Ivy Chan MD ,&nbsp;John J. Atherton MBBS, PhD ,&nbsp;Anish Krishnan MBBS, MClinEpi ,&nbsp;Christopher Hammett MBBS, MD ,&nbsp;Peter Stewart MBBS ,&nbsp;Michael Mallouhi BSc ,&nbsp;William Vollbon BSc ,&nbsp;Liza Thomas MBBS, PhD ,&nbsp;Sandhir B. Prasad MBBS, PhD","doi":"10.1016/j.echo.2025.01.007","DOIUrl":"10.1016/j.echo.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular ejection fraction (LVEF) is relatively indiscriminate for prognosis in patients with preserved or mildly reduced LVEF (&gt;40%) following myocardial infarction (MI). This study sought to determine the value of guideline-based assessment of diastolic dysfunction (DD) in predicting long-term all-cause and cardiac mortality in patients with a first-ever MI and LVEF &gt;40%.</div></div><div><h3>Methods</h3><div>A retrospective single-center study involving 2,234 patients with a first-ever MI (ST elevation MI or non–ST elevation MI) with LVEF &gt;40% was performed. Clinical, angiographic, echocardiographic, and outcomes data were obtained from prospectively maintained institutional and statewide databases. Echocardiography was performed early postadmission for all patients. Significant DD was defined was grade 2 and 3 DD.</div></div><div><h3>Results</h3><div>The mean age of patients was 61.4 ± 12.3 years, 70.7% were male, and 12.1% had 3-vessel disease. The mean LVEF was 55.8% ± 7.2%, and 14.1% had significant DD. At a median follow-up of 4.5 years, there were 219 deaths (46 cardiac deaths). On Cox proportional hazards multivariable analyses incorporating significant clinical, angiographic, and echocardiographic variables, significant DD was an independent predictor of both all-cause (hazard ratio = 2.01; 95% CI, 1.37-2.94; <em>P</em> &lt; .001) and cardiac (hazard ratio = 3.97; 95% CI, 1.98-7.99; <em>P</em> &lt; .001) mortality. Bootstrapping and calculation of Harrel's <em>C</em> confirmed the independent association of significant DD with outcomes.</div></div><div><h3>Conclusions</h3><div>Significant DD is an independent predictor of all-cause and cardiac mortality following MI in patients with preserved or mildly reduced LVEF and thus effectively reclassifies prognosis in a subgroup where the LVEF is relatively indiscriminate for survival. The benefit of further investigation and/or treatment in this subgroup needs further study.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages 380-391"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014999","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 Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study","authors":"Yi Wang MD, PhD ,&nbsp;Quirino Ciampi MD, PhD ,&nbsp;Lauro Cortigiani MD ,&nbsp;Angela Zagatina MD ,&nbsp;Ratnasari Padang MD, PhD ,&nbsp;Garvan C. Kane MD, PhD ,&nbsp;Hector R. Villarraga MD ,&nbsp;Jesus Peteiro Vazquez MD ,&nbsp;Elena Kalinina MD ,&nbsp;Alla Boshchenko MD ,&nbsp;Tamara Ryabova MD ,&nbsp;Fiore Manganelli MD ,&nbsp;Hugo Rodriguez-Zanella MD ,&nbsp;Jelena Celutkiene MD ,&nbsp;Elisa Merli MD ,&nbsp;Clarissa Borguezan-Daros MD ,&nbsp;Jorge Lowenstein MD ,&nbsp;Rosina Arbucci MD ,&nbsp;Diego M. Lowenstein Haber MD ,&nbsp;Sofia Marconi MD ,&nbsp;Eugenio Picano MD, PhD","doi":"10.1016/j.echo.2024.12.012","DOIUrl":"10.1016/j.echo.2024.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes.</div></div><div><h3>Methods</h3><div>In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction, force (SBP/LVESV), stroke volume (SV), arterial elastance, ventricular-arterial coupling, and left atrial volume index were assessed. Global longitudinal strain was available in 1,164 patients (48.9%). Six hundred eighty patients finished follow-up with a composite endpoint of major adverse cardiac events (MACEs). Patients were divided into three groups: group 1, low force (&lt;25th percentile, &lt;3.24 mm Hg/mL); group 2, intermediate force (≥25th percentile and ≤75th percentile, 3.24-5.48 mm Hg/mL); and group 3, high force (&gt;75th percentile, &gt;5.48 mmHg/mL).</div></div><div><h3>Results</h3><div>The three groups showed a gradient with descending values (group 3 &gt; group 2 &gt; group 1) for SBP, LV ejection fraction, global longitudinal strain, arterial elastance, and ventricular-arterial coupling, with the opposite gradient (group 1 &gt; group 2 &gt; group 3) for LVEDV, LVESV, SV, and left atrial volume index values (<em>P</em> &lt; .01 for all). After a median follow-up period of 16 months, 205 MACEs occurred in 138 patients. The cumulative MACE rate was lowest in group 2 (14.7% person-years) and higher in groups 1 (16.1% person-years) and 3 (22.9% person-years; log-rank <em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>Patients with HFpEF present with different LV contractile phenotypes, easily identified with resting LV force and volumetric transthoracic echocardiography. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LVEDV and normal SV, while the hypercontractile phenotype is characterized by a small left ventricle with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk for subsequent events.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages 409-420"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015031","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.2025.03.005","DOIUrl":"10.1016/j.echo.2025.03.005","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Page A11"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890831","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 MD ,&nbsp;Scott A. Hubers MD ,&nbsp;Jenny J. Cao MB Bchir ,&nbsp;Christopher G. Scott MS ,&nbsp;Robert B. McCully MD ,&nbsp;Matteo Castrichini MD ,&nbsp;Marta Figueiral MD ,&nbsp;Akanksha Mohananey MD ,&nbsp;Li Wang MBBS, PhD ,&nbsp;Rajiv Gulati MD, PhD ,&nbsp;Roberta Montisci MD ,&nbsp;Patricia A. Pellikka MD ,&nbsp;Naveen L. Pereira MD","doi":"10.1016/j.echo.2024.11.008","DOIUrl":"10.1016/j.echo.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages 421-430"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","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":"Association of Impaired Relaxation Mitral Inflow Pattern (Grade 1 Diastolic Function) With Long-Term Noncardiovascular and Cardiovascular Mortality","authors":"Kathleen A. Young MD,&nbsp;Richard J. Rodeheffer MD,&nbsp;Jared G. Bird MD,&nbsp;William R. Miranda MD,&nbsp;Horng H. Chen MB, BCh,&nbsp;Jae K. Oh MD,&nbsp;Garvan C. Kane MD, PhD","doi":"10.1016/j.echo.2025.01.005","DOIUrl":"10.1016/j.echo.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Abnormalities of left ventricular diastolic function are established independent predictors of heart failure and mortality. The aim of this study was to determine whether the association of diastolic function with all-cause mortality is driven by cardiovascular or noncardiovascular death and if impaired relaxation mitral inflow filling pattern is a risk marker.</div></div><div><h3>Methods</h3><div>Diastolic function was graded by the Mayo Clinic algorithm using the well-characterized prospective Olmsted County Heart Function Study. Those with reduced left ventricular ejection fraction, moderate or greater valve disease, clinical diagnosis of heart failure, or indeterminate diastolic function were excluded. Notably, all patients with an impaired relaxation pattern (E/A ratio &lt; 0.8) were classified as abnormal (grade 1) regardless of ejection fraction and clinical or other echocardiographic abnormalities. Individuals were followed for a median of 19.7 years (interquartile range, 18.9-20.6 years) for mortality outcomes.</div></div><div><h3>Results</h3><div>In a community cohort of 1,005 subjects 63 years (interquartile range, 57-71 years) of age, grade 1 diastolic function was common (26%) and associated with all-cause mortality (hazard ratio [HR], 4.05; 95% CI, 3.22-5.09; <em>P</em> &lt; .0001). This association persisted in a subgroup of those with impaired myocardial relaxation and no other clinical or echocardiographic abnormalities (HR, 2.71; 95% CI, 1.89-3.88; <em>P</em> &lt; .0001). The association of diastolic function with noncardiovascular death was not significant after adjustment for age, sex, and comorbidities, though there was an association with grade 1 diastolic function and risk for death of dementia (age- and sex-adjusted HR, 2.30; 95% CI, 1.54-3.45; <em>P</em> &lt; .001). The association of diastolic function and cardiovascular mortality persisted in multivariable model, including for grade 1 diastolic function (HR, 2.43; 95% CI, 1.16-5.05; <em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>Impaired relaxation mitral inflow pattern (grade 1) is common in older adults in the community and found to be associated with cause-specific death, highlighting this simple echocardiographic finding as a potential biomarker of cardiovascular and cognitive risk and not necessarily a benign finding that is normal with age.</div></div>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages 367-377"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014947","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":"Assessment of Diastolic Function: Is It Time to Relax? Rethinking Echocardiographic Approaches","authors":"Thor Edvardsen MD, PhD ,&nbsp;Lars Gunnar Klæboe MD, PhD","doi":"10.1016/j.echo.2025.02.004","DOIUrl":"10.1016/j.echo.2025.02.004","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages 378-379"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460457","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":"Moving ASE into the Innovation Fast Lane: The Expanding IRT and the Launch of the First ASE Accelerator Program","authors":"Steven Lester MD, FASE,&nbsp;Meredith Morovati MBA,&nbsp;Samantha King","doi":"10.1016/j.echo.2025.03.007","DOIUrl":"10.1016/j.echo.2025.03.007","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages A9-A10"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890830","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":"Information for Readers","authors":"","doi":"10.1016/S0894-7317(25)00182-8","DOIUrl":"10.1016/S0894-7317(25)00182-8","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Pages A7-A8"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891636","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":"Unveiling the Left Atrioventricular Coupling Index: A Promising Marker for Diastolic Dysfunction and Prognosis","authors":"Yong-Huai Wang MD, PhD,&nbsp;Yu Dong MD,&nbsp;Guang-Yuan Li MD,&nbsp;Chun-Yan Ma MD, PhD","doi":"10.1016/j.echo.2024.12.014","DOIUrl":"10.1016/j.echo.2024.12.014","url":null,"abstract":"","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":"38 5","pages":"Page 448"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068997","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}