Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques最新文献

{"title":"Right Ventricular Global Longitudinal Strain and 30-Day Mortality in Intermediate-Risk Pulmonary Embolism: An External Validation Study","authors":"Shunsuke Eguchi,&nbsp;Ayumi Eguchi,&nbsp;Yoshiyuki Orihara,&nbsp;Michael Pfeiffer,&nbsp;Brandon Peterson,&nbsp;John Boehmer,&nbsp;Robert Biederman,&nbsp;Ryan Wilson","doi":"10.1111/echo.70612","DOIUrl":"10.1111/echo.70612","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intermediate-risk pulmonary embolism (PE) carries substantial short-term mortality. Our group previously demonstrated that right ventricular global longitudinal strain (RVGLS) predicted 30-day mortality in a single-center cohort using data collected before contemporary guideline updates, identifying a cutoff value of 17.7%. However, its prognostic value in contemporary external cohorts remains uncertain. We aimed to externally validate the association between RVGLS and 30-day mortality in an independent cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of 119 patients with intermediate-risk PE treated between 2019 and 2022 at an independent institution. The primary outcome was all-cause 30-day mortality. Clinical and echocardiographic parameters were compared between survivors and non-survivors. Receiver operating characteristic and Kaplan–Meier analyses were used to assess prognostic performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 66.1 years, and 48.7% were female. Six patients (5.0%) died within 30 days. RV strain analysis was feasible in 110 patients (92.4%). Non-survivors had lower RVGLS (17.3% vs. 19.6%, <i>p</i> = 0.013). In univariable analysis, RVGLS was associated with mortality (odds ratio 0.567, <i>p</i> = 0.033). RVGLS demonstrated discriminatory performance for 30-day mortality, with an area under the curve of 0.802. Using the previously established cutoff of 17.7%, patients with reduced RVGLS had higher 30-day mortality (Log-rank <i>p</i> = 0.042).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this external cohort, RVGLS ≤ 17.7% was associated with increased 30-day mortality, supporting the prognostic value of the previously established threshold beyond the original derivation cohort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70612","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-Diastolic Right Ventricle–Pulmonary Artery Pressure Gradient by Doppler Echocardiography to Guide Cardiac Magnetic Resonance Assessment of Pulmonary Regurgitation after Right Ventricular Outflow Tract Reconstruction","authors":"Junpei Kawamura,&nbsp;Kentaro Ueno,&nbsp;Tsubasa Shimozono,&nbsp;Yoshihiro Takahashi,&nbsp;Koji Nakae,&nbsp;Koji Takumi,&nbsp;Takashi Yoshiura,&nbsp;Yasuhiro Okamoto","doi":"10.1111/echo.70614","DOIUrl":"10.1111/echo.70614","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary regurgitation (PR) after right ventricular outflow tract (RVOT) reconstruction is a major driver of right ventricular (RV) remodeling. Cardiac magnetic resonance (CMR) is the reference standard for quantifying PR but is not routinely feasible in many pediatric follow-up settings. We evaluated whether an echocardiographic early-diastolic RV–pulmonary artery (PA) pressure gradient (Echo-EaDPG), derived from early-diastolic peak PR velocity (ΔP = 4v²), can serve as a practical complementary hemodynamic marker to guide CMR assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed patients with repaired tetralogy of Fallot or related conditions who underwent echocardiography, CMR, and cardiac catheterization within a 6-month interval of each other after RVOT reconstruction. Echo-EaDPG was compared with CMR-derived PR fraction (CMR-PRF) and catheter-measured early-diastolic RV–PA pressure gradient (Cathe-EaDPG). Clinically significant PR was operationally defined as CMR-PRF ≥ 25%. Correlation, multivariable analyses, receiver operating characteristic (ROC) analysis, and bootstrap internal validation were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty patients were included. Echo-EaDPG correlated with CMR-PRF (<i>r</i> = 0.65, <i>p</i> &lt; 0.001) and Cathe-EaDPG (<i>r</i> = 0.55, <i>p</i> &lt; 0.001) and was independently associated with CMR-PRF ≥ 25% among tested echocardiographic indices. Echo-EaDPG demonstrated good discrimination for identifying CMR-PRF ≥ 25% on ROC analysis (AUC = 0.90), with bootstrap-supported robustness. Interobserver agreement for Echo-EaDPG was excellent (ICC = 0.96, 95% CI 0.82–0.99, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Echo-EaDPG is a simple Doppler-derived parameter associated with CMR-quantified PR and invasive early-diastolic RV–PA gradients after RVOT reconstruction. As an adjunct to integrated echocardiographic assessment, Echo-EaDPG may help identify patients who warrant CMR for quantitative PR evaluation, particularly when routine CMR is difficult to obtain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Reservoir Strain and Heart Failure Rehospitalization Burden in Acute Heart Failure With Atrial Fibrillation","authors":"Jumpei Yamamoto,&nbsp;Keijiro Nakamura,&nbsp;Hiromasa Hayama,&nbsp;Yoshinari Enomoto,&nbsp;Masaya Yamamoto,&nbsp;Hidehiko Hara,&nbsp;Hisao Hara,&nbsp;Yukio Hiroi","doi":"10.1111/echo.70616","DOIUrl":"10.1111/echo.70616","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To examine associations of left atrial reservoir strain, diameter, and volume index with first rehospitalization and recurrent readmission burden in acute heart failure with atrial fibrillation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 716 enrolled patients, 691 with an available measurement formed the left atrial diameter analysis cohort; left atrial volume index (LAVI) and reservoir strain (LArs) were evaluated in a 320-patient single-center subgroup. Same-day rehospitalization and death were classified as death-first. Fine–Gray and negative-binomial models examined first rehospitalization and recurrent readmission burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 691 patients, 189 had rehospitalization-first, 118 death-first, and 384 were censored. In the 320-patient subgroup, lower LArs was associated with first rehospitalization (adjusted subdistribution hazard ratio [sHR] 0.920 per 1 percentage-point increase, 95% confidence interval [CI] 0.870–0.973) and with a higher recurrent readmission rate (incidence rate ratio 0.877, <i>p</i> &lt; 0.001); the first-event association persisted after additional echocardiographic adjustment including left atrial diameter (sHR 0.928, 95% CI 0.876–0.984). Left atrial diameter was associated with rehospitalization-first (sHR 1.025/mm, 95% CI 1.011–1.039) but not death-first, whereas LAVI was associated with neither, including per standard deviation. With exploratory cutoffs, only combined abnormality was associated with first rehospitalization (sHR 2.12, 95% CI 1.16–3.85). Left atrial indices did not significantly improve discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lower LArs was associated with first heart failure rehospitalization and recurrent readmission burden, and remained associated after additional echocardiographic adjustment including left atrial diameter. Left atrial diameter was associated with first rehospitalization but LAVI was not; a general left atrial structural mechanism is not established. Incremental predictive value was limited; cohort-derived cutoffs require external validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Strain for Risk Stratification of Later-Detected Atrial Fibrillation After Acute Ischemic Stroke.","authors":"Hyejung Choi, Hyun-Wook Chu, Won-Woo Seo, Sung Eun Kim, Jun-Hee Lee, Dae-Gyun Park, Kyoo-Rok Han","doi":"10.1111/echo.70628","DOIUrl":"10.1111/echo.70628","url":null,"abstract":"<p><strong>Purpose: </strong>Atrial fibrillation (AF) may be detected after acute ischemic stroke (AIS) even when it is not identified during the initial stroke evaluation. This study evaluated the association between left atrial strain (LAS) parameters measured by routine echocardiography and later-detected AF after AIS.</p><p><strong>Methods: </strong>This retrospective study included 490 patients with AIS without prior or concurrent AF who underwent speckle-tracking LAS analysis. Later-detected AF was defined as AF newly documented more than 7 days after the index stroke. Clinical and echocardiographic parameters were compared according to later-detected AF status, and associations were evaluated using logistic regression. Exploratory receiver operating characteristic (ROC) analysis assessed the discriminatory ability of the LAS parameters.</p><p><strong>Results: </strong>Over a median follow-up of 30.6 months, later-detected AF was observed in 23 patients (4.7%). Patients with later-detected AF had lower LA reservoir strain (LASr) and less negative LA contractile strain (LASct) than those without AF (LASr: 22.4% ± 5.3% vs. 29.1% ± 8.9%; LASct: -11.3% ± 4.2% vs. -16.3% ± 5.5%; both p < 0.001). In multivariable models adjusted for CHA₂DS₂-VA score and LA volume index (LAVI), both LASr and LASct remained associated with later-detected AF (LASr: odds ratio [OR], 0.93; 95% confidence interval [CI], 0.87-0.98; p = 0.010; LASct: OR, 0.86; 95% CI, 0.78-0.93; p < 0.001). ROC analysis showed modest discriminatory ability for LASr, LASct, and LAVI.</p><p><strong>Conclusion: </strong>LASr and LASct were associated with later-detected AF after AIS and may help identify patients who may warrant closer rhythm surveillance when extended monitoring is limited.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70628"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Presystolic Wave with Subclinical Left Ventricular Dysfunction in Obstructive Sleep Apnea Syndrome.","authors":"Mevhibe Altınışık, Fatih Gülçebi, Ebru Ateş, Nisanur Yılmaz, Selim Kul","doi":"10.1111/echo.70632","DOIUrl":"10.1111/echo.70632","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea syndrome (OSAS) is associated with subclinical myocardial dysfunction. This study aimed to evaluate the association between presystolic wave (PSW) and left ventricular global longitudinal strain (GLS) in patients with confirmed OSAS and to determine whether PSW may serve as a simple echocardiographic marker of subclinical left ventricular systolic dysfunction.</p><p><strong>Methods: </strong>A total of 103 patients with polysomnography-confirmed OSAS were prospectively enrolled. Patients were classified according to the presence or absence of PSW. Clinical characteristics, polysomnographic findings, conventional echocardiographic parameters, and left ventricular GLS obtained by two-dimensional speckle-tracking echocardiography were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with the presence of PSW.</p><p><strong>Results: </strong>Fifty-seven patients were classified as PSW-positive and 46 as PSW-negative. Patients with PSW had significantly higher apnea-hypopnea index values and a greater prevalence of severe OSAS. Although left ventricular ejection fraction remained within the normal range in both groups, GLS was significantly impaired in PSW-positive patients (-16.1 ± 1.9% vs. -18.1 ± 1.3%, p < 0.001). In multivariable logistic regression analysis, GLS remained independently associated with PSW presence after adjustment for apnea-hypopnea index, body mass index, waist circumference, and beta-blocker use (OR, 2.19; 95% CI, 1.52-3.15; p < 0.001). Among patients with detectable PSW, the median peak PSW velocity was 65 cm/s (interquartile range, 57-70 cm/s) and was not significantly correlated with GLS or apnea-hypopnea index.</p><p><strong>Conclusions: </strong>In patients with OSAS, the presence of a PSW is independently associated with impaired GLS despite preserved left ventricular ejection fraction. These findings suggest that PSW may serve as a simple, non-invasive, and readily available echocardiographic marker of subclinical left ventricular systolic dysfunction in this population. Presystolic wave (PSW) has been proposed as a simple echocardiographic marker of left ventricular dysfunction. Its relationship with myocardial deformation in obstructive sleep apnea (OSA) remains uncertain. Patients with OSA underwent comprehensive transthoracic echocardiography, including Doppler assessment of PSW and speckle-tracking analysis of global longitudinal strain (GLS). Clinical, polysomnographic, and echocardiographic parameters were compared according to PSW status. PSW may serve as a simple and readily available echocardiographic marker of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70632"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Applications of Right Ventricular Strain by Two-Dimensional Speckle-Tracking Echocardiography.","authors":"Anca Balinisteanu, Miaomiao Liu, Reza Bahrami Gorji, Karolina Gumiezna, Dragos Vinereanu, Marta Cvijic, Jens-Uwe Voigt","doi":"10.1111/echo.70615","DOIUrl":"10.1111/echo.70615","url":null,"abstract":"<p><p>Assessment of right ventricular (RV) function by two-dimensional (2D) echocardiography remains challenging due to complex geometry, limited acoustic windows, and the angle dependency of conventional parameters. RV longitudinal strain, derived from 2D speckle-tracking echocardiography, has emerged as a quantitative, angle-independent marker of myocardial deformation, enabling earlier detection of dysfunction and providing incremental diagnostic and prognostic value beyond traditional indices in selected settings. RV free-wall longitudinal strain is most commonly used in clinical practice, with established reference values and growing applicability across a broad spectrum of cardiovascular and pulmonary diseases, including pulmonary hypertension, heart failure, ischemic heart disease, cardiomyopathies, and valvular heart disease. However, despite growing evidence supporting its clinical utility, its integration into routine decision-making remains limited. Important constraints persist, particularly inter-vendor variability and relatively high test-retest variability, which affect reproducibility and limit standardization. Emerging techniques, including three-dimensional strain, and artificial intelligence-based analysis, once sufficiently validated and standardized, hold potential to improve measurement accuracy and reproducibility.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70615"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LVH-Voltage Discordance and Myocardial Dysfunction in Wild-Type Transthyretin Cardiomyopathy: A Prospective Cohort Study.","authors":"Nihan Bahadır, Onur Osman Şeker, Seçkin Dereli","doi":"10.1111/echo.70625","DOIUrl":"10.1111/echo.70625","url":null,"abstract":"<p><strong>Background: </strong>In wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM), increased left ventricular wall thickness reflects amyloid infiltration rather than myocyte hypertrophy, and QRS voltage may not rise proportionally. Whether this electrical-anatomical discordance marks myocardial dysfunction and adverse outcomes within established disease is uncertain.</p><p><strong>Methods: </strong>We prospectively enrolled 220 consecutive patients with newly diagnosed wtATTR-CM in a single-centre cohort. LVH-voltage discordance was defined as maximum LV wall thickness ≥12 mm with a Sokolow-Lyon voltage < 3.5 mV. The primary outcome was absolute global longitudinal strain (GLS); secondary outcomes included impaired GLS (< 16%), serial GLS change, and clinical events.</p><p><strong>Results: </strong>Discordance was present in 41.8%. Absolute GLS was lower with discordance (13.4 ± 2.8% vs. 17.3 ± 3.5%), including after multivariable adjustment (β -2.21, 95% CI -3.04 to -1.39; p< 0.001), without interaction by rhythm (p = 0.52). Impaired GLS was more prevalent (81.5% vs. 35.2%; adjusted prevalence ratio 1.66, 95% CI 1.28-2.15). The continuous QRS amplitude-to-wall-thickness index correlated with absolute GLS (ρ = 0.35; p< 0.001). Over a median 16.0 months, discordance was associated with cardiovascular death or first heart failure hospitalization (adjusted HR 3.88, 95% CI 1.43-10.52) and first heart failure hospitalization (adjusted HR 3.48, 95% CI 1.08-11.18); mortality estimates were imprecise. Among 142 patients with serial imaging, adjusted annual GLS decline was greater with discordance (-0.65 vs. -0.31 percentage points/year).</p><p><strong>Conclusions: </strong>In established wtATTR-CM, LVH-voltage discordance was associated with worse baseline GLS, a less favorable longitudinal GLS trajectory, and HF-related outcomes. It may provide a simple marker for within-disease phenotyping, but these findings require external validation.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70625"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Strain as an Early Marker of Anthracycline-Related Cardiac Dysfunction (LAS-MACD).","authors":"Chonthicha Tanking, Nanthasit Samansit, Chanwit Wuttichaipradit","doi":"10.1111/echo.70629","DOIUrl":"10.1111/echo.70629","url":null,"abstract":"<p><strong>Purpose: </strong>Global longitudinal strain (GLS) is the recommended marker for cancer therapy-related cardiac dysfunction (CTRCD) but may miss the earliest myocardial changes. We examined whether early decline in left atrial strain (LAS) precedes GLS change in patients who subsequently develop CTRCD.</p><p><strong>Methods: </strong>In a single-center retrospective cohort of 62 women with breast cancer, speckle-tracking echocardiography measured LAS and GLS at baseline (T0), after the fourth anthracycline cycle (T1), and 3-6 months after treatment (T2). CTRCD (2022 ESC criteria) was classified by onset (T1 or T2). Analyses were exploratory.</p><p><strong>Results: </strong>CTRCD occurred in 26 patients (41.9%): 8 T1-onset, 18 T2-onset. In T2-onset patients, the early (T0→T1) relative decline in LA reservoir strain (LASr) already exceeded that of no-CTRCD patients (-19.5 ± 13.9% vs -6.4 ± 11.3%; p = 0.001), whereas early GLS change did not differ (p = 0.43). Early LASr change had the highest area under the curve (AUC) for subsequent CTRCD (0.78; 95% CI 0.65-0.90) versus GLS (0.59; DeLong p = 0.10). An exploratory 6.35% LASr decline threshold gave 100% sensitivity (95% CI 82-100%), 56% specificity (95% CI 40-71%), and 100% negative predictive value; bootstrap-corrected AUC was 0.77. LASr and GLS were only weakly-to-moderately correlated (r = -0.29 baseline; r = -0.41 early change).</p><p><strong>Conclusion: </strong>In this small retrospective cohort, early LASr decline was associated with, and tended to precede, GLS change in women who subsequently developed anthracycline-associated CTRCD. These hypothesis-generating findings support LASr as a potential early, high-sensitivity adjunctive marker requiring prospective validation.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70629"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Volume Index, Left Ventricular Outflow Tract Gradient, and Incident Atrial Fibrillation in Hypertrophic Cardiomyopathy.","authors":"Oday Salman, Arun Gajan Pradeep, Sutopa Purkayastha, Valay Parikh, Eric P Stahl","doi":"10.1111/echo.70624","DOIUrl":"10.1111/echo.70624","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a common complication of hypertrophic cardiomyopathy (HCM). Whether left atrial volume index (LAVI) or resting left ventricular outflow tract (LVOT) gradient better identifies patients who develop AF is unresolved.</p><p><strong>Objectives: </strong>To compare baseline LAVI and resting LVOT gradient as predictors of incident AF in HCM.</p><p><strong>Methods: </strong>We retrospectively studied 777 patients with HCM identified by ICD-10 code I42.1 (obstructive hypertrophic cardiomyopathy). Patients with pre-existing AF or atrial flutter were excluded, leaving 547 patients. The primary exposure was baseline LAVI (available in 167 patients; 25 incident AF events), analyzed per 10-mL/m² increment. Incident AF was defined as new AF, AF hospitalization, or cardioversion after the index date, and evaluated using Cox models. Secondary analyses assessed LVOT gradient, LAVI tertiles, time-varying mavacamten exposure, and competing risks.</p><p><strong>Results: </strong>During a median follow-up of 2.31 years, 60 patients developed incident AF. LAVI was independently associated with incident AF in the prespecified model adjusted for age, sex, and hypertension (adjusted HR per 10 mL/m², 1.27; 95% CI, 1.03-1.57; p = 0.025). AF risk increased across LAVI tertiles (log-rank χ² = 9.48; p = 0.0087). Resting LVOT gradient was also independently associated with incident AF after the same adjustment (HR per 10 mm Hg, 1.07; 95% CI, 1.00-1.15; p = 0.042; n = 190, 26 events). In a head-to-head model, neither association remained significant.</p><p><strong>Conclusions: </strong>In HCM, LAVI and resting LVOT gradient were each independently associated with incident AF, and neither remained significant when modeled together. LAVI may serve as a practical echocardiographic marker to refine AF risk assessment.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70624"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Non-Obstructive Coronary Atherosclerosis and Myocardial Work in Patients with Type 2 Diabetes Mellitus: A Coronary CT Angiography Study.","authors":"Nazile Bilgin Doğan, Özdemir Kuzucu","doi":"10.1111/echo.70631","DOIUrl":"10.1111/echo.70631","url":null,"abstract":"<p><strong>Aims: </strong>Despite advances in cardiovascular prevention, patients with type 2 diabetes mellitus (T2DM) remain at increased risk of developing subclinical myocardial dysfunction before overt cardiovascular disease becomes clinically apparent. Whether anatomically defined non-obstructive coronary atherosclerosis is associated with impaired myocardial work before obstructive coronary artery disease (CAD) develops remains unknown. This study investigated the association between coronary atherosclerotic burden on coronary computed tomography angiography (CCTA) and myocardial work in patients with T2DM and preserved left ventricular ejection fraction (LVEF).</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, consecutive T2DM patients who underwent both CCTA and transthoracic echocardiography a median of 41 days apart (interquartile range 31-57) were categorized by Coronary Artery Disease Reporting and Data System (CAD-RADS 2.0) categories 0-2. Global work efficiency (GWE) was the predefined primary outcome. Associations with myocardial work were evaluated using Jonckheere-Terpstra trend analyses and multivariable linear regression, with CAD-RADS modelled both as an ordinal term and categorically, and with adjustment extended beyond the original covariate set to include body mass index, diabetes duration, smoking, heart rate and estimated glomerular filtration rate. Secondary outcomes were corrected for multiplicity using the Holm procedure.</p><p><strong>Results: </strong>Among 114 patients (CAD-RADS 0, n = 21; CAD-RADS 1, n = 46; CAD-RADS 2, n = 47), GWE declined progressively across increasing CAD-RADS categories (98.0 ± 0.4%, 96.2 ± 1.1% and 93.0 ± 3.5%), while global wasted work increased (37 [interquartile range 32-44], 67 [61-77] and 98 [90-103] mmHg%; both p for trend <0.001). Global longitudinal strain (GLS) did not differ significantly (-20.1 ± 2.1%, -19.7 ± 1.9% and -19.3 ± 3.1%; p for trend = 0.239), and left ventricular ejection fraction remained normal in every category although a modest downward trend was present (p for trend = 0.011). Each one-category increase in CAD-RADS was independently associated with a 2.69 percentage-point lower GWE (95% CI -3.36 to -2.03) and a 30.6 mmHg% higher global wasted work (95% CI 28.0 to 33.3; both p < 0.001), with consistent findings for the Agatston score.</p><p><strong>Conclusions: </strong>In patients with T2DM and preserved LVEF, non-obstructive coronary atherosclerosis was independently associated with impaired myocardial mechanical efficiency, whereas global longitudinal strain did not differ significantly across categories. Because the design was cross-sectional, these findings describe an association and cannot establish causality or temporal sequence; prospective studies are required to determine whether myocardial work adds incremental prognostic value.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70631"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}