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

{"title":"Right Ventricular Myocardial Work by Echocardiography: A Scoping Review of Methodology, Validation, and Clinical Applications.","authors":"Ehsan Shahverdi, Carsten Schneider, Mathias Lange","doi":"10.1111/echo.70620","DOIUrl":"10.1111/echo.70620","url":null,"abstract":"<p><strong>Background: </strong>Echocardiographic assessment of right ventricular (RV) function remains challenging because conventional functional and deformation indices are strongly influenced by loading conditions. Right ventricular myocardial work (RVMW), derived by integrating myocardial deformation with ventricular pressure, has emerged as a potential framework for contextualizing RV mechanics according to afterload. However, its methodology, validation, clinical applications, and readiness for routine use have not been comprehensively mapped.</p><p><strong>Methods: </strong>A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported according to PRISMA-ScR. MEDLINE via PubMed was systematically searched from inception through August 14, 2026. The search was supplemented by targeted terminology-based searches, backward and forward citation tracking, reference-list screening, and searches using individual RVMW indices. Original human studies quantitatively evaluating echocardiography-derived RVMW were eligible. Data were charted regarding study characteristics, RVMW methodology, pressure source, work indices, validation strategy, clinical application, prognostic value, reproducibility, and methodological limitations.</p><p><strong>Results: </strong>Thirty-nine studies met the eligibility criteria. The evidence encompassed several related but methodologically distinct RVMW constructs: 27 studies primarily used conventional non-invasive subpulmonary RV pressure-strain-loop analysis, three regional myocardial-work approaches, two systemic-RV myocardial work, two invasive-pressure-integrated approaches, two single-ventricle/Fontan approaches, and three emerging three-dimensional or volume-integrated pressure-strain-volume/pressure-volume methods. These constructs differ in pressure source, ventricular geometry, and mathematical derivation and are not numerically interchangeable. The literature evolved from early physiological and proof-of-concept investigations toward invasive validation, reference-value assessment, disease-specific phenotyping, interventional studies, and preliminary prognostic applications. Pulmonary hypertension represented the most extensively investigated clinical domain, while applications expanded to heart failure, congenital and systemic-RV physiology, mechanical circulatory support, structural interventions, pediatric populations, and physiological adaptation. Substantial heterogeneity remained in strain definition, RV segmentation, pressure estimation, pressure-curve construction, and analytical methodology.</p><p><strong>Conclusions: </strong>Echocardiography-derived RVMW is a promising integrative framework that contextualizes RV deformation according to prevailing pressure load and may provide complementary information beyond conventional RV functional indices. Current evidence is strongest in pulmonary hypertension, while applications across other cardiovascular and systemic ","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70620"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972208","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":"Prevalence of Left Ventricular Diastolic Dysfunction and Prognostic Value in Septic Shock Patients According to Different Guidelines: Comparison Between Contemporary Cardiological Algorithms and Simplified Approaches.","authors":"Filipe A Gonzalez, Érico Costa, Deborah Rondinella, Filippo Sanfilippo","doi":"10.1111/echo.70638","DOIUrl":"https://doi.org/10.1111/echo.70638","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of left ventricular diastolic dysfunction (LVDD) in the context of septic shock is challenging. We aimed to compare different algorithms applied to septic patients.</p><p><strong>Methods: </strong>Secondary analysis of a prospective, single-center study of 98 consecutive adult septic shock patients undergoing comprehensive speckle-tracking echocardiography within 24 h of ICU admission. We studied the prevalence and the prognostic value of five LVDD diagnostic algorithms:2016-American Society of Echocardiography (ASE)/European Association CardioVascular Imaging(EACVI), 2024-British Society of Echocardiography(BSE), 2025-ASE, Lanspa-simplified criteria, and a further Lanspa-modified version hereby proposed (adding LVDD diagnosis when LV ejection fraction< 50%, as in 2016-ASE-EACVI guidelines). Logistic regression and Kaplan-Meier curves were used to explore the association between algorithms and 30-day mortality.</p><p><strong>Results: </strong>The prevalence of LVDD on day 1 varied widely, ranging from 32.7%(Lanspa) to 72.4%(2024-BSE). Concordance between the three cardiology guidelines ranged from slight to moderate: the lowest agreement among them was observed between the 2016-ASE/EACVI and the 2025-ASE criteria(55.1%, Kappa 0.10), whereas the highest agreement across all five algorithms was seen between the 2016-ASE/EACVI and the Lanspa-modified criteria(88.8%, Kappa 0.77). When correcting for severity score, need for invasive ventilation, and norepinephrine dose, independent prognostic values for 30-day mortality were observed only for the 2025-ASE, the Lanspa and the Lanspa-modified algorithms, but all algorithms had similar predictive performances.</p><p><strong>Conclusions: </strong>The prevalence of LVDD in septic shock is highly dependent on the diagnostic algorithm utilized. Although only the 2025-ASE, Lanspa, and Lanspa-modified algorithms demonstrated independent prognostic value after multivariable adjustment, prognostic discrimination for 30-day mortality was moderate and comparable across all approaches.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70638"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065668","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":"Serial Changes in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation: Associations With Ischemic Heart Disease and Left Ventricular End-Diastolic Diameter.","authors":"Koji Tanaka, Shigetaka Kageyama, Hirofumi Sugiyama, Riho Sano, Takahiro Suzuki, Aya Endo, Miho Kusuyama, Hiromi Takamura, Fumie Sano, Yohei Sumizawa, Sakurako Mizushima, Yusuke Suzuki, Kengo Shigenaga, Kango Sakamoto, Hidekatsu Fujita, Dai Motosugi, Eriko Kojima, Eri Ishikawa, Yoshinori Tokumasu, Muneaki Yamada, Michitomo Kawahito, Koichiro Murata, Masanao Nakai, Ryuzo Nawada, Tomoya Onodera","doi":"10.1111/echo.70626","DOIUrl":"10.1111/echo.70626","url":null,"abstract":"<p><strong>Purpose: </strong>Left ventricular ejection fraction (LVEF) recovery after transcatheter aortic valve implantation (TAVI) varies among patients with severe aortic stenosis and reduced LVEF. We characterized serial changes in LVEF and examined their associations with ischemic heart disease (IHD) and baseline left ventricular end-diastolic diameter.</p><p><strong>Methods: </strong>Among 685 patients who underwent TAVI between 2014 and 2024, 121 with native-valve severe aortic stenosis and baseline LVEF < 50% were analyzed. Echocardiography was performed before TAVI, early after TAVI (median, 3 days), and at 1, 6, and 12 months. Serial LVEF recovery was evaluated using linear mixed-effects models incorporating all available post-TAVI measurements.</p><p><strong>Results: </strong>LVEF improved significantly through 1 year, with a model-estimated increase of 12.3 percentage points (p < 0.001); left ventricular end-diastolic diameter, end-systolic diameter, and mass index also decreased. In multivariable mixed-effects models, IHD, baseline LVEF, baseline left ventricular end-diastolic diameter, and baseline mean aortic valve pressure gradient were associated with serial LVEF recovery. Adjusted recovery was greatest in patients without IHD and with smaller left ventricular end-diastolic diameter and most limited in those with IHD and larger left ventricular end-diastolic diameter.</p><p><strong>Conclusion: </strong>TAVI was associated with serial LVEF improvement and left ventricular reverse remodeling. IHD and larger baseline left ventricular end-diastolic diameter were associated with limited LVEF recovery.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70626"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972121","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 Reservoir Strain as a Marker of Carotid Vascular Remodeling: Insights Into the Atrial-Vascular Aging Continuum.","authors":"Cem Korucu","doi":"10.1111/echo.70635","DOIUrl":"10.1111/echo.70635","url":null,"abstract":"<p><strong>Background: </strong>Left atrial reservoir strain (LASr) has emerged as a sensitive marker of subclinical cardiac dysfunction and has been proposed as an early indicator of cardiovascular aging. However, whether impaired LASr reflects the progressive spectrum of carotid vascular aging has not been fully established.</p><p><strong>Aims: </strong>To evaluate the association between LASr and different stages of carotid vascular aging and to determine its ability to identify advanced carotid vascular disease in adults undergoing comprehensive cardiovascular imaging.</p><p><strong>Design: </strong>Retrospective, single-center, observational cross-sectional study.</p><p><strong>Methods: </strong>A total of 1475 consecutive adults who underwent transthoracic echocardiography and carotid ultrasonography were included. Participants were categorized into three predefined carotid vascular aging stages according to carotid ultrasonographic findings. LASr was assessed using two-dimensional speckle-tracking echocardiography. Multivariable ordinal logistic regression and receiver operating characteristic analyses were performed.</p><p><strong>Results: </strong>Of the 1475 participants, 628 (42.6%) were classified as Stage 0, 391 (26.5%) as Stage 1, and 456 (30.9%) as Stage 2. LASr progressively declined across carotid vascular aging stages (39.4 ± 6.3%, 34.7 ± 5.8%, and 28.9 ± 6.1%, respectively; p < 0.001). LASr demonstrated a significant inverse correlation with carotid intima-media thickness (r = -0.56, p < 0.001). After multivariable adjustment, lower LASr remained independently associated with progressive carotid vascular aging (adjusted OR per 1% decrease: 1.09, 95% CI 1.06-1.12; p < 0.001). LASr identified carotid plaque with an area under the curve of 0.823 (95% CI 0.801-0.845), with an optimal cutoff value of 31.8% (sensitivity 80.5%, specificity 71.2%).</p><p><strong>Conclusion: </strong>Left atrial reservoir strain progressively declined across increasing categories of carotid structural remodeling and remained independently associated with carotid vascular abnormalities after adjustment for conventional cardiovascular risk factors and echocardiographic parameters. Furthermore, LASr provided incremental discriminatory information for identifying carotid plaque beyond a predefined clinical model. These findings suggest that LASr may serve as a complementary myocardial marker of subclinical carotid vascular remodeling, although its broader role as a marker of systemic cardiovascular aging requires further longitudinal validation.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70635"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026676","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":"Artificial Intelligence-Based Echocardiographic Assessment of Diastolic Dysfunction: A Systematic Review.","authors":"Cian P Murray, Hugo C Temperley, Rob S Doyle, Abdullahi Khair, Michal Jagiello, Amal John, Patrick O'Callaghan","doi":"10.1111/echo.70630","DOIUrl":"10.1111/echo.70630","url":null,"abstract":"<p><p>Accurate non-invasive assessment of left ventricular diastolic dysfunction and filling pressures is central to the diagnosis and management of heart failure, particularly heart failure with preserved ejection fraction (HFpEF). Despite widespread use of transthoracic echocardiography, guideline-based algorithms are frequently indeterminate, variably reproducible, and difficult to apply consistently in routine practice. Artificial intelligence (AI) has emerged as a potential strategy to standardize measurement, integrate multiparametric echocardiographic data, and reduce diagnostic uncertainty. We performed a systematic review of diagnostic accuracy studies evaluating AI or machine-learning approaches applied to echocardiography for automated assessment of diastolic function or estimation of left ventricular filling pressures. Databases were searched from inception to July 7, 2026. Reference standards included invasive hemodynamics or guideline-based diastolic classification. Risk of bias and applicability were assessed using QUADAS-3. Fourteen studies were included, with development samples and validation or test cohorts reported separately. Validation ranged from small held-out invasive cohorts to large independent external datasets. Against invasive hemodynamic reference standards, reported AUCs ranged from 0.761 to 0.883, reflecting heterogeneous hemodynamic targets, thresholds, and validation designs. Studies evaluating agreement with guideline- or expert-derived classifications and automated replication of individual diastolic parameters generally reported high discrimination, although these represented distinct clinical tasks and varied substantially in the independence and scale of validation. Several studies demonstrated external or prospective validation, but robust evaluation against invasive hemodynamics remained limited. Given substantial methodological and clinical heterogeneity, findings were synthesized descriptively and no summary estimate was calculated. Despite promising diagnostic discrimination in retrospective studies, AI-based echocardiographic diastolic assessment remains limited by heterogeneous reference standards, variable validation approaches, and an absence of prospective interventional clinical-impact studies and limited prospective multicenter validation against invasive hemodynamics, precluding routine implementation at this stage.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70630"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026600","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":"Bilateral Patent Ductus Arteriosi With \"Vanished\" Left Pulmonary Artery in an Adult Patient.","authors":"Shuang Yang, Ye Zhang, Yaoqiang Xu, Jiancheng Han, Yihua He","doi":"10.1111/echo.70639","DOIUrl":"10.1111/echo.70639","url":null,"abstract":"<p><p>This rare adult case features bilateral patent ductus Arteriosi with a vanished left pulmonary artery (LPA). Anomalous ductal origin of the LPA is rarer than its right-sided counterpart. Timely surgical LPA reimplantation to the main pulmonary artery averted irreversible vascular obstruction in reactive pulmonary hypertension.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70639"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026616","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":"Serial Echocardiographic Changes in Left Ventricular Remodeling and Ischemic Mitral Regurgitation During Medical Therapy and After Coronary Revascularization: A Contemporary Cohort Study.","authors":"Jamilah AlRahimi, Rawan Asiri, Sarah Albogami, Laila Assiri, Yasser Ismail","doi":"10.1111/echo.70636","DOIUrl":"https://doi.org/10.1111/echo.70636","url":null,"abstract":"<p><strong>Background: </strong>Ischemic mitral regurgitation (IMR) reflects left ventricular (LV) remodeling, but its within-patient trajectory during sequential medical therapy and coronary revascularization remains incompletely characterized.</p><p><strong>Objectives: </strong>To compare within-patient changes in LV remodeling and IMR severity during the medical-therapy and subsequent post-revascularization intervals and examine the association between LV reverse remodeling and IMR regression.</p><p><strong>Methods: </strong>In this single-center retrospective complete-case serial-imaging cohort, 125 adults with significant IMR underwent quantitative echocardiography at baseline, after medical therapy, and 2-3 months after PCI or CABG. The primary endpoint was ≥1-grade IMR improvement from baseline to final follow-up. Patient-level changes during the medical-therapy and subsequent post-revascularization intervals were compared using Wilcoxon signed-rank tests with Holm adjustment.</p><p><strong>Results: </strong>Median LVEDV reduction was 3 mL (IQR -4 to 19) during the medical-therapy interval versus 22 mL (IQR 5-51) during the post-revascularization interval. Corresponding improvements were 1 versus 8 percentage points for LVEF, 0.02 versus 0.16 cm² for EROA, and 2 versus 21 mL/beat for regurgitant volume (Holm-adjusted p < 0.001 for all comparisons). Overall, 93 patients (74.4%) achieved ≥1-grade IMR improvement. LV reverse remodeling occurred in 80 (64.0%) and was strongly associated with IMR improvement. Excluding 25 patients with >50% LVEDV reduction yielded consistent findings.</p><p><strong>Conclusions: </strong>Serial echocardiography demonstrated substantially greater ventricular and IMR improvement during the post-revascularization interval than during the preceding medical-therapy interval. These temporal associations do not establish an independent causal effect of revascularization but support serial echocardiographic assessment of ventricular remodeling and residual IMR.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70636"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026660","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":"Cardiac Structure and Function and Pulmonary Congestion Across New York Heart Association Classes in Patients With Acute Heart Failure.","authors":"Ali Hikmat Al-Rubai, Filip Soeskov Davidovski, Caroline Espersen, Anton Stanchev, Laura Maria Adam, Ayat Khoraizat, Kristoffer Grundtvig Skaarup, Maria Dons, Jacob Christensen, Emil Durukan, Ema Rastoder, Morten Sengeløv, Katrine Feldballe Bernholm, Lisa Steen Duus, Caroline Løkke Bjerregaard, Zahra Juma, Mats Christian Højbjerg Lassen, Anne Marie Reimer Jensen, Adam Femerling Langhoff, Peter Godsk Jørgensen, Manan Pareek, Emil Wolsk, Morten Schou, Tor Biering-Sørensen","doi":"10.1111/echo.70634","DOIUrl":"10.1111/echo.70634","url":null,"abstract":"<p><strong>Background: </strong>Acute heart failure (AHF) is a major global health challenge, yet the relationship between New York Heart Association (NYHA) classification and objective markers such as echocardiography, lung ultrasound (LUS), and biomarkers remains unclear.</p><p><strong>Methods: </strong>In this prospective two-center study, patients admitted with AHF (2022-2024) underwent echocardiography, 8-zone LUS, ECG, and biomarker sampling. Patients were stratified by NYHA class at enrollment, and associations with clinical, echocardiographic, and LUS measures were analyzed. Participants were invited for an identical follow-up examination 1-3 months post-discharge. The main outcome was a 180-day composite of AHF readmission or all-cause mortality evaluated across NYHA classes.</p><p><strong>Results: </strong>Among 564 patients (mean age 78.2 years; 56.3% male), 23% were classified as NYHA class I/II, 27% as NYHA class III, and 50% as NYHA class IV. Higher NYHA class at admission was associated with older age, greater comorbidity burden, lower left ventricular ejection fraction, impaired global longitudinal strain, higher E/e' ratio, and B-line count (all p <0.05). At follow-up (n = 160), left ventricular systolic function, B-line count, and left atrial size parameters were similar across baseline NYHA class. Atrial functional parameters (peak atrial longitudinal and contraction strain) remained lower with increasing NYHA class at admission (both p <0.05). NYHA class at admission was not associated with the 180-days outcome.</p><p><strong>Conclusion: </strong>In this prospective study of hospitalized AHF patients, higher NYHA class at admission was associated with greater cardiac dysfunction, B-line burden, and comorbidity burden, but these differences largely resolved at follow-up. NYHA class at admission did not significantly predict the composite outcome.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":"e70634"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018679","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":"Artificial Intelligence in Echocardiography for Acute Coronary Syndromes: Current Evidence and Integration With Electrocardiography and Biomarkers","authors":"Predrag Mitrovic,&nbsp;Dubravka Rajic,&nbsp;Nemanja Djordjevic","doi":"10.1111/echo.70610","DOIUrl":"10.1111/echo.70610","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Early diagnosis of acute coronary syndromes (ACS) remains challenging because electrical, mechanical, and biochemical manifestations of myocardial ischemia evolve at different stages of the ischemic cascade. Although electrocardiography (ECG), cardiac biomarkers, and echocardiography are routinely used in clinical practice, these diagnostic modalities are commonly interpreted independently, potentially delaying recognition of myocardial ischemia. Recent advances in artificial intelligence (AI) offer new opportunities to improve diagnostic accuracy through multimodal integration, with echocardiography serving as the central imaging modality.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Hypothesis&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;AI-enhanced echocardiography, integrated with electrocardiographic findings, cardiac biomarkers, and clinical information, may improve the early diagnosis, risk stratification, and clinical management of patients with suspected ACS compared with conventional sequential diagnostic approaches.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A comprehensive narrative review of contemporary literature was performed to evaluate current evidence regarding AI applications in echocardiography and their integration with ECG and cardiac biomarkers for the diagnosis of ACS. Published studies addressing automated image acquisition, chamber quantification, myocardial deformation analysis, regional wall-motion assessment, multimodal machine-learning models, explainable AI, and clinical implementation were critically reviewed and synthesized.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;AI has substantially expanded the capabilities of echocardiography by enabling automated image interpretation, quantitative assessment of ventricular function, myocardial strain analysis, and detection of regional wall-motion abnormalities with high reproducibility. When integrated with ECG, serial high-sensitivity cardiac troponin measurements, and clinical variables, multimodal AI systems demonstrate the potential to improve diagnostic accuracy, facilitate earlier identification of myocardial ischemia, reduce diagnostic uncertainty, and support individualized clinical decision-making. Nevertheless, widespread implementation requires prospective multicenter validation, standardized imaging protocols, explainable algorithms, regulatory oversight, and seamless integration into clinical workflows.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;AI-enhanced echocardiography represents a promising step toward precision cardiovascular imaging and may become the ce","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"43 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867815","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":"Duration-Dependent Cardiac Effects of Anabolic-Androgenic Steroid Use in Strength-Trained Athletes: A Systematic Review and Meta-Analysis","authors":"Matheus de Medeiros Fernandes,&nbsp;Pedro Gomes Batista,&nbsp;Camila Viviane Ribera Chagas,&nbsp;Railla Raquel Albino dos Santos Silva,&nbsp;Fernanda Medeiros Santos,&nbsp;Miguel Chaves Lenzi,&nbsp;Felipe de Medeiros Fernandes,&nbsp;Ranna Santos Pessoa,&nbsp;Patrícia Jovelina de Freitas,&nbsp;Flávio Henrique Amaral Pires Véras,&nbsp;Stephan Barisic Junior,&nbsp;Douglas Nunes Cavalcante,&nbsp;Juliana Giorgi,&nbsp;Caroline Fischer-Bacca","doi":"10.1111/echo.70611","DOIUrl":"10.1111/echo.70611","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Nonmedical anabolic-androgenic steroid (AAS) use is increasing, and its duration-dependent cardiac effects remain unclear. We evaluated cardiac structure and function in AAS-using strength-trained athletes, overall and by exposure duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed, Embase, Cochrane Central, and SCOPUS through November 2025 for observational studies comparing AAS-using and nonusing strength-trained athletes of either sex. Random-effects models pooled mean differences (MD) overall and across four exposure strata (&lt;6 months, 6 months–3 years, 3–6 years, &gt;6 years); meta-regression assessed duration as a continuous moderator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty studies (1906 athletes; 95% male) were included. Overall, AAS users showed reduced left ventricular ejection fraction (LVEF; 29 studies; MD −2.84%; 95% CI −4.24 to −1.44; <i>p</i> &lt; 0.01), impaired global longitudinal strain (GLS; MD +3.27%; <i>p</i> &lt; 0.01), and increased left ventricular mass index (LVMI; MD +18.21 g/m²; <i>p</i> &lt; 0.01). Septal thickening was detectable before six months, preceding functional impairment. LVEF, LVMI, and posterior wall thickness (PWT) differed significantly across strata (all <i>p</i> ≤ 0.03), with the largest LVEF reduction beyond six years (MD −7.39%; 95% CI −10.71 to −4.07). Meta-regression suggested that exposure duration was associated with variation in selected structural and functional outcomes, corroborating LVEF, LVMI, and PWT, while GLS, E/e′, and E/A ratio showed no significant association. Right ventricular strain was impaired in an exploratory, non-stratified analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AAS use is associated with cardiac structural and functional abnormalities, with exposure duration associated with selected, but not all, outcomes. These cross-sectional comparisons do not establish within-person progression; longitudinal surveillance with deformation imaging is warranted.</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":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867771","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}