European Heart Journal - Imaging Methods and Practice最新文献

{"title":"Right Ventricular Outflow Tract Diameter Change with Exercise: a Prospective Exercise Echocardiography and Invasive CPET study","authors":"Ahmed El Shaer, Mariana Garcia-Arango, Claudia Korcarz, A. T. Broman, Chris Lechuga, N. C. Chesler, Farhan Raza","doi":"10.1093/ehjimp/qyae039","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae039","url":null,"abstract":"\u0000 While cardiac output reserve with exercise predicts outcomes in cardiac and pulmonary vascular disease, precise quantification of exercise cardiac output requires invasive cardiopulmonary testing (iCPET). To improve the accuracy of cardiac output reserve estimation with transthoracic echocardiography (TTE), this prospective study aims to define changes in right ventricular outflow tract diameter (RVOTd) with exercise and its relationship with invasively measured hemodynamics. 20 subjects underwent simultaneous TTE and iCPET, with data collected at rest, leg-raise, 25W, 50W (n = 16), 75W (n = 14), 100W (n = 6). This was followed by a second exercise study with real-time RV pressure-volume loops at similar stages (except leg-raise). The overall cohort included heart failure with preserved ejection fraction (n = 12), pulmonary arterial hypertension (n = 5), and non-cardiac dyspnea (n = 3).RVOTd was reverse engineered from the TTE-derived RVOT velocity time integral (VTI) and iCPET-derived stroke volume, using the formula: Fick stroke volume = RVOT VTI x RVOT area (wherein RVOT area = π x [RVOTd/2]2). RVOTd increased by nearly 3-4% at every 25W increment. Using linear regression models, where each subject is treated as a categorical variable and adjusting for subject intercept, RVOTd was correlated with hemodynamic variables (cardiac output, heart rate, pulmonary artery and RV pressures). Of all the predictor hemodynamic variables, cardiac output had the highest r2 model fit (adjusted r2 = 0.68), with a unit increase in cardiac output associated with a 0.0678 increase in RVOTd (p < 0.001). Our findings indicate that RVOTd increases by 3-4% with every 25W increment, predominantly correlated with cardiac output augmentation. These results can improve the accuracy of cardiac output reserve estimation by adjusting for RVOTd with graded exercise during noninvasive CPET and echocardiogram. However, future studies are needed to define these relationships for left ventricular outflow tract diameter.","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141013470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact","authors":"M. van Wely, M. Rooijakkers, N. Stens, S. el Messaoudi, Tim Somers, L. van Garsse, Dick Thijssen, R. Nijveldt, Niels van Royen","doi":"10.1093/ehjimp/qyae040","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae040","url":null,"abstract":"\u0000 Transcatheter aortic valve replacement (TAVR) is standard of care in aortic stenosis (AS) with results comparable to surgical aortic valve replacement (SAVR). However, paravalvular regurgitation (PVR) is more common after TAVR. With the alteration of devices and implantation techniques, the incidence of moderate or more PVR has declined. Mild PVR is still common in around 30% of TAVR patients in low risk trials. Progression of AS causes myocardial hypertrophy and varying degrees of diastolic dysfunction which may cause heart failure even in combination with small volumes of PVR. Any degree of PVR is associated with increased risk of overall and cardiovascular mortality. Predictors of PVR are annular eccentricity, severe calcification of the aortic valve, bicuspid aortic valves, and type of prosthesis where balloon-expandable devices are associated with less PVR.\u0000 PVR is diagnosed using echocardiography, aortic angiogram with or without videodensitometry, hemodynamic parameters, or cardiac magnetic resonance (CMR). PVR can be treated using post-dilation, interventional treatment using a vascular plug, or implantation of a second device. Successful post-dilation depends on balloon size which should at least be equal to or more than 95% of the mean annulus diameter. Implantation of a second device to reduce PVR is successful in approximately 90% of cases, either through lengthening of the sealing skirt in case of inadequate position or through further expansion of the index device. Implantation of a vascular plug can successfully reduce PVR and reduce mortality.","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":"121 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary vascular stenosis scoring in fibrosing mediastinitis","authors":"Yangyang Wang, Chao Bu, Mengdi Zhang, Juan Wang, Kaiyu Jiang, Mingwang Ding, H. Su, Xiaozhou Long, Mengfei Jia, Yu Li, Yunshan Cao","doi":"10.1093/ehjimp/qyae034","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae034","url":null,"abstract":"\u0000 \u0000 \u0000 This study aimed to develop a scoring system for evaluating the degree of pulmonary vascular stenosis in fibrosing mediastinitis (FM).\u0000 \u0000 \u0000 \u0000 A retrospective single-center study was conducted on 56 patients with FM in China between April 2014 and August 2021. The involvement of pulmonary vessels in patients with FM was assessed using dual phase-computed tomography pulmonary angiography, and we found that 85.7% of the patients had both pulmonary artery (PA) and vein (PV) involvement. PA involvement was mainly located proximal to both the upper PA and bilateral basal trunk levels in the lower lungs. The involvement of the superior PV was more common than that of the inferior PV, and the right inferior PV was the least involved. Most of these lesions exhibited moderate or severe stenosis. Additionally, a scoring system for the degree of pulmonary vascular stenosis was developed. Correlation analysis revealed a negative correlation between the final pulmonary vascular score and pulmonary arterial pressure, pulmonary vascular resistance, and maximum tricuspid regurgitation velocity. The calculated score of 17.1 was the best cut-off value for the diagnosis of mild and severe pulmonary hypertension.\u0000 \u0000 \u0000 \u0000 We successfully developed a scoring system for pulmonary vascular stenosis that can be used to evaluate the severity of pulmonary vessel involvement and pulmonary hypertension. This scoring system may be relevant in the future development of target-based strategies for percutaneous interventions.\u0000","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":"12 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141020580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial and Ventricular Deformation: Alterations and Predictive Value of Echocardiography Parameters in End-Stage Renal Disease Patients after Kidney Transplantation","authors":"Abdulhamid Bagheri, Mohammad Khani, Erfan Ghadirzadeh, Amir Moradi, Fariba Bayat, Seyed Pooria Salehi Mashhad Sari, Elham Paraandavaji, Tooba Akbari, A. H. Hermis","doi":"10.1093/ehjimp/qyae027","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae027","url":null,"abstract":"\u0000 \u0000 \u0000 End-stage renal disease (ESRD) patients are prone to alterations in cardiac hemodynamics specifically on the left ventricle (LV) and left atrial (LA) functions usually due to factors like uremia, fluid overload, and inflammation. While studies on LV function in ESRD exist, research on LA function is limited. Successful KTx is believed to reverse pathological cardiac remodeling, and monitoring changes in cardiac strain before and after transplantation may guide pre and posttransplant care. This study has two main objectives: to investigate alterations in LA and LV strain and other echocardiographic parameters after KTx and to identify independent factors predicting impaired strain parameters post-KTx.\u0000 \u0000 \u0000 \u0000 We conducted a prospective cohort study of 49 ESRD patients who underwent KTx. Echocardiography was performed at baseline and at three months after KTx. LV end-diastolic volume, LV end-systolic volume, LV end-diastolic diameter, LV ejection fraction (LVEF), E/e’, maximum LA volume index (LAVi), LV global longitudinal strain (LVGLS), and all LA strain values, including booster (LASb), conduit (LAScd), and reservoir (LASr), improved significantly after KTx (P < 0.05). Regarding independent predictors of impaired LA and LV strains, pre-KTx values of LVEF, LAVi, and NT-proBNP were associated with LVGLS impairment after KTx; pre-KTx values of LAVi and LVEF were associated with LASr impairment after KTx.\u0000 \u0000 \u0000 \u0000 The present study provided valuable evidence on the effects of KTx on uremic cardiomyopathy demonstrated by LA strain and LV strain improvements, and indicated pre-KTx LVEF and LAVi as significant independent predictors of LVGLS and LASr impairment after KTx.\u0000","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":" 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140688253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular imaging research and innovation in 2023: a review by the Research and Innovation Committee of the European Association of Cardiovascular Imaging (EACVI)","authors":"A. Barison, Ana Teresa Timoteo, Riccardo Liga, Sonia Borodzicz-Jazdzyk, Saloua El Messaoudi, Christina Luong, G. Mandoli, Sara Moscatelli, A. A. Ramkisoensing, Sarah Moharem-Elgamal, Gianluca Pontone, Danilo Neglia","doi":"10.1093/ehjimp/qyae029","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae029","url":null,"abstract":"\u0000 In 2023, cardiovascular imaging has made significant advancements, in terms of technology, pathophysiology and clinical application. In this review, the most recent research findings in the field of cardiovascular imaging are discussed. Artificial intelligence, large population cohorts, together with several technical improvements, have had a crucial impact on the technological advancements of echocardiography, cardiovascular magnetic resonance (CMR), computed tomography (CT) and nuclear medicine. In the field of ischaemic heart disease, it has been demonstrated that appropriate non-invasive imaging strategies improve patients’ management, reduce invasive procedures and the need for additional testing at follow-up. Moreover, improvements in plaque characterization with CT is an expanding field of research with relevant implications for the prediction of disease severity, evolution and response to treatment. In the field of valvular heart disease, imaging techniques have advanced alongside improvements in transcatheter treatment for aortic stenosis, mitral, and tricuspid regurgitation. Finally, in the field of heart failure and cardiomyopathies, cardiovascular imaging has reinforced its crucial role in early diagnosis and risk evaluation, showcasing advanced techniques that outperform traditional methods in predicting adverse outcomes.","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140688304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial to ventricular volume ratio and relation to fitness, cardiovascular risk factors and diastolic function in healthy individuals. The HUNT Study","authors":"Sigbjorn Sabo, H. Dalen, John Nyberg, B. Grenne, E. O. Jakobsen, B. Nes, U. Wisløff, J. M. Letnes","doi":"10.1093/ehjimp/qyae028","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae028","url":null,"abstract":"\u0000 \u0000 \u0000 Left atrial (LA) and ventricular (LV) remodeling is thought to be balanced in healthy individuals, and the LA end-systolic volume (LAV) to LV end-diastolic volume (LVEDV) ratio (LA:LV) could help discriminate between pathological and physiological LA enlargement. We aimed to assess LA:LV and its associations with age, sex, and cardiovascular risk factors HbA1C, body mass index (BMI), systolic blood pressure, and peak oxygen uptake (VO2peak). The association to measures of LV diastolic function and filling pressures were compared to LAV and LA reservoir strain.\u0000 \u0000 \u0000 \u0000 Cardiopulmonary exercise testing and measurement of risk factors ten years apart and echocardiography at follow-up was performed in 1,348 healthy adults (52% women, mean (SD) age 59 (12) years) prospectively included in a large population study. All risk factors were significantly associated with LA:LV in univariate analyses, while BMI and VO2peak was significantly associated with LA:LV in adjusted models. A higher LA:LV was associated with increased odds ratio (OR) of diastolic dysfunction (OR (95% CI) 2.6 (2.1, 3.3)). Measures of LV filling pressures were more closely associated with LA:LV than LAV and LA reservoir strain, but LA reservoir strain was more closely related to some diastolic function measures. In individuals with LAV >34mL/m2 the LA:LV explained 29% of variance in VO2peak (p < 0.001).\u0000 \u0000 \u0000 \u0000 A higher LA:LV was associated with, and may improve, assessment of diastolic dysfunction and filling pressures. The LA:LV differentiates VO2peak in individuals with enlarged LAV and may have a role in evaluating whether LA enlargement reflects pathology.\u0000","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of experience in transesophageal echocardiographic evaluation of vegetation size in patients with infective endocarditis: a reliability study","authors":"Louise Schmidt, Lauge Østergaard, Frederik Fasth Grund, Line Schmidt, J. Linde, Lars Køber, E. Fosbøl","doi":"10.1093/ehjimp/qyae024","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae024","url":null,"abstract":"\u0000 \u0000 \u0000 Vegetation size assessed by transesophageal echocardiography (TOE) is a decisive metric in guiding surgical intervention and prognosis in patients with definite infective endocarditis (IE). The aim of this study was to assess the impact of echocardiographic experience on reliability and reproducibility of TOE measurements of vegetations in patients with IE.\u0000 \u0000 \u0000 \u0000 Twenty-nine raters from a cardiac department at a tertiary center were divided into three groups according to echocardiographic experience: experts, cardiologists, and novices. All raters were instructed to measure the maximum length of vegetations in 20 different TOE exams. Interrater agreement was evaluated using Intraclass Correlation Coefficient (ICC), one-way ANOVA, Kruskal-Wallis test, and Bland-Altmann plots. Reliability was assessed by minimal detectable change (MDC). All measurements were compared with the measured size agreed on by the multidisciplinary IE team.\u0000 There was an overall significant interrater variance between the three groups (p < 0.001). The variance was 10.1, 14.8, and 21.7 for the experts, cardiologists, and novices, respectively. ICC was excellent for experts (96.3%) and cardiologists (93.7%) and good for novices (84.6%). The three groups tended to measure smaller than the endocarditis team. MDC was 2.6 mm for experts, 3.3 mm for cardiologists, and 3.6 mm for novices.\u0000 \u0000 \u0000 \u0000 The study showed good to excellent intraclass correlation but high dispersion in all groups. Variance decreased with higher experience. Our findings support current recommendations that complicated cases should be cared for by the multidisciplinary endocarditis team and underlines importance of echocardiographic expertise when evaluating and measuring vegetations in patients with IE.\u0000","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":"32 S21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140725359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subepicardial hypoattenuation revealed by CT angiography in a patient with cardiac sarcoidosis","authors":"S. Piciucchi, E. Gardini, C. Dallaserra, M. De Vita, V. Poletti, C. Ravaglia","doi":"10.1093/ehjimp/qyae023","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae023","url":null,"abstract":"","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140747574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial cardiac magnetic resonance imaging for guidance of therapy management in patients treated with anakinra due to recurrent pericarditis","authors":"F. Bianco, Valentina Bucciarelli, F. Coretti, Serena Cataldi, Francesca Damadei, Elena Raffaelli, N. Schicchi, Alessia Omenetti, Bianca Lattanzi, Emanuela Berton, F. C. Surace, A. Baldinelli, Luciana Breda, Salvatore Cazzato, C. Catassi, A. Dello Russo, Sabina Gallina","doi":"10.1093/ehjimp/qyae019","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae019","url":null,"abstract":"\u0000 \u0000 \u0000 To determine the utility of serial cardiac magnetic resonance (CMR) imaging for guidance of therapy management in patients treated with anakinra due to recurrent pericarditis (RP), compared with c-reactive protein (CRP) assay alone.\u0000 \u0000 \u0000 \u0000 In 2018-21, we enrolled 18 (14.5±1.8-year-old, 72% males) consecutive RP patients treated with anakinra (100 mg/day in patients ≥ 18 years old; 2 mg/kg/day < 18 years old) due to RP corticosteroid-dependent, or not responsive to colchicine or non-steroidal anti-inflammatory drugs. After hospitalization, they were 1:1 randomized to CMR [no pericardial edema and/or late gadolinium enchantment (LGE)] or CRP (<0.6 mg/dL). Tests were repeated every 3-months until negative to halve the anakinra dosage and cessation. The idiopathic etiology was the most prevalent (n=8, 44%), followed by postpericardiotomy (n=6, 33%). After a median treatment period of 8.7±3.6 months, CRP-guided RP patients experienced more recurrences than CMR-guided ones (6 vs. 1, P=0.016), with the worst prognosis in terms of recurrences (Log-rank, P= 0.025) and significant increased time of treatment (12.7±2 vs. 16.1±3.4 months, P=0.019). In a multivariable exploratory Cox regression model, the number of previous recurrences and the idiopathic etiology were independent predictors of RP during the anakinra treatment. New recurrences were subsequently directed to CMR imaging, and therapy modified according to the LGE/edema trend. After 1-year follow-up, no further recurrence was detected.\u0000 \u0000 \u0000 \u0000 Among patients with RP and treated with anakinra, serial CMR imaging of the pericardium can be utilized as an imaging biomarker, more informative for therapy duration than the solely CRP assessment.\u0000 \u0000 \u0000 \u0000 NCT06071156\u0000","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Reservoir Strain is a Superior Discriminator of Cardioembolism in Ischemic Stroke","authors":"Aditya Bhat, Gary C H Gan, H. Chen, S. Khanna, V. Mahajan, Arnav Gupta, C. Burdusel, Nigel Wolfe, L. Lee, M. C. P. Nunes, C. Taconeli, J. L. P. da Silva, Timothy C. Tan","doi":"10.1093/ehjimp/qyae022","DOIUrl":"https://doi.org/10.1093/ehjimp/qyae022","url":null,"abstract":"\u0000 \u0000 \u0000 Echocardiographic measures of left heart size and function have long been associated with cardioembolic mechanisms of stroke development, however the diagnostic performance and comparison of measures of atrial function in this context has not been well studied. We sought to evaluate the diagnostic performance of LA reservoir strain (LASr) in identification of cardioembolism in the ischemic stroke population relative to traditional measures of left heart size and function.\u0000 \u0000 \u0000 \u0000 Consecutive patients admitted to our institution with ischemic stroke or transient ischemic attack were recruited and underwent comprehensive transthoracic echocardiography. Strokes were classified by etiology with comparison undertaken between cardioembolic and non-cardioembolic types.\u0000 \u0000 \u0000 \u0000 418 consecutive stroke patients with a cardioembolic (n = 229) or non-cardioembolic (n = 189) stroke etiology were analyzed. LASr was impaired in cardioembolic compared to non-cardioembolic strokes (16.7 ± 8.2% vs 26.0 ± 5.5%, p < 0.01) and provided greatest discrimination [area under the curve (AUC) 0.813, 95%CI 0.773 to 0.858] in differentiating stroke subtypes when compared to LVEF (AUC difference 0.150, p < 0.01), LAVI (AUC difference 0.083, p < 0.01) and E/e’ (AUC difference 0.163, p < 0.01). Inclusion of LASr in a model with conventional left heart echocardiographic factors improved model performance with a net reclassification improvement of 1.083 (95%CI 0.945 to 1.220, p < 0.01). Further, a proposed user-defined model-based clinical algorithm with LASr demonstrated improved diagnostic accuracy of identification of cardioembolic stroke subtypes which was best appreciated in patients without atrial fibrillation.\u0000 \u0000 \u0000 \u0000 LASr may provide enhanced diagnostic accuracy beyond conventional echocardiographic measures to discriminate cardioembolic from non-cardioembolic stroke mechanisms, in particular amongst those without comorbid atrial fibrillation.\u0000","PeriodicalId":508944,"journal":{"name":"European Heart Journal - Imaging Methods and Practice","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140214159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}