Right heart catheterization (RHC) is the reference standard for diagnosing pulmonary hypertension (PH), whereas echocardiography is the primary noninvasive tool for identifying patients who require further evaluation. Whether electrocardiography (ECG) and natriuretic peptides provide incremental diagnostic information beyond echocardiographic assessment in patients referred for RHC remains uncertain. This single-center retrospective study included 130 hospitalized patients with suspected PH who underwent echocardiography, 12-lead ECG, B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, and RHC during the same admission. PH was defined as mean pulmonary arterial pressure > 20 mmHg on RHC. A temporal validation cohort of 42 consecutive eligible patients was used to evaluate the final model without refitting. To reduce collinearity, the final multimodal model included pulmonary artery systolic pressure estimated by echocardiography (PASP ECHO), ECG positivity, and BNP/NT-proBNP positivity. Model discrimination was assessed using receiver operating characteristic analysis, areas under the curve (AUCs) were compared using DeLong’s test, calibration was assessed using calibration plots and calibration metrics, and internal validation was performed using bootstrap resampling. Among 130 patients in the derivation cohort, 111 had PH and 19 did not. The final multimodal model showed higher discrimination than PASP ECHO alone in the derivation cohort (AUC 0.825, 95
Heart failure (HF) is a systemic syndrome in which venous congestion and impaired perfusion can produce clinically important hepatic dysfunction. The term cardiohepatic syndrome (CHS) describes this bidirectional interaction, but cardiac and hepatic abnormalities are still often evaluated in parallel rather than as a connected hemodynamic process. Ultrasound is uniquely suited to an integrated assessment because it can characterize cardiac structure and function, systemic venous congestion, hepatic hemodynamics, tissue stiffness, and treatment-related change at the bedside. Conventional transthoracic echocardiography remains the foundation of evaluation, while three-dimensional echocardiography and speckle-tracking techniques improve quantification of right ventricular, atrial, and subclinical myocardial dysfunction. Abdominal Doppler ultrasound, venous congestion scoring, and liver elastography add complementary information, although liver stiffness must be interpreted cautiously because congestion, inflammation, cholestasis, and fibrosis can produce overlapping signals. Artificial intelligence may improve acquisition, measurement reproducibility, and multimodal data integration, but external validation and transparent reporting remain essential. This review summarizes contemporary evidence and proposes a practical, sequential pathway that combines echocardiography, venous Doppler findings, liver stiffness, laboratory biomarkers, and dynamic reassessment after decongestion. The central clinical principle is that CHS should be evaluated as a time-varying cardiohepatic phenotype rather than diagnosed from a single cardiac, hepatic, or biochemical measurement.
Abstract Purpose To study left atrial stiffness index (LASI) and left atrial activation time (LA-AT) changes in an older population with silent paroxysmal atrial fibrillation (PAF) compared to age-matched control. Methods Individuals with newly diagnosed PAF and a randomly selected age-matched control group without AF were enrolled from STROKESTOP2-study. All participants had NT-proBNP levels 125–900 ng/L. TTE examinations were analyzed retrospectively offline using dedicated software. Besides conventional echocardiographic measurements, LA-AT was obtained by measuring the time delay between the onset of the P-wave on ECG and tissue Doppler Á peak wave in lateral LA wall. LASI was calculated as the ratio of left ventricular filling (E/é) to peak atrial longitudinal strain (PALS). Results Mean age was 76 ± 0.3 years. The PAF group ( n = 67) presented significant increase of LASI (0.41 (0.29–0.60) vs. 0.32 (0.29–0.43), P = 0.001) and prolonged LA-AT (170 (140–180) ms vs. 140 (120–144) ms, P < 0.001) compared to controls ( n = 94). Subgroup analysis in participants with normal LA volume index (LAVI) ≤ 34 ml/m 2 , LASI and LA-AT remained significantly increased/prolonged in PAF ( N = 27) compared to controls ( N = 72). NT-proBNP-levels did not differ between PAF (228 (181–348) ng/L) and controls (216 (156–317) ng/L) ( P = 0.18). ROC curve analysis identified thresholds LASI > 0.54 and LA-AT > 139 msec for discrimination of silent PAF. Conclusion Indices reflecting LA stiffness and atrial conduction delay were significantly elevated in recently diagnosed PAF patients. LASI and LA-AT thresholds might non-invasively detect early atrial remodeling without structural enlargement in elderly patients with high risk of PAF and mildly increased NT-proBNP levels.
Undetected atrial fibrillation (AF) is an important potential mechanism after cryptogenic stroke. Speckle-tracking echocardiography-derived left atrial (LA) phasic strain and left ventricular global longitudinal strain (LV GLS) have been reported to differ between patients with and without AF subsequently detected after stroke, but the magnitude and consistency of these group-level differences remain uncertain. PubMed, Embase, and Web of Science were searched from inception to May 3, 2026. Eligible reports enrolled adults with cryptogenic ischemic stroke or embolic stroke of undetermined source (ESUS); mixed undetermined-source cerebrovascular cohorts were retained only when the source report explicitly framed the population as cryptogenic stroke/ESUS or undetermined-source cerebrovascular disease. No numerical percentage threshold for cohort composition had been prespecified in the registered protocol. Reports excluded known AF at baseline, measured LV GLS or LA phasic strain by speckle-tracking echocardiography, and reported AF detected during follow-up. Random-effects meta-analyses used raw mean differences (MDs) and complementary Hedges g standardized mean differences (SMDs), with restricted maximum-likelihood estimation, Hartung-Knapp confidence intervals (CIs), and prediction intervals. Prespecified outcome-level deduplication was retained; revision-stage analyses included a monitoring-duration subgroup analysis, a cohort-only reservoir-strain sensitivity analysis, and a conduit-strain sensitivity analysis addressing unresolved values in Bufano et al. Nineteen reports representing 17 cohort clusters were included. Outcome-specific analyses comprised 7 datasets for LV GLS (n = 1,403), 17 for LA reservoir strain (n = 2,755), 10 for the primary LA conduit-strain analysis excluding Bufano et al. (n = 1,958), and 14 for LA contractile strain (n = 2,455). Patients with subsequently detected AF had lower LA reservoir strain (MD, -7.44
Left ventricular ejection fraction (EF) and global longitudinal strain (GLS) are widely used for cardiac surveillance in patients receiving potentially cardiotoxic cancer therapy. While GLS is more sensitive for detecting early myocardial dysfunction, the relationship between EF and GLS in routine clinical practice remains incompletely characterized, and discordance between these parameters may complicate clinical interpretation. This retrospective observational study included 117 oncology patients undergoing serial echocardiographic assessment at baseline, early follow-up (6–12 weeks), and short-term follow-up (3–6 months). EF was measured by biplane Simpson’s method, and GLS by speckle-tracking echocardiography as absolute values. EF deterioration was defined as a ≥ 10
