Journal of Echocardiography

To evaluate the difference in prognostic utility of echocardiographic parameters between pre- and post-transcatheter aortic valve implantation (TAVI) periods. This study enrolled 189 patients who underwent TAVI at Kumamoto University Hospital between 2015 and 2023 and had available echocardiographic data for the pre- and post-TAVI periods. Thirty-seven deaths occurred within the follow-up period (median 574 [357–934] days after post-TAVI period). Apical longitudinal strain (LS) in the pre- and post-TAVI periods and mid LS in the post-TAVI period were significantly associated with all-cause death after adjusting for various factors (pre-TAVI apical LS, hazard ratio [HR] 0.92, 95

Pectus excavatum (PE) can mechanically displace and compress the heart, often altering right ventricular (RV) geometry and function. Comprehensive preoperative echocardiographic characterization in large adult cohorts is limited. This study describes structural and functional cardiac findings in a large cohort of adults with PE evaluated by transthoracic echocardiography (TTE) prior to surgical repair. We retrospectively reviewed adult patients undergoing primary minimally invasive repair of PE (MIRPE) at a single tertiary center between January 2016 and July 2024 who had at least one preoperative TTE. Echocardiographic measurements followed scientific guidelines and included anatomical, functional, and hemodynamic assessment of the cardiac chambers, evaluation of valvular morphology, and visual assessment of cardiac compression. Among 639 adults (median age 28 years), cardiac compression was identified in 64

An isolated increase in tricuspid regurgitation velocity (TRV) during exercise stress echocardiography is frequently observed in patients with dyspnea, even in the absence of E/e’ elevation. However, the pathophysiological and prognostic significance of this finding, particularly in patients without risk factors for pulmonary hypertension (PH), remains uncertain. Patients who underwent bicycle exercise stress echocardiography with simultaneous expired gas analysis for the evaluation of exertional dyspnea were retrospectively identified. After excluding patients with risk factors for PH, participants were categorized into three groups: controls (exercise TRV ≤ 3.2 m/s and exercise E/e’ <15; n = 360), isolated exercise-induced increase in TRV (isolated Ei-TRV, exercise TRV > 3.2 m/s and exercise E/e’ <15; n = 83), and heart failure with preserved ejection fraction (HFpEF, exercise E/e’ ≥15; n = 211). Peak oxygen consumption was comparable between isolated Ei-TRV and controls, but significantly reduced in HFpEF. Over a median follow-up of 595 days, HFpEF patients had a two-fold higher risk of all-cause death and worsening HF events compared with controls whereas outcomes in isolated Ei-TRV did not significantly differ from controls. Nearly all patients with isolated Ei-TRV exhibited an abnormally elevated mean pulmonary artery pressure/cardiac output slope (mPAP/CO > 3 mmHg/L/min), and those with slopes > 5.2 mmHg/L/min had reduced peak oxygen consumption compared with those with slope ≤ 5.2 mmHg/L/min. In dyspneic patients without apparent risks for PH, isolated Ei-TRV was associated with preserved exercise capacity, without increased adverse outcomes compared with controls. Assessment of mPAP/CO slope may help refine risk stratification compared to exercise TRV alone in this population.

Sex-related differences in left ventricular (LV) remodeling in response to severe aortic stenosis (AS) and post-transcatheter aortic valve implantation (TAVI) remain unclear. Previous studies have demonstrated inconsistent and discordant findings regarding the relationships between LV remodeling and clinical endpoints across sexes following TAVI. More importantly, it has been shown that females with severe AS are often diagnosed later and less likely to be referred for TAVI. We sought to evaluate sex-based differences in LV remodeling prior to and after TAVI, and to assess whether these differences were associated with long-term clinical outcomes. We conducted a retrospective study of 977 patients with severe AS undergoing TAVI (2013–2020). Serial echocardiograms were performed at baseline (before TAVI) and at various timepoints post-TAVI. Echocardiographic parameters related to LV remodeling were extracted. Clinical outcomes (myocardial infarction [MI], heart failure hospitalization [HFH], stroke, and survival) were tracked over 10 years. Compared with males, females had larger baseline indexed LV end-diastolic dimension (26.5 ± 4.0 mm/m2 vs. 25.3 ± 3.5; p < 0.001), lower LV mass index[LVMI] (101.5 ± 28.0 vs. 111.5 ± 30.1 g/m2; p < 0.001), higher left ventricular ejection fraction (59.5 ± 11.13 vs. 53.8 ± 13.5

Left atrial (LA) mechanical function may change after catheter ablation for atrial fibrillation (AF); however, the determinants of follow-up LA function remain unclear. We aimed to characterize 6-month changes in LA strain and identify baseline determinants of follow-up LA strain after ablation for paroxysmal AF. This prospective study enrolled consecutive patients undergoing first-time pulmonary vein isolation for paroxysmal AF. Two-dimensional speckle-tracking echocardiography from apical four- and two-chamber views was performed at baseline and 6 months to assess LA reservoir strain (LASr) and contraction strain (LASct). Factors associated with 6-month LASr and ΔLASr (6-month minus baseline) were examined using multivariable linear regression. Of 167 enrolled patients, 121 without structural heart disease and with analyzable echocardiograms in sinus rhythm at baseline and 6 months were included (67 ± 11 years; 68

In 2023, Based on the continued evidence of stress echocardiography, the new practical guideline that describes the safe and effective methodology of stress echocardiography is now created by Guideline Committee of the Japanese Society of Echocardiography and is designed to expand the use of stress echocardiography for valvular heart disease and heart failure with preserved ejection fraction (HFpEF), as well as ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The Valsalva maneuver is essential for evaluating left ventricular diastolic function and diagnosing patent foramen ovale (PFO). Furthermore, in association with the recent insurance coverage for myocardial myosin inhibitors, a new drug for hypertrophic cardiomyopathy, the Valsalva maneuver has become increasingly important in the diagnosis of hypertrophic obstructive cardiomyopathy. Based on the above background, the Guideline Committee of the Japanese Society of Echocardiography prepared the practice guidance for “Stress echocardiography using the Valsalva maneuver” as the focused update incorporated into the “Practice guidance for the implementation of stress echocardiography.”

Accurate quantification of aortic valve area (AVA) is essential in the evaluation of aortic stenosis (AS) severity. While two-dimensional (2D) Transesophageal echocardiography (TEE) is widely used for AVA planimetry, three-dimensional (3D) TEE may offer superior accuracy due to improved anatomical visualization. We aimed to compare AVA measurements by 2D versus 3D TEE in patients with AS. We conducted a systematic review and meta-analysis of studies reporting AVA measurements using both 2D and 3D TEE in adult patients with AS. Paired measurements, means and standard deviations, or correlations between techniques were extracted. The primary outcome was the mean difference in AVA (cm²) between modalities. Secondary outcomes included pooled correlation coefficients and assessment of heterogeneity. Analyses were performed using random-effects models. Eight studies comprising 381 patients were included. The pooled mean absolute difference between 2D and 3D TEE was 0.16 cm² (95

Guideline-recommended algorithms (GL-algorithm) often results in indeterminate left ventricular filling pressure (LVFP). Despite high accuracy, machine learning (ML) methods lack interpretability, which necessitates the development of explainable ML models for clinical use. To develop an explainable ML model for estimating LVFP, providing patient-level interpretation using gold-standard right heart catheterization (RHC) data. We retrospectively enrolled 956 patients who underwent echocardiography and RHC at three hospitals within a median of 3 days. Two extreme gradient boosting models were trained using data from two hospitals (n = 621) to estimate elevated pulmonary artery wedge pressure (PAWP ≥ 18 mmHg) as a surrogate for elevated LVFP. Model 1 used variables from GL-algorithm, while Model 2 used variables selected based on Shapley additive explanations (SHAP) values. Models’ area under the receiver-operating characteristic curve (AUROC) for elevated LVFP were compared using external test data from the other hospital (n = 335). Overall, 31.0

BACKGROUND:Manual interpretation of echocardiographic data for strain analysis is time-consuming and prone to inter-observer variability. With the advent of artificial intelligence (AI), its potential to streamline echocardiographic interpretation and reduce variability has attracted increasing interest. This study aimed to evaluate the accuracy of AI-derived strain measurements, focusing on left ventricular global longitudinal strain (LVGLS) and left atrial reservoir strain (LASr), compared with expert sonographer measurements. METHODS AND RESULTS:A total of 150 patients were included regardless of underlying disease. Echocardiographic parameters, including LVGLS and LASr, were independently assessed by an expert sonographer and the fully automated software (Us2.ai). Correlations and agreement were evaluated using intraclass correlation coefficients (ICC) and complementary analyses. Subgroup analyses were also performed for LVGLS stratified by left ventricular ejection fraction (EF) categories, and for LASr stratified by left atrial volume index (LAVi) categories. For LVGLS, the ICC was 0.83 (95% CI: 0.77-0.88) and 0.77 (95% CI: 0.67-0.84) for LASr. The accuracy of both LVGLS and LASr was generally maintained across different EF and LAVi subcategories. CONCLUSIONS:The fully automated software showed reliable correlations with expert sonographer measurements, particularly for LVGLS, while correlation for LASr was not as high. With further investigation, the fully automated software may become a useful tool for echocardiographic analysis in clinical practice.

In patients with aortic stenosis (AS), risk stratification for valve intervention is primarily based on valve severity, symptom burden, and left ventricular (LV) function. However, cardiac damage may extend beyond the LV to involve the left atrium (LA), which can contribute to adverse outcomes. This study aimed to evaluate the prognostic value of the left atrial stiffness (LAS) in predicting one-year all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR). We conducted a retrospective study of patients with severe AS who underwent TAVR between 2010 and 2023 at a single tertiary center. LAS was calculated as the ratio of E/e′ to LA reservoir strain (LASr) using speckle-tracking echocardiography. Univariable and multivariable Cox regression analyses were performed to identify predictors of one-year mortality. The optimal cutoff value of LAS was determined using receiver operating characteristic (ROC) curve analysis. Among 260 patients, LAS was significantly higher in non-survivors than survivors (p < 0.001). In Cox regression analysis, LAS was strongly associated with one-year all-cause mortality (HR, 1.19; 95

BackgroundCancer therapy-related cardiac dysfunction (CTRCD) has become an important clinical issue with advances in cancer treatment and improved patient survival. The Japanese Society of Echocardiography previously published practice guidance in 2020. The present document provides an updated revision reflecting recent developments in cardio-oncology.MethodsThis guidance was developed based on contemporary evidence, including the 2022 European Society of Cardiology cardio-oncology guidelines, recent clinical studies, and advances in echocardiographic and multimodality imaging technologies.ResultsLeft ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are emphasized as essential parameters for diagnosing and monitoring CTRCD. The document provides standardized protocols for echocardiographic evaluation before, during, and after cancer drug therapy, as well as recommendations for long-term surveillance following radiotherapy. It also addresses cardiovascular complications associated with immune checkpoint inhibitors, particularly myocarditis, and highlights the importance of measurement accuracy, quality control, artificial intelligence, and three-dimensional echocardiography in clinical practice.ConclusionsThis updated guidance offers practical and evidence-based recommendations for echocardiographic assessment in cardio-oncology, aiming to facilitate early detection of cardiotoxicity and optimize multidisciplinary management.

Aortic stenosis in older adults often requires valve replacement and transcatheter aortic valve implantation (TAVI) is an option with good outcomes. However, recent hospitalizations due to heart failure (HF) may worsen results. This systematic review and meta-analysis adhering to PRISMA guidelines. We systematically searched PubMed, Cochrane Library and Scopus from database inception until July 2025. Data were analyzed by Review Manager using Risk Ratio (RRs) and 95

Behçet’s disease is a multisystemic inflammatory disorder that may affect the cardiovascular system through mechanisms such as vasculitis, endothelial dysfunction, and microvascular ischemia. Although cardiac involvement is often subclinical, early detection is important for prognosis. Global longitudinal strain (GLS) has emerged as a sensitive tool for identifying subtle myocardial dysfunction. This study aimed to compare conventional and strain-based echocardiographic parameters between patients with Behçet’s disease and healthy controls, and to investigate the relationship between disease activity and myocardial strain. A total of 59 patients with Behçet’s disease and 58 age- and sex-matched healthy volunteers were included. Clinical activity was assessed using the Behçet’s Disease Current Activity Form (BDCAF). All participants underwent comprehensive transthoracic echocardiography, including tissue Doppler imaging and two-dimensional speckle-tracking analysis. Left ventricular (LV) and right ventricular (RV) GLS, MAPSE, TAPSE, MPI, diastolic parameters, and conventional chamber measurements were recorded. Correlation and multivariable linear regression analyses were performed to determine predictors of LV GLS. Patients with Behçet’s disease had significantly lower LV and RV GLS values compared with controls (LV GLS: −21.6 [IQR 18.4–24.5] vs. −21.7 [18.0–24.5], p = 0.001; RV GLS: −22.1 [19.0–27.2] vs. −22.8 [22.1–27.2], p = 0.001). MAPSE (1.7 [1.3–2.4] vs. 1.87 [1.2–3.0], p = 0.001), TAPSE (2.0 [1.3–2.9] vs. 2.16 [1.6–2.9], p = 0.001), and MPI (0.6 [0.3–1.0] vs. 0.7 [0.4–1.1], p = 0.049) were also significantly reduced in the Behçet group. Diastolic function parameters were impaired in the Behçet group, including a lower E/A ratio (1.0 [0.5–2.1] vs. 1.2 [0.7–1.8], p = 0.001) and prolonged isovolumic relaxation time (147.3 [74–289] ms vs. 117.2 [88–197] ms, p = 0.001). BDCAF scores showed a strong negative correlation with both LV GLS (r = − 0.56, p < 0.001) and RV GLS (r = − 0.64, p < 0.001). In multivariable linear regression analysis, the presence of Behçet’s disease (β = 0.618, p < 0.001), diabetes mellitus (β = −0.192, p = 0.009), and age (β = −0.228, p = 0.001) emerged as independent predictors of impaired LV GLS. Behçet’s disease is associated with subclinical impairment of both LV and RV function despite preserved ejection fraction. GLS strongly correlates with disease activity, suggesting that inflammatory burden contributes to early myocardial dysfunction. Incorporating strain analysis into routine cardiac evaluation may improve early detection and risk stratification in Behçet’s disease.

Left atrial (LA) reservoir function is an important determinant of left ventricular (LV) filling. While atrial fibrillation (AF) has been suggested to impair LA function, the impact of atrial fibrillation on left atrial reservoir function, in comparison with normal sinus rhythm (NSR), has not been fully elucidated We studied 40 patients with AF and 42 with NSR, matched for age and maximum LA volume. Echocardiographic measurements included maximum and minimum LA volume, LA reservoir volume, stroke volume, LA reservoir strain (LAS), and LV global longitudinal strain (GLS). The standard apical four-chamber view was used for speckle-tracking LAS analysis Maximum LA volume was comparable between AF and NSR groups (99.6 vs. 97.7 mL, ns). However, reservoir volume was significantly lower in AF (19.1 vs. 37.4 mL), and reservoir fraction was markedly reduced (25.1 vs. 97.6

Supporting data of exercise stress echocardiography (ESE) in patients with chronic aortic regurgitation (AR) was limited, and no reports have focused on the mechanisms of the impaired left ventricular contractile reserve (LVCR) in AR. We retrospectively registered 44 consecutive asymptomatic or equivocally symptomatic patients undergoing ESE with more than moderate to severe chronic AR and a left ventricular ejection fraction (LVEF) of ≥ 50

Aortic stenosis (AS) is the most prevalent valvular heart disease among the elderly, often leading to chronic left ventricular (LV) pressure overload, myocardial hypertrophy, and fibrosis. Following surgical or transcatheter aortic valve replacement (SAVR/TAVI), relief of afterload can induce reverse remodeling - characterized by reductions in LV size, LV mass index (LVMI), improvements in LV ejection fraction (LVEF), global longitudinal strain (GLS), and left atrial (LA) parameters. The extent of reverse remodeling varies significantly among patients and is closely associated with prognosis. Greater regression in LVMI and improvements in LVEF or GLS have been linked to reduced cardiovascular events and mortality. Conversely, persistent LV hypertrophy, lack of LVEF improvement, or impaired GLS recovery are associated with adverse outcomes. Factors influencing reverse remodeling include underlying myocardial conditions such as advanced fibrosis, or comorbidities like hypertension and diabetes, and/or residual hemodynamic burden [ e.g., elevated blood pressure, prosthesis-patient mismatch, residual aortic regurgitation (AR)]. Echocardiographic assessment of LVMI, LVEF, GLS, and LA indices enables clinicians to evaluate reverse remodeling, stratify risk, and guide post-operative management. Emerging evidence suggests GLS and LA strain may provide prognostic information beyond conventional LVEF. Optimizing hemodynamic conditions and considering early intervention before irreversible myocardial damage could help promote reverse remodeling and may improve long-term outcomes. Comprehensive echocardiographic follow-up is essential for identifying patients at higher residual risk and support its role in risk stratification following valve intervention.