BACKGROUND:Sacubitril-valsartan (SV), an angiotensin receptor-neprilysin inhibitor, improves clinical outcomes in HFrEF patients through reverse remodeling; however, predictors of response remain uncertain. Left atrial strain (LAS) assessment may refine the definition and prediction of remodeling in this cohort. METHODS:In our hospital's heart failure registry, HFrEF patients prescribed SV were retrospectively identified. Correlations were assessed between LAS phases (reservoir [LASr], conduit [LAScd], and contractile [LASct]) and both left ventricular ejection fraction (LVEF) and left ventricular end-systolic volume (LVESV), using baseline values and therapy-associated changes (Δ). Multivariable linear regression was used to investigate associations between baseline LAS phases and subsequent ΔLVEF and ΔLVESV. RESULTS:Among 127 patients, SV therapy was associated with improvements in LVEF (+5.8 ± 12.8%; p < 0.001) and LVESV (-23.5 ± 53.5 mL; p < 0.001), as well as in left atrial and ventricular volumes. At baseline, LASr and LAScd correlated with both LVEF and LVESV, while only ΔLASr correlated with both ΔLVEF and ΔLVESV. On multivariable regression, baseline LASr, and LAScd were both associated with subsequent ΔLVEF (β per 5% increase: -1.69 [95% CI: -3.03 to -0.36] and -2.12 [95% CI: -4.12 to -0.13], respectively) and ΔLVESV (β per 5% increase: 11.01 [95% CI: 5.28 to 16.74], and 14.95 [95% CI: 6.39 to 23.51], respectively). When additionally adjusted for the baseline of the corresponding outcome measure, only LASr remained independently associated with ΔLVESV (β per 5% increase: 4.77 [95% CI: 0.01 to 9.53], p = 0.049). CONCLUSION:In HFrEF patients, LASr tracks SV-associated reverse remodeling and is independently associated with subsequent therapy-associated changes in LVESV.
AIMS:Tricuspid regurgitation (TR) is related to heart failure (HF) progression in individuals with transposition of the great arteries (TGA) and a systemic right ventricle (sRV). While tricuspid valve (TV) variants have been described in the general population, their prevalence and impact in patients with congenital heart disease are still unknown. We aim to systematically describe TV morphology in patients with TGA and sRV and identify factors associated to more than mild regurgitation using transthoracic 3D echocardiography. METHODS AND RESULTS:Echocardiographic exams of adults (>18years) with a sRV, including TGA following Mustard/Senning repair and congenitally corrected TGA (ccTGA) followed at a single tertiary center were retrospectively reviewed by two independent observers. A dedicated software for tricuspid annulus (TA) measurements from 3D images was used. Among 85 patients with a sRV, TV anatomy assessment by 3D echo was feasible in 74 (87%, 41 ± 12 years, 35% female, 49% ccTGA): non-trileaflet morphology was demonstrated in 54% of ccTGA and in 42% of TGA patients. Bicuspid and pentacuspid TV were more frequent in TGA, while quadricuspid TV was the second most frequent TV morphology in ccTGA patients. Interobserver agreement for TV morphology, prolapse, tenting height and annular size was good. By logistic regression, age, sex, presence of one prolapsing leaflet and most 3D measurements of TA from the dedicated software were associated with TR severity, while TV anatomy was not. On multivariable analysis, sex, prolapsing leaflets (OR 20.2, 95% CI: 4.62-127.7; p = 0.002), TA area by 3D (OR 1.3, 95% CI:1.02-1.79; p = 0.04) and maximum leaflets tenting height (OR 31, 95% CI: 2.8-170; p = 0.02) retained significant association to moderate/severe TR. CONCLUSIONS:Assessment of TV morphology by 3D transthoracic echocardiography is feasible and reliable in TGA patients with sRV. In our cohort, some variants were more common than previously described prevalence in the general population. While non-trileaflet morphology is frequent, significant TR is mainly associated with annular dilation, leaflet tenting, and prolapse rather than valve anatomy alone. Further studies are required to investigate the clinical relevance of TV anatomical variants in this subset.
PURPOSE:Assessing left ventricular end diastolic pressure (LVEDP) is critical in managing patients with heart failure. This study aims to explore the utility of left atrial speckle tracking echo (STE) and tissue Doppler derived indices (TDI) in predicting LVEDP in patients with heart failure in India. METHODS:This prospective study included 210 hemodynamically stable patients admitted with heart failure who underwent left heart catheterization. Echocardiography (TDI and STE indices) and Invasive LVEDP were recorded. RESULTS:Elevated LVEDP was associated with significantly higher ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') and lower LA strains in reservoir (LAS-r) values. In Bivariate analysis LAS-r showed inverse correlation with LVEDP (-0.74, 95% CI -0.78 to -0.68; p <0.0001). Multivariate regression identified Biplane LAS-r as an independent predictor of LVEDP (0.42; 95% CI 0.31-0.55; p < 0.0001).Receiver operating characteristic(ROC) analysis showed that LAS-r (cut-off ≤17)had superior diagnostic accuracy (AUC 0.97; sensitivity 88.4%, specificity 93.1%) compared to E/e' (0.71), LAS-ct, and LAVi (0.81, 0.64). E/e' though an independent predictor (1.09, 95% CI 1.02-1.14; p 0.008), had markedly lower sensitivity(57.2%) than that of LAS-r. Conventional markers like LA volume index (LAVi) and LVEF were not significant in the multivariate model. Diastolic dysfunction 2016 guidelines showed 64.29% accuracy in diagnosing patients with raised LVEDP. CONCLUSIONS:In patients with heart failure, parameters like mean E/e' ratio, LAVi, E wave DT are useful indices to estimate LVEDP; however, peak LAS-r (cut-off ≤17) provides a better prediction of LVEDP and could be considered a promising noninvasive index to assess LVEDP in patients of heart failure.
OBJECTIVE:To evaluate the corrected index of cardio-electrophysiological balance (ICEBc) and left ventricular mechanical dispersion (LVMD), in obese individuals and to examine their associations with obesity severity and electromechanical myocardial heterogeneity. METHODS:This prospective case-control study included obese individuals (BMI ≥30 kg/m2) and normal-weight healthy controls. All participants underwent standard 12-lead electrocardiography and transthoracic echocardiography. The ICEB and corrected ICEB (ICEBc) were calculated from ECG recordings. LVMD was assessed using two-dimensional speckle-tracking echocardiography. Comparisons between groups and correlation analyses between ICEBc, LVMD, and body mass index (BMI) were performed using appropriate statistical methods, with p < 0.05 considered statistically significant. RESULTS:Obese individuals had higher systolic and diastolic blood pressures. LVMD was significantly higher and global longitudinal strain was significantly lower in obese participants. QTc and ICEBc were significantly higher in obesity. Among obese subgroups, LVMD and ICEBc increased with obesity severity. LVMD showed a good positive correlation with ICEBc (r = 0.675, p < 0.001). BMI correlated moderately with LVMD (r = 0.543, p < 0.001) and weakly with ICEBc (r = 0.257, p = 0.021). CONCLUSION:Obesity was associated with higher LVMD and ICEBc values, suggesting increased electrical and mechanical myocardial heterogeneity. LVMD and ICEBc may serve as complementary, non-invasive surrogate markers of obesity-related electromechanical remodeling. Larger longitudinal studies with rhythm monitoring are required to determine whether these parameters predict clinical arrhythmic events.
BACKGROUND:By combining left ventricular (LV) global longitudinal strain (GLS) with LV volume during the cardiac cycle, LV strain-volume loops (SV-loops) can be generated. LV SV-loop derived parameters provide new insights into the interaction between cardiac contraction and volume in a variety of cardiac diseases and may even have prognostic value. The aim of this study is to describe SV-loops in a healthy adult population and investigate potential sex- and age-related differences of LV SV-loop characteristics. METHODS:In 125 healthy volunteers aged 18-72 years, apical 2-, 3- and 4-chamber views were acquired to measure GLS. Custom software was used to combine strain and volume data to construct SV-loops. Different parameters were derived: (i) linear slope of systolic strain-volume relation (S-Slope); (ii) linear slope of early-systolic strain-volume relation (ES-Slope); (iii) linear slope of early-diastolic strain-volume relation (ED-Slope); (iv) linear slope of late-diastolic strain-volume relation (LD-slope) and (v) uncoupling between systolic and diastolic strain-volume relation (UNCOUP). RESULTS:For systolic strain-volume relation, higher values were observed in females compared to males, with S-Slope values of 0.19 %/mL m-2 [0.17-0.22] and 0.13 %/mL m-2 [0.11-0.14], respectively (p < 0.001). Similarly, ED-Slope was higher in females than in males, with values of 0.18 %/mL m-2 [0.10-0.28] and 0.12 %/mL m-2 [0.06-0.18] respectively (p = 0.003). Low values for uncoupling between the systolic and diastolic strain-volume relation were observed, with a mean value of 0.34 ± 1.1. Additionally, UNCOUP was positively correlated with age (r = 0.4; p < 0.05). CONCLUSIONS:Higher values observed in systolic and early-diastolic strain-volume relation in females may reflect sex-specific differences in LV contraction. While the exact mechanisms remain unclear, these findings suggest potential variations in myocardial deformation patterns that warrant further investigation. Consistent with previous work, relative coupling of the systolic and diastolic strain-volume relationship was identified in our cohort of healthy individuals. However, with increasing age, higher values for uncoupling were observed, suggesting age-related alterations in ventricular mechanics that may contribute to changes in cardiac function over time.
OBJECTIVE:To noninvasively monitor cardiac functional changes throughout chemotherapy in colorectal cancer patients using pressure-strain analysis, validate their predictive value for early detection of subclinical cardiac dysfunction. METHODS:This retrospective observational study included colorectal cancer patients receiving FOLFOX/CAPEOX chemotherapy. Myocardial work parameters-including global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE)-were serially assessed using noninvasive pressure-strain loop technology at baseline (T0), after the first cycle (T1), mid-therapy (T2), and treatment completion (T3). Its predictive performance was evaluated by analyzing the trends of the aforementioned parameters and using receiver operating characteristic (ROC) curves. RESULTS:Significant cardiac dysfunction emerged as early as the first chemotherapy cycle: GLS decreased by 8.7% (p < 0.001), GWI declined by 6.2% (p < 0.001), GWE reduced by 0.5% (p < 0.001), and GWW markedly increased (p < 0.001). The combined myocardial work model (GWI + GCW + GWE + GWW) predicted subclinical dysfunction with superior AUC (0.875) versus the GLS-only model (AUC = 0.813, p = 0.037). CONCLUSIONS:FOLFOX/CAPEOX chemotherapy induces early myocardial mechanical inefficiency. Myocardial work parameters are sensitive monitoring markers, and their integrated model enhances early detection of subclinical cardiac injury.
BACKGROUND:Chronic thromboembolic pulmonary hypertension (CTEPH) leads to right atrial (RA) dysfunction, which correlates with poor prognosis. However, most studies on RA function in pulmonary hypertension (PH) focus on heterogeneous PH etiologies, with limited data on CTEPH alone. This study aimed to assess RA function in CTEPH patients using standard two-dimensional (2DE) and M-mode echocardiography, and validate the clinical value of RA-related parameters. METHODS:We enrolled 91 CTEPH patients and 30 healthy controls. RA volume/function parameters (maximal volume index [RAVmaxI], total/passive/active emptying fractions [TotEF/PassEF/ActEF]) and tricuspid annular plane systolic excursion (TAPSE, decomposed into atrial [TAPSEra] and ventricular [TAPSErv] components; TAPSEra% = TAPSEra/TAPSE) were measured via 2DE/M-mode echocardiography. Correlations with clinical (WHO functional class [WHO-FC], 6-min walk distance [6MWD]) and laboratory (NT-proBNP) indices were analyzed; receiver operating characteristic (ROC) curves evaluated predictive value for WHO-FC ≥ III. RESULTS:Compared to controls, CTEPH patients had higher RAVmaxI (43.46 ± 13.34 vs. 22.52 ± 2.89 mL/m2, P < 0.001), lower TotEF (39.45 ± 9.43 vs. 50.07 ± 7.52%, P < 0.001) and PassEF (14.33 ± 6.43 vs. 30.03 ± 5.26%, P < 0.001), and higher ActEV/TotEV (59.76 ± 17.37 vs. 34.05 ± 12.75%, P < 0.001). TAPSEra% was higher in CTEPH patients (58.69 ± 19.54 vs. 30.52 ± 7.92%, P < 0.001). RAVmaxI (≥37.47 mL/m2, AUC = 0.899, sensitivity = 75.4%, specificity = 91.7%) and TAPSEra% (≥45.05%, AUC = 0.849, sensitivity = 90.2%, specificity = 70.0%) effectively predicted WHO-FC ≥ III (both P < 0.001). CONCLUSIONS:Impaired RA reservoir and conduit functions are hallmarks of CTEPH, with compensatory active contraction counteracting the reduction in passive filling. Given their noninvasive nature and high reliability, RAVmaxI and TAPSEra% are valuable indices for identifying patients with WHO-FC ≥ III and quantifying CTEPH severity, justifying their integration into standard echocardiographic protocols.
BACKGROUND:Abnormal nocturnal blood pressure patterns are associated with subclinical cardiac dysfunction in hypertension (HT). However, their relationship with the myocardial performance index (MPI) is not well-defined. METHODS:This retrospective study included 196 hypertensive patients who underwent 24-h ambulatory blood pressure monitoring (ABPM). Patients were classified as dipper, non-dipper, and reverse dipper according to nocturnal systolic blood pressure variation. Echocardiographic parameters, including MPI, were compared. Multivariate linear regression analysis was performed. RESULTS:The highest MPI values were found in the reverse dipper group (p < 0.001). Reverse dipper (B = 0.054, p < 0.001) and non-dipper (B = 0.023, p = 0.002) patterns were independently associated with increased MPI. MPI showed moderate discriminatory power in predicting the reverse dipper pattern (area under the curve [AUC] = 0.693). CONCLUSION:Reverse dipper and non-dipper patterns are associated with increased MPI. This finding suggests an association between abnormal circadian blood pressure patterns and subclinical cardiac dysfunction. Further prospective studies are required to determine clinical relevance.
OBJECTIVE:Severe aortic stenosis (AS) leads to chronic pressure overload of the left ventricle (LV). We explored the prognostic value of preoperative left ventricular end-diastolic dimension (LVEDD) dilation in patients with severe AS. METHODS:This is a retrospective study of 108 patients with severe AS who underwent transcatheter aortic valve implantation with the Venus-A valve. These participants were assigned to the large LVEDD and non-large LVEDD groups. The receiver operating characteristic and Kaplan-Meier curves were generated to assess the predictive value of preoperative LVEDD dilation for poor patient prognosis (readmission or death within 1 year postoperatively), as well as its effects on the readmission risk owing to heart failure, and complications and survival rates within 1 year postoperatively. RESULTS:Significant differences were observed between the two groups in B-type natriuretic peptide, creatinine, aortic valve area, transfemoral access, aortic valve peak velocity, mean transvalvular pressure gradient, LVEDD, left ventricular end-systolic dimension, left atrial dimension, interventricular septal thickness, relative wall thickness, left ventricular mass index, left ventricular ejection fraction, E/A ratio, E/e' ratio, and stroke volume index. Preoperative LVEDD dilation showed a predictive value for poor patient prognosis (AUC = 0.843; 95%CI: 0.761-0.906, 50.9 mm cut-off value, 99.9% sensitivity, 62.07% specificity). Preoperative LVEDD dilation was an independent influencing factor for poor prognosis within 1 year postoperatively, associated with increased readmission risk and reduced patient survival rate. CONCLUSION:Preoperative LVEDD dilation is an independent influencing factor for poor postoperative prognosis in patients. It helps predict poor prognosis within 1 year postoperatively.
PURPOSE:Dasatinib, a tyrosine kinase inhibitor used to treat chronic myeloid leukemia (CML), is known to cause cardiopulmonary toxicities; however, little is known about the echocardiographic changes associated with this therapy. We present a comprehensive echocardiographic assessment of patients with CML on Dasatinib therapy. METHODS:We performed a retrospective cohort analysis on adult patients with CML receiving Dasatinib between 2017 and 2023. Comprehensive clinical and echocardiographic data with speckle-tracking analyses were included. RESULTS:Of 199 patients with CML on Dasatinib, 75 (38%) patients had a pre-Dasatinib echocardiogram, and 49 (25%) patients had both pre- and post-Dasatinib echocardiograms. Among 44 patients with analyzable echocardiograms (average age 59 ± 15 years old, 39% female), 7 (16%) patients had baseline heart failure with preserved ejection fraction (HFpEF). After initiation of Dasatinib, there was a significant increase in left ventricular (LV) end-diastolic diameter index (2.4 [2.2, 2.6] vs. 2.6 [2.4, 2.8]cm/m2, p < 0.01), LV end-systolic volume index (16 [13, 26] vs. 21 [14, 26] mL/m2, p = 0.04) and LV mass index (85.3 [75.4, 94.4] vs. 93.1 [80.6, 114.7]g/m2, p < 0.01). There was a significant increase in left atrial (LA) volume index (LAVI, 29.0 ± 10.6 vs. 33.4 ± 13.0 mL/m2, p = 0.01), decrease in lateral e' velocity (11.8 ± 3.3 vs. 10.4 ± 2.8 cm/sec, p < 0.01) and increase in E/e' (9.5 ± 2.8 vs. 10.7 ± 3.5, p = 0.04) post-Dasatinib. Among patients with abnormal LAVI post-Dasatinib, higher LAVI correlated with worsened LA reservoir strain (r = -0.59, p = 0.01). LV ejection fraction and global longitudinal strain were not significantly changed. Patients with baseline HFpEF were significantly more likely to have progression in diastolic dysfunction compared to patients without HFpEF (p = 0.03). CONCLUSION:Dasatinib was associated with significant changes in LV structure, LA volume, and diastolic parameters in patients with CML. Patients with baseline HFpEF were more likely to progress in diastolic dysfunction on Dasatinib.
Purpose: Cardiovascular (CV) events remain a major source of morbidity and mortality following liver transplantation (LT). Dobutamine stress echocardiography (DSE) is commonly used for pre-transplant risk stratification, though its clinical utility in this setting remains uncertain. We evaluated post-transplant outcomes associated with abnormal DSE findings to explore its role in CV risk assessment. Methods: Adult LT candidates who underwent DSE at a single center were included. DSE results were categorized as positive, negative, or inadequate. The primary outcome was postoperative cardiac events; secondary outcomes included mortality and transplant delays. Analyses included Mann-Whitney U and Fisher's exact tests, ROC analysis, logistic regression, and random survival forest (RSF) modeling. Results: Of 981 evaluated candidates, 644 (66%) underwent DSE. Postoperative cardiac events occurred in 25 patients (4%), none had a positive DSE. Of six patients with positive DSE, one had obstructive coronary disease on subsequent testing. Inadequate DSE (mostly failure to reach target heart rate or hemodynamic intolerance) occurred in 113 patients (18%); 30% underwent further evaluation, with a median transplant delay of 25 (IQR 2.5-43) days. Pooling positive and inadequate DSE yielded an AUC of 0.64 and odds ratio of 2.25 (p < 0.01) for association with postoperative cardiac events. RSF modeling identified five hemodynamic features during DSE as top predictors. Conclusion: DSE may have limited utility when interpreted within a binary positive/negative framework in LT candidates. Inadequate DSE may identify higher-risk patients but may lead to increased downstream testing and transplant delays. Physiological responses during stress testing may provide complementary information for risk assessment and warrant further investigation.
BACKGROUND:Mitral annular disjunction (MAD) is an anatomical anomaly increasingly recognized for its association with myocardial fibrosis and malignant arrhythmias. Identifying predictors of this fibrosis is crucial for risk stratification. This study aimed to define the functional and morphological predictors of left ventricular (LV) fibrosis in patients with MAD using cardiac magnetic resonance imaging (CMR). METHODS:In a retrospective single-center study, 60 patients with CMR-confirmed MAD were evaluated. Late gadolinium enhancement (LGE) was used to identify LV fibrosis, categorizing patients into two groups: those without fibrosis (Group I, n = 50) and those with fibrosis (Group II, n = 10). Clinical, volumetric, and feature-tracking strain parameters were compared between groups, and univariate logistic regression was performed to identify predictors of fibrosis. RESULTS:The prevalence of LV fibrosis was 16.7%. Patients with fibrosis (Group II) demonstrated significant LV remodeling, in the form of higher indexed end-diastolic and end-systolic volumes (ESV) (LVEDVI: 116.2 vs. 98.4 mL/m2, p = 0.032; LVESVI: 47.5 vs. 38.2 mL/m2, p = 0.023), and markedly impaired biventricular strain, including LV global circumferential strain (LV GCS: -13.6 vs. -17.8, p = 0.0004) and right ventricular strain (RV GLS: -19.9 vs. -24.4, p = 0.028; RV GCS: -7.8 vs. -11.5, p = 0.003). On univariate analysis, the severity of mitral regurgitation (MR) (OR = 4.86, p = 0.049) and impaired LV global longitudinal strain (GLS) (OR = 1.44 per 1% reduction, p = 0.034) were identified as significant predictors of LV fibrosis. CONCLUSION:In patients with MAD, the hemodynamic burden of significant MR and subclinical LV dysfunction, quantified by impaired LV GLS, are key significant predictors on univariate analysis of myocardial fibrosis. CMR, particularly tissue characterization with LGE and myocardial strain analysis, provides critical insights for enhanced risk assessment, potentially guiding early intervention strategies in high-risk individuals.
Constrictive pericarditis in the setting of cardiac sarcoidosis is an uncommon but severe manifestation of granulomatous heart disease, capable of producing irreversible structural deformation and life-threatening haemodynamic compromise. Progressive calcific pericardial encasement can result in focal aneurysm-like deformation of the right ventricular outflow tract-a consequence of chronic external constraint rather than intrinsic myocardial pathology. This case illustrates the complementary role of multimodal cardiac imaging in characterizing this phenotype and documents the catastrophic thromboembolic vulnerability inherent to its clinical context. Despite periprocedural interruption of oral anticoagulation limited to a single withheld dose before cavotricuspid isthmus ablation for atrial flutter, the patient sustained simultaneous acute left middle cerebral artery infarction and bilateral pulmonary embolism within 48 h, underscoring the imperative for risk-stratified, individualized anticoagulation management in this population.
BACKGROUND:Left ventricular structural abnormalities (concentric left ventricular remodeling [CR] or left ventricular hypertrophy [LVH]) and left ventricular diastolic dysfunction (LVDD) are key components of clinical diastolic heart failure (HF) and are associated with cardiometabolic risk factors, which are highly prevalent in Mexican Americans. OBJECTIVES:This study aimed to determine the prevalence of subclinical LV structural abnormalities (LVH or CR) and LVDD (Stage B HF) in a sample of asymptomatic Hispanics/Latinos and to examine the cardiometabolic determinants of these abnormalities. METHODS:Demographic, metabolic biomarkers, and body composition data were obtained in 1128 participants (57.8% females, mean age 52.6 ± 0.8 years) from the Cameron County Hispanic Cohort study. Abnormalities in cardiac structure and function were evaluated using transthoracic echocardiography. Visceral fat tissue was estimated utilizing dual-energy x-ray absorptiometry. Weighted logistic regression analyses were conducted while adjusting for demographic and clinical covariates. RESULTS:Weighted prevalence rates of LV structural abnormalities (55.9% ± 2.2%) and LVDD (19.6% ± 2.0%) were high. In adjusted models, age, body mass index (BMI), hypertension, and metabolic syndrome were associated with CR, LVH, or LVDD. In women, but not men, higher visceral adiposity and the presence of metabolic syndrome were associated with CR or LVH. CONCLUSIONS:There is a high prevalence of Stage B HF among Hispanics/Latinos. This study presents evidence of independent differential relationships of visceral adiposity, metabolic syndrome, and hypertension on CR, LVH, or LVDD in a Mexican American cohort. Targeted intervention strategies are important for preventing early cardiac abnormalities and mitigating the transition to symptomatic disease.
BACKGROUND:Myocardial bridging (MB) is a congenital coronary anomaly characterized by systolic compression of an intramyocardial coronary artery segment. Although often considered benign, MB may be associated with altered coronary hemodynamic and regional myocardial dysfunction. Speckle-tracking echocardiography (STE) allows sensitive assessment of myocardial deformation and may detect subtle abnormalities not evident with conventional echocardiographic parameters. This study aimed to evaluate myocardial deformation in patients with MB and to investigate the relationship between bridge severity and strain parameters. METHODS:Patients with MB identified by coronary angiography between 2010 and 2022 were retrospectively analysed. Only patients with isolated mid-left anterior descending artery MB and no significant coronary artery disease were included. Patients were categorized according to the degree of systolic narrowing as mild (<50%, group I) or moderate-severe (≥50%, group II). Control subjects had normal coronary angiograms without MB. Conventional echocardiographic parameters and STE-derived global longitudinal strain (GLS) and segmental strain values were compared among groups. RESULTS:Ninety-seven subjects were included (62 with MB and 35 controls). LVEF and overall GLS were similar between MB patients and controls. However, GLS differed significantly across control, group I, and group II (-19.6 ± 2.1%, -20.4 ± 1.9%, and -18.0 ± 3.2%, respectively; p = 0.001). Patients with moderate-severe MB demonstrated less negative strain values in multiple myocardial segments, whereas strain parameters were comparable between controls and mild MB. CONCLUSION:Moderate-severe MB is associated with regional myocardial deformation abnormalities. STE may provide additional functional insight into myocardial mechanics in hemodynamically significant MB.
PURPOSE:This study investigated standard and advanced echocardiographic parameters in endurance athletes with different training profiles, and their association with exercise performance. METHODS:Consecutive endurance athletes undergoing cardiological screening or orthopedic evaluation for knee injuries at Campus Bio-Medico University Hospital underwent advanced echocardiography and cardiopulmonary exercise testing. Athletes were categorized into three groups: (1) Long-Distance (marathon and ultramarathon runners, n = 30); (2) Mid-Distance (middle-distance runners, n = 27); and (3) Detrained (≥ 6 months training interruption, n = 31). RESULTS:Left ventricular ejection fraction did not differ among groups. The Long-Distance group had the highest stroke volume index, followed by the Mid-Distance and Detrained groups (p <0.001). Long-Distance athletes showed lower left ventricular global longitudinal strain (p = 0.003) and left atrial reservoir strain (p = 0.003) compared to the other groups, with no differences in right ventricular free wall strain. Myocardial work analysis showed higher work index and constructive work, and lower wasted work, leading to greater global work efficiency in the Long-Distance group (p <0.001). In multivariable linear regression analysis, stroke volume index (β = 1.02, p < 0.001) and global work efficiency (β = 1.00, p = 0.001) were independently associated with Peak VO2, whereas global longitudinal strain was not. CONCLUSION:Advanced echocardiography provides additional insights into the athlete's heart. Myocardial work indices reflect training-related cardiac adaptations, and left atrial reservoir strain is influenced by training status. These findings, together with the association of stroke volume index and global work efficiency with Peak VO2, support the integration of advanced echocardiographic parameters into athlete evaluation and monitoring.
PURPOSE:Describe longitudinal echocardiographic changes during the first year of life in infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) and assess the prognostic value of early echocardiographic parameters. METHODS:This study was a prospective longitudinal cohort study. Preterm infants with BPD underwent echocardiographic screening at 28 days of life and, if diagnosed with PH, were followed every 3 months until 12 months or death. RESULTS:During the first year of life, 40.9% of infants died, 52.3% survived with complete resolution of PH, and 6.8% survived with persistent mild PH. Severe BPD was significantly more prevalent among non-survivors. At the 28-day of life echocardiographic assessment, survivors exhibited higher tricuspid annular plane systolic excursion (8.67 vs. 7.45 mm) and lower left ventricular eccentricity index (1.05 vs. 1.30), whereas tricuspid regurgitation gradient and pulmonary artery acceleration time did not differ significantly. Serial echocardiography showed a consistent trend toward improvement in pulmonary artery acceleration time, left ventricular eccentricity index and tricuspid annular plane systolic excursion, suggesting a reduction in pulmonary vascular resistance and maturation of right ventricular systolic function. Receiver operating characteristic analysis showed that tricuspid annular plane systolic excursion at 28 days had modest discriminatory ability for predicting 1-year survival, with a cutoff value of 7.14 mm associated with improved survival. CONCLUSION:In infants with BPD-associated PH, echocardiographic abnormalities frequently improve over time among survivors. Longitudinal echocardiographic assessment may aid early risk stratification, with tricuspid annular plane systolic excursion providing supportive prognostic information when interpreted in conjunction with other echocardiographic parameters.
Objective This study investigated the clinical significance of fetal umbilical artery (UA) and middle cerebral artery (MCA) Color Doppler parameters in the prenatal diagnosis of hypertensive disorder complicating pregnancy (HDCP) in pregnant women of advanced maternal age (AMA).Methods AMA women with HDCP (245 gestational hypertension cases, 193 mild preeclampsia, 152 severe preeclampsia) and 80 healthy AMA pregnant women (control) in the late stage of singleton pregnancy were enrolled. Fetal UA and MCA Color Doppler parameters (systolic-to-diastolic ratio [S/D], pulsatility index [PI], and resistance index [RI]) were recorded. Influencing factors, and diagnostic and predictive value of these color Doppler parameters for HDCP and disease severity were assessed by logistic regression models and receiver operating characteristic curves.Results Total bilirubin, total protein (TP), creatinine, Cl-, and antithrombin III (AT-III) closely correlated with HDCP severity. Fetal UA S/D, PI, and RI values increased while MCA S/D, PI, and RI values decreased with the worsening of HDCP. Fetal UA S/D, MCA S/D, and MCA RI were independent influencing factors for HDCP occurrence, while fetal UA RI, MCA S/D, and MCA PI were independent influencing factors for HDCP severity. The combined detection of these parameters demonstrated superior predictive value for HDCP occurrence and severity than individual parameter detection.Conclusion This study identifies several fetal UA and fetal MCA Color Doppler ultrasound parameters as potential influencing factors for HDCP occurrence and severity. The combined detection of these parameters may provide a reference for early recognizing HDCP and evaluating severity in women of AMA.
Purpose To evaluate the feasibility of two-dimensional speckle tracking echocardiography (2D-STE) for quantitatively assessing right atrial global longitudinal strain (RAGLS) in normal fetuses, and to compare RAGLS among normal fetuses, fetuses with left ventricular outflow tract obstruction (LVOTO), and those with moderate-to-severe tricuspid regurgitation (TR). Methods A total of 32 fetuses with LVOTO, 25 with moderate-to-severe TR, and 100 normal fetuses were enrolled. RAGLS was compared among the three groups, and its correlations with gestational age (GA) and other echocardiographic parameters were analyzed. Inter- and intra-observer repeatability was assessed using intraclass correlation coefficients (ICC) and Bland-Altman analysis. Results RAGLS differed significantly among the three groups (p < 0.01). The RAGLS values in both the TR and LVOTO groups were significantly lower than those in the control group (both p < 0.01), whereas the LVOTO group exhibited significantly higher RAGLS compared to the TR group (p < 0.05). In the control group, RAGLS was negatively correlated with GA (r = -0.47, p < 0.01). However, in the TR or LVOTO groups, RAGLS showed no significant correlation with GA or other measured parameters (all p > 0.05). The inter- and intra-observer repeatability of RAGLS measurements was good (ICC > 0.75). Conclusion The right atrial reservoir function is impaired in fetuses with TR and those with LVOTO. RAGLS may serve as a sensitive indicator for quantitatively evaluating RA dysfunction in fetal cardiac anomalies.
Purpose Accurate quantification of ventricular volumes and function is critical for managing congenital heart disease (CHD) and guiding surgical and interventional decisions. Although cardiac magnetic resonance imaging (CMR) and cardiac catheterization (CA) are gold standards, their use is limited by availability, invasiveness, and patient tolerance. Three-dimensional echocardiography (3DE) offers a non-invasive alternative; however, validation across modalities in heterogeneous CHD populations is limited. The aim of this study was to evaluate the clinical utility of 3DE in patients with CHD by comparison with against measurements obtained by CMR and CA. Methods We retrospectively analyzed patients with CHD undergoing 3DE, CMR, and CA. Ventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and cardiac index (CI) were measured and compared across the three modalities. 3DE data were analyzed using Philips QLAB. Correlation coefficients, regression equations, and Bland-Altman analyses were used to assess agreement across modalities. Results Thirty-six patients were included between 2024 and 2025. Strong correlations were observed between 3DE and CMR (LVEDV r = 0.94, RVEDV r = 0.93) as well as 3DE and CA (LVEDV r = 0.86, RVEDV r = 0.89). 3DE systematically underestimated volumes (3DE < CMR < CA). EF showed excellent correlation across modalities, whereas CI exhibited greater variability. Bland-Altman analysis confirmed a systematic bias that remained within clinically acceptable limits for population-level assessment, although individual-based variability should be considered. Conclusions 3DE provides reliable volumetric and functional assessment in patients with CHD, with strong correlation with CMR and CA despite systematic underestimation of absolute values. 3DE is a practical noninvasive modality for serial follow-up.
