BACKGROUND:Pulmonary regurgitation (PR) after right ventricular outflow tract (RVOT) reconstruction is a major driver of right ventricular (RV) remodeling. Cardiac magnetic resonance (CMR) is the reference standard for quantifying PR but is not routinely feasible in many pediatric follow-up settings. We evaluated whether an echocardiographic early-diastolic RV-pulmonary artery (PA) pressure gradient (Echo-EaDPG), derived from early-diastolic peak PR velocity (ΔP = 4v2), can serve as a practical complementary hemodynamic marker to guide CMR assessment. METHODS:We retrospectively analyzed patients with repaired tetralogy of Fallot or related conditions who underwent echocardiography, CMR, and cardiac catheterization within a 6-month interval of each other after RVOT reconstruction. Echo-EaDPG was compared with CMR-derived PR fraction (CMR-PRF) and catheter-measured early-diastolic RV-PA pressure gradient (Cathe-EaDPG). Clinically significant PR was operationally defined as CMR-PRF ≥ 25%. Correlation, multivariable analyses, receiver operating characteristic (ROC) analysis, and bootstrap internal validation were performed. RESULTS:Forty patients were included. Echo-EaDPG correlated with CMR-PRF (r = 0.65, p < 0.001) and Cathe-EaDPG (r = 0.55, p < 0.001) and was independently associated with CMR-PRF ≥ 25% among tested echocardiographic indices. Echo-EaDPG demonstrated good discrimination for identifying CMR-PRF ≥ 25% on ROC analysis (AUC = 0.90), with bootstrap-supported robustness. Interobserver agreement for Echo-EaDPG was excellent (ICC = 0.96, 95% CI 0.82-0.99, p < 0.001). CONCLUSIONS:Echo-EaDPG is a simple Doppler-derived parameter associated with CMR-quantified PR and invasive early-diastolic RV-PA gradients after RVOT reconstruction. As an adjunct to integrated echocardiographic assessment, Echo-EaDPG may help identify patients who warrant CMR for quantitative PR evaluation, particularly when routine CMR is difficult to obtain.
PURPOSE:To examine associations of left atrial reservoir strain, diameter, and volume index with first rehospitalization and recurrent readmission burden in acute heart failure with atrial fibrillation. METHODS:Among 716 enrolled patients, 691 with an available measurement formed the left atrial diameter analysis cohort; left atrial volume index (LAVI) and reservoir strain (LArs) were evaluated in a 320-patient single-center subgroup. Same-day rehospitalization and death were classified as death-first. Fine-Gray and negative-binomial models examined first rehospitalization and recurrent readmission burden. RESULTS:Of 691 patients, 189 had rehospitalization-first, 118 death-first, and 384 were censored. In the 320-patient subgroup, lower LArs was associated with first rehospitalization (adjusted subdistribution hazard ratio [sHR] 0.920 per 1 percentage-point increase, 95% confidence interval [CI] 0.870-0.973) and with a higher recurrent readmission rate (incidence rate ratio 0.877, p < 0.001); the first-event association persisted after additional echocardiographic adjustment including left atrial diameter (sHR 0.928, 95% CI 0.876-0.984). Left atrial diameter was associated with rehospitalization-first (sHR 1.025/mm, 95% CI 1.011-1.039) but not death-first, whereas LAVI was associated with neither, including per standard deviation. With exploratory cutoffs, only combined abnormality was associated with first rehospitalization (sHR 2.12, 95% CI 1.16-3.85). Left atrial indices did not significantly improve discrimination. CONCLUSION:Lower LArs was associated with first heart failure rehospitalization and recurrent readmission burden, and remained associated after additional echocardiographic adjustment including left atrial diameter. Left atrial diameter was associated with first rehospitalization but LAVI was not; a general left atrial structural mechanism is not established. Incremental predictive value was limited; cohort-derived cutoffs require external validation.
PURPOSE: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. METHODS: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 (<6 months, 6 months-3 years, 3-6 years, >6 years); meta-regression assessed duration as a continuous moderator. RESULTS: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; p < 0.01), impaired global longitudinal strain (GLS; MD +3.27%; p < 0.01), and increased left ventricular mass index (LVMI; MD +18.21 g/m2; p < 0.01). Septal thickening was detectable before six months, preceding functional impairment. LVEF, LVMI, and posterior wall thickness (PWT) differed significantly across strata (all p ≤ 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. CONCLUSION: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.
BACKGROUND: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. HYPOTHESIS: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. METHODS: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. RESULTS: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. CONCLUSIONS:AI-enhanced echocardiography represents a promising step toward precision cardiovascular imaging and may become the central imaging component of future multimodal diagnostic pathways for patients with suspected ACS. Integration of structural, functional, electrical, biochemical, and clinical information through AI-supported decision systems has the potential to improve diagnostic performance and optimize emergency cardiovascular care.
PURPOSE:Mitral annular calcification (MAC) is associated with atrial fibrillation and diastolic dysfunction, but its relationship with left atrial (LA) mechanics is poorly defined. The ratio of E/e' to LA reservoir strain (LASr) is a non-invasive surrogate of, not a direct measure of, LA stiffness. We assessed MAC and its severity against LASr and this LA stiffness index (LASI). METHODS:In this single-center cross-sectional study with prospective recruitment, 112 adults in sinus rhythm with ejection fraction ≥50% (58 with MAC, 54 age- and sex-similar controls) underwent two-dimensional speckle-tracking echocardiography. MAC was graded mild to severe; LASI was calculated as E/e' divided by LASr. RESULTS:LASr was lower (23.2 ± 7.8% vs. 26.7 ± 7.7%, p = 0.018) and LASI higher (0.57 ± 0.30 vs. 0.34 ± 0.20, p < 0.001) in the MAC group. In models excluding the index components, MAC severity was independently associated with higher LASI (β = 0.41, p < 0.001) and MAC presence with lower LASr (-3.6 points, p = 0.016). After clinical adjustment, each 0.1-unit LASI increase was associated with MAC (odds ratio 1.71, 95% CI[1.34-2.17]). LASI discriminated MAC with an area under the curve of 0.762 (0.674-0.851; cut-off 0.31, sensitivity 79%, specificity 63%), which did not differ from E/e' (p = 0.52) or LA volume index (p = 0.48). CONCLUSION:MAC and its severity were associated with impaired LA reservoir function and a higher non-invasive stiffness index. The index did not discriminate MAC better than its simpler components, so these cross-sectional findings are hypothesis-generating.
BACKGROUND:The assessment of stable coronary artery disease has been performed using the first-phase ejection fraction (EF1) in previous research. However, the use of EF1 has seldom been employed in the evaluation of early left ventricular systolic dysfunction among patients with hypertrophic cardiomyopathy (HCM). OBJECTIVE:We aimed to assess early left ventricular systolic dysfunction in patients with HCM by application of first-phase EF1. METHODS:The cohort included 90 HCM patients who were stratified according to pathophysiological subtype into 50 with nonobstructive (NO-HOCM) and 40 with obstructive (HOCM) disease. An additional 50 age-matched healthy individuals served as controls. Baseline characteristics, conventional echocardiographic parameters, EF1 were measured and serum B-type natriuretic (BNP) peptide was detected. Additionally, the correlations between EF1 and both LVMI and BNP were compared, and receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) for assessing the value of EF1 in the early detection of left ventricular systolic dysfunction in HCM patients. RESULTS:Compared to the control group, patients with HOCM showed higher systolic blood pressure and lower heart rate (p < 0.05). Both HOCM and NO-HCM showed enlarged LAD and LVDd, elevated LVMI, LVEF, E/e' ratios and BNP compared with controls (p < 0.05). However, EF1 was decreased in HCM patients than that in controls (38.20 ± 2.02, P < 0.05), especially in HOCM patients (22.29 ± 3.59 & 25.12 ± 3.19, P < 0 .05). EF1 was negatively correlated with both LVMI and BNP (all r > 0.3, P < 0.001). Receiver operating characteristic (ROC) curve analysis demonstrated that EF 1 (AUC = 0.874) exhibited superior diagnostic value for assessing early left ventricular systolic dysfunction in patients with HCM compared with LVEF (AUC = 0.649). The optimal cut-off value for EF1 was < 28.5%, with a sensitivity of 90.6% and a specificity of 81.5%, corresponding to an AUC of 0.874 (95% CI: 0.804-0.946, p < 0.001). CONCLUSION:Compared with healthy controls, patients with HCM had a lower EF1, and this reduction was significantly more pronounced in those with HOCM. Given its high sensitivity in evaluating left ventricular systolic function in patients with HCM, EF1 represents a promising adjunctive parameter for the multimodal assessment of systolic function in this population.
BACKGROUND:Mitral regurgitation (MR) is among the most common valvular heart diseases, but its echocardiographic quantification remains challenging, particularly in secondary MR and in some organic causes. Three-dimensional vena contracta area (3D VCA) allows direct planimetry of the regurgitant orifice. We aim to compare 3D VCA with two-dimensional (2D) parameters and to derive aetiology-specific severity cut-offs in a Tunisian cohort. METHODS:Prospective cross-sectional study. Patients with at least moderate MR underwent transthoracic and 2D/3D transesophageal echocardiography with planimetry of the VCA. Spearman correlations between 3D VCA and 2D parameters (vena contracta width, PISA-derived regurgitant orifice area), and diagnostic performance for severe MR (ROC, Youden index), were analyzed. RESULTS:Ninety-seven patients were included (mean age 61.6 ± 12.5 years; sex ratio 1.1). MR was primary in 66% (rheumatic 34%, degenerative 31%) and secondary in 34%; jets were mostly single, eccentric and holosystolic, and 62.9% had severe MR. 3D VCA correlated strongly with PISA-derived orifice area (rho = 0.78) and with vena contracta width (rho = 0.65), particularly in organic, rheumatic, degenerative and eccentric MR. 3D VCA and 2D orifice area identified severe MR with an area under the curve of 0.93; the optimal 3D VCA cut-off was 0.43 cm2 overall, 0.42 cm2 (rheumatic), 0.55 cm2 (degenerative) and 0.39 cm2 (secondary). CONCLUSION:3D VCA reliably quantifies MR, provides aetiology-specific cut-offs and outperforms 2D methods in complex jets. Multicenter validation is needed, particularly in rheumatic-endemic regions.
BACKGROUND:Left ventricular (LV) myocardial work (MW) assessment is a novel non-invasive tool for relatively load-independent assessment of LV myocardial contractile function. In this study, we compared LVMW characteristics across three conditions- aortic stenosis (AS), chronic kidney disease (CKD), and cardiac amyloidosis (CA)- that share increased LV wall thickness but arise from fundamentally different pathophysiological mechanisms. METHODS:The study included 25 consecutive patients in each of the following groups: severe AS scheduled for aortic valve replacement, CKD on maintenance hemodialysis, and light-chain CA. An additional group of twenty-five apparently healthy individuals served as controls. LV global longitudinal strain (GLS) and MW were quantified using speckle tracking echocardiography. RESULTS:LV mass was significantly increased in all three disease groups compared with controls. LV ejection fraction was mildly reduced but similar in all the three disease groups. LVGLS was impaired in all patient groups, with the greatest reduction observed in CA. Global work index and global constructive work were highest in patients with AS [1815 mmHg% (interquartile range or IQR 1271, 2061) and 2094 mmHg% (IQR 1815, 2521), respectively] and lowest in patients with CA [804 mmHg% (IQR 596, 1091) and 1117 mmHg% (IQR 810, 1256)], while CKD patients demonstrated intermediate values. Multivariable analyses adjusting for demographic and hemodynamic variables confirmed these findings. CONCLUSION:Our study demonstrates distinct patterns of MW across conditions associated with increased LV wall thickness. These findings support the complementary role of MW assessment in the comprehensive evaluation of LV function and myocardial dysfunction. Larger prospective studies are required to establish its diagnostic and prognostic utility.
Transthoracic echocardiography is the cornerstone of cardiac imaging, yet conventional volumetric and Doppler indices may fail to detect clinically meaningful changes in ventricular performance. Patients often improve symptomatically and biochemically after device-based or medical therapies without parallel changes in standard echocardiographic measures, reflecting that the left ventricle functions not only as a pressure-volume pump but as a complex fluid-dynamic system in which myocardial mechanics and intracavitary blood flow are tightly coupled. Blood speckle imaging (BSI) tracks red blood cell speckle patterns, enabling angle-independent, contrast-free, real-time visualization and qualitative assessment of intraventricular vortex organization. We present a three-patient proof-of-concept case series including non-ischemic dilated cardiomyopathy treated with cardiac contractility modulation, ischemic cardiomyopathy managed by conduction-system pacing (CSP), and heart failure with preserved ejection fraction treated with medical optimization. BSI was performed before and after therapy and interpreted alongside a review of the intracardiac flow-dynamics literature. In all patients, symptoms and N-terminal pro-B-type natriuretic peptide levels improved despite minimal changes in left ventricular volumes and conventional systolic indices, whereas BSI revealed reorganization of intraventricular flow, characterized by fewer competing vortices, reduced late-diastolic persistence, and more physiological vortex positioning. These observations support the hypothesis that flow reorganization may represent an early marker of ventricular recovery preceding detectable structural remodeling. To our knowledge, this is among the first adult reports of therapy-associated left ventricular flow reorganization assessed by BSI across distinct heart failure phenotypes. These findings are hypothesis-generating and require prospective validation against quantitative four-dimensional flow cardiovascular magnetic resonance.
Kawasaki disease (KD) with intravenous immunoglobulin (IVIG) non-response is a high-risk state in which fever response, coronary evolution, and myocardial dysfunction may diverge. This narrative review, appraised against SANRA after drafting, examines echocardiography across the disease-management lifecycle, from pre-treatment risk enrichment to long-term surveillance. PubMed/MEDLINE searches were supplemented by cross-source discovery and metadata verification. Standardized serial coronary measurement with consistent use of one Z-score system remains the management core. Initial composite echocardiographic abnormalities, myocardial deformation, and tissue-Doppler indices may enrich risk assessment, but current discrimination is moderate and thresholds lack external validation. IVIG non-response and coronary aneurysm are related but non-interchangeable; defervescence does not establish coronary safety, whereas definite baseline coronary artery aneurysm is a treatment-relevant high-risk phenotype. Deformation, myocardial work, right-heart indices, coronary flow reserve, and complementary imaging can refine selected clinical questions but should not trigger treatment in isolation. Echocardiography can therefore structure coronary and myocardial surveillance, but cannot yet independently determine treatment resistance or support a universal multimodal treatment score. Prospective multicenter standardization, external validation, and clinical-utility testing are required before multimodal imaging-guided treatment decisions are adopted.
BACKGROUND:Intracardiac echocardiography (ICE) is increasingly used to guide cardiovascular interventions. This study compared the performance of ICE with transesophageal echocardiography (TEE) in device closures of interatrial communications. METHODS:A systematic search through PubMed, Scopus, Cochrane Library, and Europe PMC identified clinical studies directly comparing ICE and TEE as imaging guidance modalities for percutaneous closure of ASD or PFO in pediatric and adult populations. The key outcomes encompassed procedural time, fluoroscopy time, procedural success, complete closure at the latest follow-up, and major and minor complications. Pooled mean differences (MD) and risk ratios (RR) with corresponding 95% confidence intervals (CI) were measured by applying the random-effects model. RESULTS:Twelve studies comprising 5054 participants (ICE = 2480; TEE = 2574) were included in the quantitative analysis. Meta-analysis demonstrated a numerically shorter procedural time (MD -20.80 min; 95% CI -29.84 to -11.75; p < 0.00001), but not fluoroscopy time (MD -1.17 min; 95% CI -2.64 to 0.30; p = 0.12), in the ICE group compared with the TEE group. Procedural success rates and complete closure at the latest follow-up were comparable between both imaging strategies. In safety analyses, ICE was associated with a meaningful reduction of risk of major complications compared to TEE (RR 0.77; 95% CI 0.64 to 0.92; p = 0.004). Comparable findings were observed in the incidence of minor complications. CONCLUSION:ICE represents a promising alternative imaging modality for guiding transcatheter closure of ASD and PFO. Compared with TEE, ICE is associated with a numerically reduced procedural duration and a lower incidence of major complications, while maintaining comparable procedural success and long-term closure rates.
BACKGROUND:The progression of mitral valve (MV) remodelling in atrial fibrillation (AF) patients without significant mitral regurgitation (MR) remains poorly characterized. We aimed to determine whether AF burden-paroxysmal versus persistent-differentially affects MV annular geometry, leaflet morphology, and functional dynamics using three-dimensional transesophageal echocardiography (3D-TEE). METHODS:In prospective cross-sectional observational study, 46 consecutive AF patients without significant MR (paroxysmal AF: n = 18; persistent AF: n = 28) underwent comprehensive 3D transesophageal echocardiography. Offline semi-automated quantitative analysis (4D MV Assessment, TomTec) was performed to assess mitral annular dimensions and geometry, leaflet morphology (area and angulation), and functional parameters including tenting volume, coaptation depth, and dynamic annular motion. RESULTS:Despite comparable demographics, persistent AF patients had larger LA diameter (45.4 ± 7.1 vs. 40.3 ± 6.3 mm; p = 0.05), lower LVEF (45.5 ± 15.4 vs. 56.5% ± 15.2%; p = 0.042), and greater LV end-systolic dimension (41.3 ± 9.7 vs. 33.1 ± 9.4 mm; p = 0.018). 3D-TEE demonstrated significant annular enlargement in persistent AF: larger AP diameter (3.92 ± 0.53 vs. 3.60 ± 0.47 cm; p = 0.042), AL-PM diameter (3.74 ± 0.50 vs. 3.49 ± 0.34 cm; p = 0.048), 3D annular area (11.98 ± 3.19 vs. 10.34 ± 2.05 cm2; p = 0.038), and 2D annular area (9.78 ± 2.83 vs. 8.27 ± 1.87 cm2; p = 0.035). Anterior leaflet area was larger (8.93 ± 2.07 vs. 7.60 ± 2.02 cm2; p = 0.036) and distal anterior leaflet angle was reduced (16.97 ± 5.03 vs. 20.76 ± 6.40°; p = 0.042). Annular shape, tenting parameters, coaptation depth, and dynamic motion were preserved in both groups. CONCLUSION:Persistent AF was associated with early mitral annular enlargement, anterior leaflet remodelling, impaired LV function, and LA dilation, even in the absence of significant MR. However, the higher heart rate in persistent AF, unrecorded AF duration, and lack of data on prior rhythm-control therapy limit attribution of these changes to AF burden alone. These findings are hypothesis-generating and require confirmation in prospective studies accounting for these potential confounders.
BACKGROUND:Current risk stratification algorithms for intermediate-risk pulmonary embolism (PE) inadequately identify patients who may benefit from escalated care interventions (ECIs) beyond anticoagulation and do not incorporate temporal assessments of right ventricular (RV) function. OBJECTIVES:To evaluate whether changes in tricuspid annular plane systolic excursion (TAPSE) on repeat transthoracic echocardiography (TTE) before ECIs are associated with clinical outcomes in acute intermediate-risk PE. METHODS:Acute intermediate-risk PE patients at a single quaternary care center were retrospectively identified. Inclusion required two or more TTE studies with TAPSE measurements before discharge or ECI initiation. Patients were stratified into worsening (ΔTAPSE < 0 mm) and stable/improving cohorts. The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, intubation, ICU admission, vasopressor requirement, and ECIs. RESULTS:Eighty-eight patients met inclusion criteria (38 worsening, 50 stable/improving). Worsening TAPSE was associated with a significantly increased risk of 30-day mortality (RR 5.26; p = 0.003), 90-day mortality (RR 3.01; p = 0.004), and intubation (RR 1.86; p = 0.010). In univariate logistic regression, each 1 mm increase in ΔTAPSE was associated with lower odds of 30-day mortality (OR 0.86; p = 0.005). Among 53 patients with initial TAPSE ≥16 mm, those with subsequent decline had significantly higher 30-day mortality (33.3% vs. 8.7%; p = 0.048). CONCLUSION:Worsening RV function on repeat echocardiography was associated with short-term mortality in acute intermediate-risk PE, even with initially preserved cardiac function. Serial assessment of RV function may refine risk stratification, and the impact on patient triage and escalation decisions warrants prospective evaluation.
PURPOSE:Right ventricular (RV) dysfunction and increased pulmonary arterial (PA) pressure may occur in children with obstructive sleep apnea (OSA). Long-term data on RV-PA coupling in children with OSA with or without adenotonsillectomy are absent. METHODS:This prospective cohort study included children aged 5 to 12 years diagnosed with tonsillar hypertrophy and moderate-to-severe OSA. All subjects underwent echocardiographic assessment and sleep study at least 5 years since initial recruitment. Right atrial, RV function and indexed pulmonary artery acceleration time (PAATi) were evaluated. RV-PA coupling was assessed by tricuspid annular plane systolic excursion (TAPSE) / PAATi and RV global longitudinal strain (GLS) / PAATi. RESULTS:We evaluated 160 subjects, including 38 with OSA who declined adenotonsillectomy (Group I), 80 with OSA post-adenotonsillectomy (Group II), and 42 controls (Group III). Baseline demographics were similar across groups. At a mean follow-up of 7.2 ± 2.5 years, the latest OAHI did not differ significantly between the two OSA groups. Echocardiographic assessment revealed small intergroup differences in RA total strain, peak tricuspid annular systolic velocity, RVGLS and PAATi, whereas TAPSE, RV fractional area change and systolic strain rate were comparable across groups. Importantly, RV-PA coupling indices did not differ significantly among the three groups. Furthermore, within the OSA cohort, neither follow-up duration nor current OAHI severity correlated significantly with RV function or RV-PA coupling indices. CONCLUSIONS:RV function and RV-PA coupling are preserved in adolescents and young adults with a childhood diagnosis of OSA, irrespective of prior adenotonsillectomy.
AIMS:The study investigated the predictive value of serum soluble ST2 (sST2) and left atrial strain parameters for left ventricular systolic dysfunction (LVSD), and the correlation analysis with corresponding indicators in patients with chronic coronary syndrome (CCS). METHODS:A total of 135 patients with CCS who presented to the Cardiology Department Zhongda hospital and underwent echocardiographic examinations from January 2025 to December 2025 were ultimately included. Based on two-dimensional speckle tracking echocardiography, left ventricular global longitudinal strain and left atrial strain were measured within 72 h of CCS diagnosis, and the patients were categorized into two groups: LV GLS > -17%, LVSD group; and LV GLS≤-17%, non- LVSD group. Baseline data were collected from all patients and compared between the two groups. The correlation between sST2 and LA parameters in CCS patients was evaluated using Spearman correlation. Based on the results of the multivariate logistic regression analysis, a predictive model for LVSD in CCS patients was established. RESULTS:In the LVSD group, sST2 levels, early diastolic mitral inflow velocity (E)/ early diastolic mitral annular velocity (e') ratio, left atrial volume index (LAVI), and left atrial stiffness index (LASI) were increased. In the CCS patients, sST2, E/e', LAVI, and LASI demonstrated good correlation. sST2 and LASI were independent predictors for diagnosing LVSD in patients with CCS. ROC curve analysis showed that ST2 and LASI had diagnostic value for left ventricular systolic dysfunction in patients with CCS. CONCLUSION:This study found that in patients with CCS complicated by LVSD, sST2 levels were elevated, left atrial strain parameters were impaired, and a certain correlation was observed between the two. Furthermore, we investigated whether sST2 and LASI are independent predictors for diagnosing LVSD in CCS patients. By combining these two indicators, a diagnostic model can be constructed.
OBJECTIVE:This study aimed to evaluate subclinical myocardial mechanical alterations by utilizing three-dimensional speckle tracking imaging (3D-STI) in patients with type 2 diabetes mellitus (T2DM) combined with subclinical hypothyroidism (SCH), and evaluate its intergroup discriminatory capacity. METHODS:A total of 147 participants were enrolled and divided into four groups: prediabetes group (n = 37), isolated T2DM group (n = 35), T2DM combined with SCH group (n = 40), and healthy control group (n = 35). Conventional echocardiographic indices, three-dimensional myocardial strain parameters, and ventriculo-arterial coupling indicators were compared among groups. Receiver operating characteristic (ROC) curves were plotted to evaluate the ability of myocardial strain parameters to identify individuals presenting early subclinical left ventricular myocardial mechanical abnormalities within the study cohort. Partial correlation analysis was performed to explore the independent correlation between thyroid-stimulating hormone (TSH) and left ventricular functional parameters after adjusting for confounding variables. Multiple linear regression analysis was applied to assess the independent effect of TSH on myocardial comprehensive index (MCI) after adjusting for confounding factors. RESULTS:Glycated hemoglobin (HbA1c) was elevated in the prediabetes, T2DM, and T2DM + SCH groups, while TSH was significantly higher in the T2DM + SCH group. Global longitudinal strain (GLS), left ventricular twist angle (LVtw), torsion (Tor), and myocardial comprehensive index (MCI) decreased progressively across the four groups. Effective arterial elastance (Ea) and ventriculo-arterial coupling index (VAC) were increased in the T2DM and T2DM+SCH groups. ROC analysis demonstrated that MCI yielded the highest AUC (0.967) and sensitivity (97.30%) for prediabetes, and the optimal AUC (0.937), sensitivity (90.00%) and specificity (85.71%) for T2DM+SCH. Partial correlation analysis was performed after adjustment for age, sex, BMI, systolic blood pressure, diastolic blood pressure, triglycerides and HbA1c. The results revealed a significant negative correlation between TSH and MCI (r = -0.616, p < 0.01). Multivariate linear regression analysis was conducted with MCI as the dependent variable. After adjusting for age, sex, BMI, blood pressure, lipid and glucose metabolic parameters, TSH was independently negatively associated with MCI. When TG-Ab and TPO-Ab were added for exploratory analysis, elevated TSH remained independently associated with decreased MCI, while thyroid autoantibodies showed no independent effect. Partial correlation analysis indicated a moderate negative correlation between TSH and MCI (r = -0.407, p < 0.01). CONCLUSION:3D-STI enables the identification of early subclinical myocardial mechanical alterations in patients with T2DM combined with SCH.
BACKGROUND:Long-term durability of degenerative mitral regurgitation (DMR) reduction after transcatheter edge-to-edge repair (TEER) remains limited, and reliable anatomical predictors are still lacking. METHODS:This study prospectively enrolled patients with symptomatic DMR undergoing TEER across 27 centers in China. All pre-procedural clinical and echocardiographic parameters were collected and analyzed. The primary outcome was MR ≤ 1+ at 3-year follow-up. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify predictors and optimal cutoff values. RESULTS:A total of 78 patients with available 3-year echocardiographic assessments were included in the imaging-based analysis (mean age, 74.4 ± 5.1 years; 67.9% with NYHA class III/IV symptoms; mean STS score for mitral valve replacement, 6.8 ± 2.7%). At 3-year follow-up, 49 patients (62.8%) maintained MR ≤1+. TEER was associated with significant reverse cardiac remodeling, including reductions in left ventricular end-diastolic volume (125.4 ± 40.6 to 99.8 ± 19.7 mL) and pulmonary artery systolic pressure (43.0 ± 11.6 to 34.3 ± 11.4 mmHg) (both p < 0.001), while LVEF remained stable. Mitral valve (MV) prolapse/flail width independently predicted MR durability (OR: 0.789; 95% CI: 0.655-0.951; p = 0.013). ROC analysis identified a cutoff value of 16 mm (AUC: 0.714; p = 0.002), with patients having prolapse/flail width ≥16 mm demonstrating lower rates of MR ≤1+ at 3 years. CONCLUSIONS:Pre-procedural prolapse/flail width is an independent predictor of 3-year MR durability after TEER in patients with DMR. Larger prolapse/flail width is associated with reduced mid-term MR stability, suggesting its potential value for risk stratification and procedural planning. TRIAL REGISTRATION:This study has been registered at ClinicalTrials.gov with a number of NCT04734756.
BACKGROUND:Intravenous immunoglobulin (IVIG) resistance in children with Kawasaki disease (KD) is associated with an increased risk of coronary artery injury and subsequent adverse cardiovascular outcomes. Early identification of patients at risk remains difficult in clinical practice. Conventional coronary ultrasound is largely based on geometric parameters, such as luminal diameter and Z scores, and may not fully capture local heterogeneity within coronary images. In this study, we investigated whether pretreatment coronary artery ultrasound radiomics could improve early identification of IVIG resistance in children with KD. We further developed a multimodal prediction model incorporating radiomics, the prognostic nutritional index (PNI), and clinical characteristics. METHODS:A total of 352 children diagnosed with KD and treated at The First Affiliated Hospital of Guangxi Medical University between January 2020 and January 2026 were retrospectively included. All patients received standardized treatment after diagnosis. Demographic characteristics, pretreatment laboratory results, conventional coronary ultrasound parameters, and two-dimensional static ultrasound images of the left coronary artery (LCA), left anterior descending artery (LAD), and right coronary artery (RCA) were collected. The pretreatment two-dimensional static coronary ultrasound images were imported into 3D Slicer for region-of-interest segmentation. A clinical prediction model was constructed using multivariable logistic regression. PNI was defined a priori as the primary nutritional-immunologic indicator. In addition, the potential incremental predictive value of other nutritional-inflammatory indices, including the C-reactive protein-to-albumin ratio (CAR), neutrophil-to-albumin ratio (NAR), neutrophil percentage-to-albumin ratio (NPAR), and C-reactive protein-albumin-lymphocyte (CALLY) index, was further evaluated. Radiomics features were selected through repeated segmentation, intraclass correlation coefficient (ICC)-based stability filtering, correlation filtering, and least absolute shrinkage and selection operator (LASSO) regression. The Clinic, Clinic + PNI, Radiomics, and Clinic + PNI + Radiomics models were assessed using receiver operating characteristic curves, DeLong tests, calibration curves, decision curve analysis, and Shapley Additive Explanations (SHAP) interpretation. The Kobayashi, Egami, and Sano scores were evaluated in the same training and validation cohorts. RESULTS:Among the 352 children, 57 (16.2%) were classified as IVIG resistant. Multivariable analysis showed that higher pretreatment maximum coronary artery Z score (Zmax), longer fever duration, and higher neutrophil count were associated with an increased risk of IVIG resistance. In the validation cohort, the Clinic + PNI model showed favorable discriminatory ability, with an AUC of 0.855 (95% CI, 0.767-0.911), a sensitivity of 0.882, and a negative predictive value of 0.969. Seven radiomics features were selected and used to construct the radiomics score (Rad-score). In the training cohort, the Clinic + PNI + Radiomics model achieved higher AUC values than the Clinic, Clinic + PNI, and Radiomics models. This pattern was also observed in the validation cohort, where the integrated model achieved the highest AUC of 0.880 (95% CI, 0.817-0.944), although the between-model differences did not reach statistical significance. Decision curve analysis showed that the integrated model offered a favorable net benefit within clinically meaningful threshold ranges. SHAP analysis suggested that its predictions reflected the joint influence of systemic inflammatory burden, nutritional and immune status, and local imaging heterogeneity captured from coronary ultrasound images. The Kobayashi, Egami, and Sano scores yielded validation AUCs of 0.616, 0.567, and 0.449, respectively. CONCLUSIONS:Pretreatment coronary ultrasound radiomics may provide complementary information to conventional clinical, laboratory, and ultrasonographic parameters for assessing the risk of IVIG resistance in children with KD. By integrating inflammatory burden, nutritional-immunologic status, and local coronary imaging heterogeneity, the Clinic + PNI + Radiomics model showed favorable discrimination and potential clinical net benefit in internal validation. However, its incremental value and clinical applicability require further confirmation in external cohorts.
PURPOSE:To determine whether right ventricular (RV) longitudinal functional indices measured from standard and RV-focused apical four-chamber (A4C) views are interchangeable at the individual level. METHODS:We conducted a secondary cross-sectional agreement analysis of anonymized echocardiographic data acquired in Dalian, China, from January 2021-January 2022. The primary analysis included 115 of 120 screened adults after prespecified eligibility and audit-stage exclusions; sensitivity analyses retained all 120. Paired measurements comprised tricuspid annular plane systolic excursion (TAPSE), lateral tricuspid annular S', e', and a' velocities, and tissue motion annular displacement (TMAD)-derived indices. Observer reproducibility was evaluated in 30 cases. RESULTS:TAPSE was similar between standard and RV-focused views (22.4 ± 3.6 vs 22.4 ± 3.2 mm; mean difference, -0.09 mm; p = 0.805), and other group-level differences were small. Individual agreement was limited: intraclass correlation coefficients (ICCs) were 0.40 for TAPSE, 0.45-0.65 for tissue Doppler velocities, and 0.39-0.68 for TMAD indices. Sensitivity-analysis ICCs remained poor to moderate (0.21-0.65). Intraobserver and interobserver ICCs in the 30-case subset were 0.97-1.00 and 0.94-0.99, respectively. CONCLUSION:Standard and RV-focused A4C views produced similar group means but only poor-to-moderate individual agreement. The acquisition view should be kept consistent and documented in serial reports and research datasets.
