Search

This article provides insights into the left heart dynamics in neonatal cold septic shock through a case series of infants with septic shock and cardiovascular dysfunction. The study emphasizes the need for further research on the prognostic value of echocardiography in septic children and the lack of large-scale neonatal data on cardiovascular dysfunction in sepsis. The infants in the case series experienced various symptoms and echocardiograms revealed low biventricular output and valve regurgitation. The article discusses the importance of early and serial assessments using echocardiography and highlights the potential impact of cardiac dysfunction on outcomes. However, more prospective studies are needed in this area. [Extracted from the article]

Summary: A 7‐month‐old Warmblood cross colt was presented for the assessment of a laceration of the right hind pastern of 4‐days duration. At presentation, the colt was in poor body condition and had a rough, dull coat. Cardiac auscultation revealed a grade 5/6 pansystolic murmur on the left side and grade 4/6 continuous murmur on the left and right sides and a regular cardiac rhythm. Electrocardiographic examination confirmed sinus tachycardia. Echocardiographic examination showed malformation of the aortic and mitral valves, with associated regurgitation and evidence of left atrial and ventricular volume overload. Dysplasia of the mitral, tricuspid and aortic valves was confirmed by post‐mortem examination. Valvular dysplasia is a rare cause of cardiac failure in horses. [ABSTRACT FROM AUTHOR]

Background: The role of speckle tracking in the assessment of right atrial (RA) deformation parameters has not been investigated yet. The purpose of this article is to establish the effects of normal pregnancy on RA mechanical changes obtained by 2‐dimensional speckle‐tracking echocardiography. Methodology: A total of 49 healthy pregnant women were included in the study. All participants were followed for each trimester and postpartum period, encompassing standard assessments of both RA and ventricular functions, as well as measurements of RA global peak atrial longitudinal strain (RA‐Global‐PALS) and RA global peak atrial contraction strain (RA‐Global‐PACS). Additionally, the RA segments were individually evaluated with respect to strain parameters. Results: During pregnancy, the increased volume load resulted in elevated RA reservoir function, as indicated by RA‐Global‐PALS, and increased contraction parameter, as indicated by RA‐Global‐PACS. These changes were within physiological limits and reversible. Segmental analysis of the right atrium showed similar findings for regional PACS and PALS parameters. Conclusion: In this study, we established normal RA deformation parameters for healthy pregnancies. These data will aid in discerning various measures of RA phasic function in cardiovascular and systemic conditions among normal pregnant women. Moreover, they may offer insights into potential cardiac pathologies that may arise during the pregnancy. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Background Methods and Results Conclusion Aortic regurgitation (AR) is a well‐known cause of impaired outcome in patients with centrifugal left ventricular assist devices (cfLVADs). The failure of the aortic valve (AV) to open at least intermittently is associated with cusp remodeling, commissural fusion, and ultimately developing AR.Our aim was to characterize patients in whom AV opening (AVO) was preserved 6 months after implantation and identify determinants related to it.We conducted standardized echocardiography and collected clinical and laboratory tests at the outpatient clinic 6 months after implantation. We classified patients into those showing intermittently opening of the AV, every 2–3 beats, or in every cycle (AVO) and those whose AV was continuously closed (NAVO). From the 219 cfLVAD implanted in our center between March 2018 and January 2020, 156 subjects were alive and on the device after 6 months. In 2 of the reviewed echocardiograms, we could not evaluate the AV. 99 patients (64%) showed AVO compared to 55 (36%) with NAVO. The first presented higher mean arterial pressure (84 ± 10 vs. 77 ± 13 mm Hg, p = 0.002), larger LV end‐diastolic diameter (LVEDD 57.5 ± 12 vs. 52.7 ± 13 mm, p = 0.022), a better TAPSE (15 ± 4 vs. 13 ± 4 mm, p = 0.028), and less frequently significant AR than patients with NAVO (moderate/severe AR in 6% vs. in 20%, p = 0.042). In a multiple logistic regression, a lower NYHA Class, a larger LVEDD, and a better LV ejection fraction appeared as significant predictors of AVO. After a median follow‐up of 3.2 years, we found no significant impact on survival stratifying patients by AVO (log‐rank p = 0.53).AVO was associated with better RV function, lower NYHA Class, and a lower rate of significant AR. This could indicate that AVO should be pursued in LVAD patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Trial Registration Intracardiac echocardiography (ICE) has been widely used in the catheter ablation of atrial fibrillation (AF). However, the value of ICE in the training of transseptal puncture (TSP) is unclear.ICE‐Training Study was a single‐center, parallel‐group, unmasked, randomized controlled trial registered in ChineseClinicalTrials.gov. Participants were randomly assigned (1:1) to different groups (1) the ICE simulator training group (ICE‐ST), in which TSP was trained and performed under the guidance of both ICE and x‐ray; and (2) the conventional simulator training group (Con‐ST), in which TSP was trained and performed only under the guidance of x‐ray. The trainees need to undergo the training stage and the evaluation stage.From October 2022 to December 2022, 18 consecutive fellows (age 32.4 ± 4.4 years, 12 males) without experience of TSP were included. The training period (16.9 ± 6.6 vs. 29.6 ± 8.7 times, p = 0.003) and the fluoroscopy time (120.3 ± 25.3 vs. 189.3 ± 40.2 s, p < 0.001) of the ICE‐ST group was significantly shorter than that of the Con‐ST group. No significant difference was found in the comprehensive performance of TSP in the ICE‐ST group (composite score 96.7 ± 5.7) and the Con‐ST group (composite score 95.9 ± 6.3, p = 0.62), but the selection of TSP sites in the ICE‐ST group was commonly better than that in the Con‐ST group.ICE could improve the efficiency of TSP training and optimize the site of TSP to facilitate catheter manipulation in the ablation.ChineseClinicalTrials.gov identifier: ChiCTR2200058377 [ABSTRACT FROM AUTHOR]

Correlation between echocardiographic and pathoanatomic variables and their prognostic value in murine cardiomyopathy models remain unknown. Using echocardiography, morphometrics, and survival monitoring, we characterized transgenic (TG) mice with dilated cardiomyopathy due to cardiac overexpression of β2‐adrenoceptors focusing on predicting heart failure (HF) risk and HF mortality. In 12‐month‐old non‐TG and TG mice, echocardiography was performed to determine left ventricular (LV) dimensions (d), wall thickness (h), and fractional shortening (FS). Animals were monitored for 3 months for survival. Organ weights and pathological events indicating left HF were determined. TG mice (n = 76) had reduced FS and enlarged LV, and 79% died of HF or likely arrhythmias during the follow‐up period while all non‐TG mice (n = 26) survived. These mice with left HF also had pulmonary congestion and hypertrophy/dilatation of the right ventricle (RV). Weights of lungs, RV, and atria were intercorrelated (r = 0.79–0.83) and also negatively correlated with FS × (h/d) index (r = −0.502 to −0.609). By FS × (h/d) tertiles, TG mice of low tertiles were identified with the highest mortality (96%) largely due to HF (76%). In conclusion, in aged cardiomyopathy mice a good correlation existed between echocardiographic and pathoanatomic variables. Echocardiography‐derived LV function and remodeling were useful in identifying a subgroup of TG mice with a high risk of HF and HF fatality. [ABSTRACT FROM AUTHOR]

ABSTRACT Context Objective Design Patients Main Outcomes Results Conclusion Treating overt hyperthyroidism prevents atrial fibrillation (AF). Though subclinical hyperthyroidism (SH) has been associated with AF, it is unknown whether treating SH prevents AF.We aimed to identify the association between treating SH and incident AF.In a pharmacoepidemiologic retrospective cohort study, patients diagnosed with SH between 2000 and 2021 were followed.Outpatients ≥ 18 years with biochemical SH and without prior AF, hypothyroidism, thyroid cancer, pituitary disease, or pregnancy were included.The primary outcome was incident AF. Secondary outcomes were ECG and echocardiographic features associated with AF.Of 2169 patients screened, 360 (131 treated and 229 untreated) were followed up for a mean of 4.27 years. In the treated and untreated groups, AF occurred in 4 (3.1%) and 15 (6.6%) patients (p = 0.15), and AF incidence was 0.8% and 1.4%/year (p = 0.31), respectively. The hazard ratio (HR) for treatment as a time‐dependent variable was 0.60 (95% CI 0.19–1.92; p = 0.39). As some cases of AF were documented nearly simultaneously with SH treatment, a sensitivity analysis was performed reassigning two patients diagnosed with AF < 30 days after starting SH treatment to the untreated group. Here, in the treated and untreated groups, AF occurred in 1.6% and 7.4% (p = 0.02), and AF incidence was 0.4% and 1.8%/year (p = 0.02), respectively. The HR was 0.25 (0.06–1.13; p = 0.07). There were no differences in ECG or echocardiographic features.There was an overall trend towards lower incidence and prevalence of AF following treatment of SH, supporting the need for larger scale studies. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Coronavirus disease 2019 (COVID‐19) was declared a global pandemic in 2019. It remains uncertain to what extent COVID‐19 effects the heart in heathy individuals. To evaluate the effect of the COVID‐19 on cardiac structure and function in middle‐aged and older individuals.A single‐centre prospective observational study enroled a total of 124 participants (84 with history of COVID‐19 [COVID‐19 group] and 40 without a history of COVID‐19 [non‐COVID group]). All participants underwent echocardiography with speckle tracking to assess cardiac structure and function at rest and during peak exercise.There were no differences in left and right ventricular diastolic function (p ≥ 0.05) between the COVID‐19 and non‐COVID‐19 groups. Participants in COVID‐19 group demonstrated higher left ventricular mass (130 ± 39.8 vs. 113 ± 27.2 g, p = 0.008) and relative wall thickness (0.38 ± 0.07 vs. 0.36 ± 0.13, p = 0.049). Left ventricular global longitudinal strain was reduced in the COVID‐19 group at rest and at peak‐exercise (rest: 18.3 ± 2.01 vs. 19.3 ± 1.53%, p = 0.004; peak exercise: 19.1 ± 2.20 vs. 21.0 ± 1.58%, p ≤ 0.001). However, no difference was seen in resting left ventricular ejection fraction (58 ± 2.89 vs. 59 ± 2.51%, p = 0.565) between groups. Right ventricular fractional area change was reduced in the COVID‐19 group (p = 0.012).Cardiac structural and functional remodelling was observed in middle‐aged and older otherwise healthy individuals with a history of COVID‐19. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions We aimed to detect subclinical cardiac impairment in children with ulcerative colitis (UC) and test the association between absolute monocytic count (AMC) and lymphocyte‐to‐monocyte ratio (LMR) with disease activity.A group of children with UC and a comparable group as healthy controls were included. All children underwent history‐taking, clinical examination and blood testing for complete blood counts with white blood cell differentials, LMR and erythrocyte sedimentation rate (ESR). Disease severity was assessed using the Paediatric UC Activity Index score. We used echocardiography for tissue Doppler, M‐Mode, two‐dimensional and three‐dimensional (3D) speckle tracking echocardiography (STE) for left ventricular function assessment.Forty children were included, 20 with UC as cases, and 20 healthy controls. Disease activity was mild in 75% cases and moderate in 25% cases. Cases had significantly higher ESR than the control group (P < 0.001). Among cases, positive correlations were observed between monocytic, and platelet counts with left ventricular end‐diastolic diameter (r = 0.5, P = 0.02; r = 0.5, P = 0.03). Children with UC had significantly lower ejection fraction and impaired left ventricular systolic function compared to the control group (P < 0.001) assessed by 3D STE, yet this observation was not reached by the conventional method (P = 0.3).In children with UC, 3D STE could detect subclinical left ventricular systolic dysfunction that conventional echocardiography could not. AMC and LMR showed no significant difference between children with UC and controls. [ABSTRACT FROM AUTHOR]

Background: Left ventricular stroke work index (LVSWI) and cardiac power index (CPI) account for the haemodynamic load of the left ventricle and are promising prognostic values in cardiogenic shock. However, accurately and non‐invasively measuring these parameters during veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) is challenging and potentially biased by the extracorporeal circulation. This study aimed to investigate, in an ovine model of cardiogenic shock, whether Pressure‐Strain Product (PSP), a novel speckle‐tracking echocardiography parameter, (1) can correlate with pressure‐volume catheter‐based LVSWI and CPI, and (2) can be load‐independent during the flow modification of V‐A ECMO. Methods: Nine Dorset‐cross ewes (51 ± 4 kg) were included. After cardiogenic shock was induced, full support V‐A ECMO (X L/min based on 60 mL/kg/min) commenced. At seven time points during 24‐h observation, echocardiographic parameters as well as pressure‐volume catheter‐based LVSWI and CPI were simultaneously measured with X and following X‐1 L/min of ECMO flow. PSP was calculated by multiplying global circumferential strain or global radial strain, and mean arterial pressure, for PSPcirc or PSPrad, respectively. Results: PSPcirc showed a stronger correlation with LVSWI (correlation coefficient, CC =.360, p <.001) and CPI (CC =.283, p <.001) than other echocardiographic parameters. The predictability of PSPcirc for pressure‐volume catheter‐based LVSWI (AUC.82) and CPI (AUC.80) was also higher than other echocardiographic parameters. No statistically significant differences were identified between the two ECMO flow variations in PSPcirc (p =.558). Conclusions: A novel echocardiographic parameter, PSP, may non‐invasively predict pressure‐volume catheter‐based LVSWI and CPI in a load‐independent manner in a cardiogenic shock supported by V‐A ECMO. [ABSTRACT FROM AUTHOR]

Introduction: The hemodynamic effects of mitral valve repair (MVr) with respect to transmitral pressure gradients (TMPGs) have not been described well in patients undergoing leaflet preservation techniques. In a population of patients undergoing robotic MVr with leaflet preservation, we investigate the expected change of the postrepair intraoperative TMPG in the postoperative follow‐up period. Methods: We retrospectively studied 144 adult patients who underwent robotic MVr. Demographic, clinical, procedural, and echocardiographic data were collected and analyzed. Results: We found a slight increase in the mean TMPG from the intraoperative postrepair to the immediate postoperative period (intraoperative 3.3 ± 1.4 mmHg vs. first postoperative transthoracic echocardiography [TTE] follow‐up 3.6 ± 1.9 mmHg, p = 0.016) with a gradual decline in the long‐term follow‐up (mean TMPG at last follow‐up TTE 2.4+2.1 mmHg). When dichotomizing the patient population using a cutoff of 3 mmHg for the intraoperative mean TMPG, patients with an intraoperative mean TMPG > 3 mmHg had higher mean TMPG gradients at first TTE (4.5 ± 2.4 vs. 3.1 ± 1.3 mmHg, p < 0.001) as well as at last TTE (3.0± 2.2 vs. 2.1 ± 2.0 mmHg, p = 0.01) when compared with patients with an intraoperative mean TMPG ≤ 3 mmHg. There was no difference in clinical outcomes. Conclusions: Although the hemodynamic effect of MVr seems to be small, patients with an intraoperative TMPG > 3 mmHg have a higher mean TMPG at follow‐up. The hemodynamic effect does not seem to have an impact on clinical outcome. [ABSTRACT FROM AUTHOR]

Purpose: Diagnosing cardiac amyloidosis (CA) is difficult due to nonspecific clinical symptoms and echocardiographic findings. Prior studies have suggested that apical sparing strain patterns may be diagnostically useful. With increasing strain usage, it remains unclear how specific this pattern is to diagnose CA. We analyzed strain patterns between CA and end‐stage renal disease (ESRD) patient populations. Methods: Patients with ESRD proven negative for CA (n = 19) were compared to CA patients with CKD stage 3 or less (n = 25). The ESRD cohort was stratified based on time on dialysis. Echocardiographic longitudinal strain (LS) parameters were collected, including regional and global LS, echocardiographic, and demographic parameters. Relative apical LS was calculated using the following equation: average apical LS/(average mid LS + average basal LS). Results: No significant differences were found regarding regional strain or relative apical strain. Our study showed a sensitivity of 80% and specificity of 42% when using a relative apical strain ratio of >1. All groups demonstrated an apical sparing strain pattern visually on the bulls‐eye plot. Conclusion: ESRD demonstrates significant overlapping findings across various imaging modalities compared to CA. We demonstrated that relative apical sparing strain is nonspecific for CA among patients with ESRD. Our study calls into question the clinical value of relative apical‐sparing stain patterns in identifying CA in an ESRD population and suggests that diagnostic evaluation should be driven by strong clinical suspicion and other imaging and demographic variables. [ABSTRACT FROM AUTHOR]

Background: Echocardiographic right ventricular (RV) dysfunction is a strong risk determinant for prognosis in patients with heart failure (HF). Although parameters of RV systolic function are widely used to define RV dysfunction, there is scarce data to suggest these parameters are best suited to predict HF‐related outcomes. Aims: We aimed to understand which morphologic or functional parameters are most closely associated with short‐term mortality and HF‐related hospitalization in patients with HF. Methods: A total of 191 patients from eight study centers were included to this study. A detailed echocardiographic examination was done at enrollment, and patients were followed up for 6 months via direct interviews or phone calls. Results: All right‐sided echocardiographic parameters other than tricuspid annular plane systolic excursion were associated with outcomes. In a proportional hazards model that included right‐heart parameters, RV longitudinal diameter (HR: 1.07, 95%CI: 1.04–1.10, p < 0.001), wall thickness (HR: 1.3, 95%CI: 1.13–1.50, p < 0.001), and tricuspid annular systolic velocity (HR: 0.90, 95%CI: 0.82–0.96, p = 0.02) were found as the independent predictors. However, only RV longitudinal dimension (HR: 1.04, 95%CI: 1.01–1.08, p = 0.01) and RV wall thickness (HR: 1.32, 95%CI: 1.10–1.60, p = 0.004) were associated with short‐term outcomes after adjusting for other clinical and left‐sided echocardiographic variables. On a Bayesian logistic regression model that included right‐sided echocardiography variables, there was strong evidence for including either RV longitudinal diameter (BF10: 190.4) or wall thickness (BF10: 30.7) to the final model. Conclusion: Parameters of RV morphology were better predictors of short‐term outcomes in HF patients. [ABSTRACT FROM AUTHOR]

Purpose: For the repair of atrial/ventricular septal defects (ASD/VSD), transthoracic echocardiography (TTE) is easy to perform, cost‐effective, and does not require general anesthesia and intubation. Still, TTE is not universally accepted. To compare efficacy and safety of TTE versus transesophageal echocardiography (TEE) to guide percutaneous ASD/VSD closure. Methods: PubMed, Embase, and the Cochrane library were searched for articles published from their inception to December 2023. The primary outcome was the procedural success rate. The secondary outcomes were residual shunt, late complications, procedure time, and fluoroscopy time. All meta‐analyses were performed using a random‐effects model. Results: Eight studies and 1295 patients were included. There were no significant differences between TTE and TEE regarding the procedural success rate (OR = 1.93, 95% CI: 0.90–4.13, p = 0.092; I2 = 52.2%, Pheterogeneity = 0.063) and residual shunt rate (OR = 0.81, 95% CI: 0.38–1.76, p = 0.600; I2 = 0%, Pheterogeneity = 0.518). Compared with TEE, TTE reduced the frequency of late complications (OR = 0.25, 95% CI: 0.14–0.43, p < 0.001; I2 = 13.8%, Pheterogeneity = 0.326), reduced the procedure time (WMD = −8.92, 95% CI: −12.08, −5.75, p < 0.001; I2 = 87.4%, Pheterogeneity < 0.001), and reduced the fluoroscopy time (WMD = −5.08, 95% CI: −9.59, −0.56, p = 0.028; I2 = 95.6%, Pheterogeneity < 0.001). The sensitivity analyses showed that the results of the meta‐analyses were robust. Conclusion: Compared with TEE, TTE showed no differences regarding the rates of success and residual shunt, but there were lower rates of late complications and shorter procedure and fluoroscopy times. [ABSTRACT FROM AUTHOR]

Takotsubo syndrome (TTS) is a clinical syndrome characterized by a transient left ventricular dysfunction whose diagnosis can be challenging due to its resemblance to acute myocardial infarction (AMI). Despite the growing recognition of TTS, acute complications and long‐term mortality rates are comparable to those observed in AMI patients. In this context, a systematic diagnostic approach is imperative for an accurate patient assessment, with due consideration of the distinctive characteristics and optimal timing of each imaging modality. Coronary angiography with ventriculography may be reserved for cases presenting with ST‐segment elevation, whereas in all other cases, the use of multimodality noninvasive imaging allows for a comprehensive evaluation of typical diagnostic features and detection of acute complications while also providing prognostic insights. The aim of this review is to evaluate the current research on non‐invasive modalities and to propose a diagnostic algorithm that will facilitate the identification and management of TTS. [ABSTRACT FROM AUTHOR]

Introduction: Transthoracic (TTE) follow up guidelines after PFO device closure are vague. The primary goal of this study was to perform a literature search to characterize the timing of complications that occur after PFO device placement to determine the utility of long‐term routine TTE. Methods: A search was performed in Medline (PubMed) with English language and publication date (2000–2023) filters were applied. Studies were included if they reported on patients who underwent a PFO device closure. Studies were excluded if they only reported on ASD device closure patients, were meta‐analysis or review papers, or did not report any outcomes for the PFO device procedure. Results: A total of 305 articles met the criteria (observational cohort study, n = 196; case study, n = 99; and randomized control study, n = 10). Age at the time of PFO device closure was 47.5 ± 9.3 years. The incidence of complications was 6.9% (3358/48 348). Maximum range of follow‐up was 0–17 years. The plurality of complications was due to arrhythmias (46.3%, 1554/3358), followed by residual shunts (29.7%, 999/3358). The majority of complications occurred ≤6 months post‐device placement (57.8%, 1941/3358). Only 0.8% (27/3358) of complications took place >5 years. All patients with complications >5 years of device placement were presented with clinical symptoms related to their complications. Conclusion: The incidence of patients presenting with PFO‐reported complications beyond 5 years post‐procedure diminished. The utility of routine TTE beyond 5 years post‐PFO after device placement should be further assessed. [ABSTRACT FROM AUTHOR]

The article explores the impact of bifurcation angles on computed tomography (CT)-derived fractional flow reserve (FFRCT) decline in vessels with no apparent coronary artery disease (CAD). Topics include the correlation between bifurcation angles and FFRCT changes, the identification of optimal cut-off values for bifurcation angles in the left anterior descending (LAD) and left circumflex (LCX) arteries and the significance of vessel length as a predictor of distal FFRCT values.

Thymoma is a relatively uncommon thoracic solid tumor, and considered to possess malignant potential. Usually, the lung, pleura, and mediastinum are the most frequently affected sites for metastasis in thymoma. However, the thymoma presenting simultaneous intrathoracic and extrathoracic metastases are exceedingly rare. Herein, we present an exceptionally uncommon case of invasive thymoma with multiple metastases. Furthermore, our case underscores the indispensable role of multimodality imaging in confirming the primary diagnosis and guiding treatment decisions. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) continues to have high rates of adverse outcomes, despite recent advances in diagnosis and management. Although the use of computer tomography and nuclear imaging appears to be increasing, echocardiography, widely available in most centers, is the recommended initial modality of choice to diagnose and consequently guide the management of IE in a timely‐dependent fashion. Echocardiographic imaging should be performed as soon as the IE diagnosis is suspected. Several factors may delay diagnosis, for example, echocardiography findings may be negative early in the disease course. Thus, repeated echocardiography is recommended in patients with negative initial echocardiography if high suspicion for IE persists in patients at high risk. However, systematic echocardiographic screening should not be utilized as a common tool for fever, but only in the presence of a reasonable clinical suspicion of IE. It may increase the risk of false‐positive rates of patients requiring IE therapy or may exacerbate diagnostic uncertainty about subtle findings. Considering the complexity of the disease, the echocardiographic use should be increasingly time‐efficient and should focus on the correct identification of IE lesions and associated complications. The path to identify patients who need surgery passes through an echocardiographic skill ensuring the identification of the cardiac anatomical structures and their involvement in the destructive infective extension. We pointed out the role of echocardiography focused on the correct identification of IE distinctive lesions and the associated complications, as part of a diagnostic strategy, within an integrated multimodality imaging, managed by an "endocarditis team". [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) poses a risk for cardiovascular damage during pregnancy. This study focused on evaluating changes in left ventricular myocardial performance in GDM patients using the left ventricular pressure‐strain loop (LV‐PSL) method and examining risk factors associated with reduced myocardial function. Methods: A prospective, randomized study involving 112 pregnant women diagnosed with GDM was conducted from June 2021 to June 2024. Additionally, 84 healthy pregnant women from the same period served as the control group. Utilizing both conventional echocardiography and two‐dimensional speckle tracking echocardiography, left ventricular myocardial work metrics were assessed using LV‐PSL technology. Results: GDM patients demonstrated significantly reduced values for global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), and global constructive work (GCW) (p < 0.05), while conventional ultrasound measures showed no significant difference between GDM and control groups. GWI, GWE, GCW, and GLS had high predictive value for cardiac function changes in GDM patients, with GWE showing the highest predictive value {Area under curve (AUC) = 0.866, cutoff value = 95.5%, specificity = 0.77, sensitivity = 0.87}. GWI, GWE, and GCW were negatively correlated with GLS (r = −0.532, −0.411, −0.425, all p < 0.001), whereas global wasted work (GWW) showed a positive correlation with GLS (r = 0.325 and p < 0.001). These parameters were also correlated with HbA1c levels (r = −0.316, −0.256, −0.260, all p < 0.001 for negative correlations, and r = 0.172, p < 0.05 for positive correlations). Multivariate logistic regression indicated that 1‐h OGTT (mmol/L), 2‐h OGTT (mmol/L), and HbA1c (%) were significant predictors of left ventricular systolic function (GWE) in GDM patients. Conclusions: LV‐PSL is an effective tool for early detection of left ventricular systolic function impairment in GDM patients. [ABSTRACT FROM AUTHOR]

Background/Aim: Mitral regurgitation (MR) is frequently observed in non‐valvular atrial fibrillation (NVAF) patients and is a significant risk factor for its progression. This study aims to investigate the three‐dimensional anatomical characteristics of the mitral valve (MV) in patients with different types of NVAF to elucidate the underlying mechanisms of MR. Methods: A retrospective analysis was conducted on 82 paroxysmal atrial fibrillation patients (PAF group) and 66 persistent atrial fibrillation patients (PerAF group) who underwent real‐time three‐dimensional transesophageal echocardiography (RT 3D‐TEE) before initial ablation. Additionally, 30 patients undergoing RT 3D‐TEE for the assessment of patent foramen ovale were selected as the control group. Basic echocardiographic variables were measured, left atrioventricular volume and strain parameters were calculated using automated software (Dynamic‐HeartModel and AutoStrain). MV anatomic features were analyzed using the 4D‐MV Assessment software (TomTec Imaging Systems). Results: The maximum left atrial volume (LAVmax) was highest in the PerAF group, followed by the PAF and control groups, with statistically significant differences (p < 0.01). Left atrial reservoir strain (LASr) showed an opposite trend, being the lowest in the PerAF group (p < 0.01). The proportion of moderate to severe MR was significantly higher in the PerAF group (27.3%) compared to the PAF group (11.0%) (p < 0.01). Compared to controls, the AF groups exhibited mitral annular (MA) dilation, flattening of the MA plane, and increased leaflet area (all p < 0.05). Correlation analysis between effective regurgitant orifice area (EROA) and left atrioventricular structure and function parameters, as well as various annular parameters, showed that EROA was significantly correlated with left ventricular end‐diastolic volume (LVEDV), LAVmax, LASr, anterior and posterior diameter, annular area, ratio of annular height to commissural diameter (AH/CD ratio), posterior leaflet area, posterior leaflet length, and the C‐shaped annulus length (all p < 0.05). Conclusions: Significant remodeling of the MV apparatus occurs in NVAF patients, with more pronounced changes in PerAF patients, contributing to a higher incidence of moderate to severe MR. RT 3D‐TEE‐based MV automated assessment offers significant advantages in accurately diagnosing MV remodeling and supporting the evaluation of MR in NVAF patients. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease (CKD) possess a pronounced risk for cardiovascular events. A noninvasive left ventricular pressure‐strain loop (LV‐PSL) has recently been introduced to detect subtler changes in cardiac function. This study aims to investigate the value of LV‐PSL for quantitative assessment of myocardial work (MW) in patients with CKD. Methods: Seventy‐five patients with CKD were enrolled retrospectively (37 patients with CKD Stages 2–3, and 38 patients with CKD Stages 4–5), and 35 healthy volunteers were included as controls. All subjects underwent transthoracic echocardiography. LV‐PSL analysis was performed to estimate LV MW and efficiency. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained by echocardiography, and the differences among the groups were compared. Results: There was a significant increase in GWW and reduction in GWE in patients with CKD compared to normal controls (p < 0.05). No significant difference in GWI and GCW was observed among the three groups. Multiple linear regression revealed that increased GWW was significantly associated with age, serum creatinine, and systolic pressure, and decreased GWE was associated with age, serum creatinine, and GLS. Conclusion: LV‐PSL can be used for noninvasive quantitative assessment of MW in patients with CKD, providing a new sensitive approach for the clinical assessment of myocardial function. [ABSTRACT FROM AUTHOR]

Complete transposition of the great arteries (TGA) is the most common cause of cyanosis in the first week of life. Prenatal diagnosis helps with counseling, planning delivery, and postnatal management for resource‐rich health services. In a resource‐limited setting, postnatal diagnosis is the norm. This work examines cases of complete TGA in one center in Cambodia without prenatal testing. Twenty‐four cases were studied over 5 years. Complex TGA was frequently seen. The majority had normal coronary anatomy and arterial switch operation (ASO) was performed in most cases with a favorable outcome. Complete transposition of the great arteries is the most common cyanotic congenital heart disease in the first week of life. Typically, the left ventricle is connected to the posteriorly placed pulmonary artery whereas the right ventricle gives rise to the anteriorly placed aorta. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is revolutionizing cardiac imaging, including echocardiography. However, AI has scarce penetration in resource‐limited regions. The implementation of AI‐aided echocardiography (AIE) poses unique challenges and opportunities in resource‐limited areas. Some obvious advantages of AIE include aiding image acquisition, interpretation, and triaging patients based on severity. The challenges AIE faces in resource‐limited regions include a lack of data accessibility for model development, physician apprehension, and an outdated regulatory framework. Based on our early experience with AI, we believe AIE in resource‐limited regions will enhance health equity, improve access to the technology, and lead to cost savings. However, significant efforts are needed to realize these objectives. [ABSTRACT FROM AUTHOR]

Aim: To (1) compare QT dispersion (QTd) and echocardiographic features between athletes with concentric left ventricular (LV) hypertrophy, athletes with eccentric LV hypertrophy, and sedentary controls with a normal LV geometric pattern and (2) quantify associations between QTd and echocardiographic features within these groups. Methods: Male athletes competing in different sports and sedentary men were stratified into groups according to their LV geometric pattern. These groups included eccentric LV hypertrophy (LV index > 115 g/m2, relative wall thickness [RWT] < 0.42) consisting of 38 athletes, concentric LV hypertrophy (LV index > 115 g/m2, RWT > 0.42) consisting of 40 athletes, and normal LV geometric pattern (LV index < 115 g/m2, RWT < 0.42) consisting of 40 sedentary controls. Following a cross‐sectional design, participants underwent electrocardiographic (ECG) and echocardiographic screening. Data were compared between groups using one‐way analyses of variance with Bonferroni post hoc tests. Associations between corrected QTd and echocardiographic variables were quantified using Pearson correlations. Results: Alongside structural disparities between groups, corrected QTd was significantly (p < 0.001) lower in athletes with eccentric LV hypertrophy compared to athletes with concentric LV hypertrophy and sedentary controls. Significant, moderate‐to‐very‐large correlations were found between corrected QTd and interventricular septal wall thickness in athletes with concentric (r = 0.416, p = 0.008) or eccentric LV hypertrophy (r = 0.734, p < 0.001), and sedentary controls (r = 0.464, p = 0.003). Conclusion: The provided comparative and relationship data may inform the development of more precise approaches for ECG and echocardiographic screening in athletes, particularly in those with concentric LV hypertrophy who may be at greater risk for developing prolonged QTd. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function–a key prognostic factor in TR–remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Right atrial volume (RAV) and function have proven prognostic value in the assessment of cardiac disease and may be more accurately assessed using three‐dimensional echocardiography (3DE). Normal 3DE reference values for the right atrial (RA) volume and function in healthy children have not yet been published. Furthermore, current methods of indexing cardiac measurements to body surface area (BSA) alone may be insufficient. We aimed to develop reference values for 3DE‐derived RAV and function in the pediatric population, to provide a comparison of regression methods using BSA, height, weight, and sex, and to compare 3DE values to two‐dimensional echocardiography (2DE) derived volumes. Methods: We retrospectively analyzed 187 3DE datasets acquired for a multi‐center study on healthy children at two international centers. 3DE volumes were measured with vendor‐agnostic software (Tomtec), and 2DE endo‐diastolic volume (EDV) using the area‐length single‐plane approach. Regression curve‐fitting of height (Ht), weight (Wt), BSA, and sex were explored to optimize Pearson coefficient and homoscedasticity. Results: The relationship of 3DE RAVs to BSA alone was heteroscedastic, with a residual positive relationship on indexing (R2 = 0.2506). Optimal regression of Ln (Volume) = b0 + x*Ln (Ht) + y*Ln (Wt) + z*Sex was homoscedastic. Total RA emptying fraction (EF) did not vary across age or sex, however active and passive emptying was best fit by a spline curve with a knot at approximately BSA = 1 m2. Strong agreement with 2DE‐derived EDV was present (r2 = 0.83). Conclusion: We provide reference values for RA size and function in the pediatric population and provide a comparison of methods for indexing these values. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is strongly linked to the incidence and mortality of cardiovascular diseases (CVDs), with left ventricular myocardial damage being the most prevalent. This study aimed to assess left ventricle (LV) dysfunction using three‐dimensional speckle tracking imaging (3D‐STI) in CKD patients. Methods: A total of 110 CKD patients and 55 healthy volunteers underwent echocardiography. CKD patients were divided into CKD1 group and CKD2 group based on the estimated glomerular filtration rate (eGFR). Assessing cardiac function via two‐dimensional speckle tracking echocardiography (2D‐STE) and three‐dimensional speckle tracking echocardiography (3D‐STE) parameters, with strain presented in absolute terms. Collecting and comparing clinical and echocardiographic parameters from three groups, assessing 3D‐STI's value in evaluating LV functional impairment in CKD patients via correlation and receiver operating characteristic (ROC) curve analyses, and identifying risk factors for CKD progression to end‐stage renal disease (ESRD) through univariate and multivariate analyses. Results: In CKD2 group, 2D‐left ventricular ejection fraction (LVEF), 3D‐LVEF, 2D left ventricular global longitudinal strain (2D‐LVGLS), 3D‐LVGLS, and 3D‐left ventricular global circumferential peak strain (LVGCS) significantly worsen compared to the control and CKD1 groups, with statistically significant distinctions between the latter two (all p < 0.05). The absolute value of 3D‐LVGLS shows a robust correlation with N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and serum creatinine (Scr) (r = −0.598, −0.649, both p < 0.001). ROC curve analysis indicates higher diagnostic efficacy of 3D‐LVGLS and 3D‐LVGCS for LV systolic function than 2D‐LVGLS. Univariate and multivariate analyses reveal an independent association of 3D‐LVGLS with the progression to ESRD in CKD. Conclusion: 3D‐LVGLS and 3D‐LVGCS effectively detect LV dysfunction in CKD patients. Specifically, 3D‐LVGLS demonstrates a robust correlation with NT‐proBNP and Scr and is independently linked to CKD progressing to ESRD. [ABSTRACT FROM AUTHOR]

Background: Left bundle branch area pacing (LBBAP) is safe and effective, but studies in older patients are lacking. This study compared the clinical and echocardiographic outcomes of LBBAP and right ventricular pacing (RVP) in patients aged ≥75 years. Methods: This prospective observational study included older patients with symptomatic bradycardia who underwent LBBAP or RVP between 2019 and 2022. Clinical data, including pacing and electrophysiological characteristics, echocardiographic measurements, and device‐related complications were collected. The primary endpoint was a composite of all‐cause mortality, heart failure hospitalization, and upgrade to biventricular pacing. Secondary outcomes included changes in left ventricular ejection fraction (LVEF). Results: Of 267 included patients, 110 underwent LBBAP and 157 underwent RVP. LBBAP was successful in 109 patients (success rate: 99.1%), with one patient eventually undergoing RVP. The pacing parameters of LBBAP were similar to those of RVP, except for a significantly narrower paced QRS duration (112.8 ± 11.6 vs. 138.3 ± 23.9 ms, p <.001). Ventricular lead implanting procedural duration was longer for LBBAP than RVP (14.0 vs. 6.0 min, p <.001), as was the fluoroscopy time (4.0 vs. 2.0 min, p <.001). During a mean follow‐up period of 31.0 ± 16.8 months, the primary outcome incidence was significantly lower following LBBAP than RVP (15.1% vs. 21.1%; hazard ratio, 0.471; 95% confidence interval, 0.215–1.032; p =.036) in 149 patients (55.8%) with ventricular pacing burden > 20%. RVP reduced LVEF from 62.7 ± 4.1% at baseline to 59.8 ± 7.8% at the final follow‐up (p =.001), whereas LBBAP preserved LVEF (61.4 ± 6.3% vs. 60.1 ± 7.4%, p =.429). Conclusion: LBBAP demonstrated improved clinical outcomes compared with RVP and maintained LVEF in older patients with high ventricular pacing burdens. [ABSTRACT FROM AUTHOR]

We present a case of a neonate who presented with worsening heart failure due to congenital complete atrioventricular (AV) block, secondary to maternal anti Ro/SSA and anti‐LA/SSB antibodies. The patient was implanted a temporary pacemaker in view of hemodynamic deterioration and subsequently was weaned off ionotropic support and referred for permanent epicardial pacemaker implantation. We report temporary pacemaker implantation in a neonate with hemodynamic instability as a stabilizing measure and discuss technical challenges for the same. [ABSTRACT FROM AUTHOR]

Ventricular diverticula are saccule‐like structures formed by the protrusion of the ventricular myocardium from the endocardial surface towards the free wall. Most diverticula are muscular structures, and patients usually have no obvious clinical symptoms. However, diverticula may contribute to arrhythmogenesis due to localized myocardial structural disturbances. Right ventricular apical diverticulum (RVAD) is very rare, and we report a case of highly symptomatic accelerated idioventricular rhythm (AIVR) originating from the RVAD that underwent intracardiac echocardiography (ICE)–guided catheter ablation with no recurrence during follow‐up. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Biventricular pacing (BIV) is the gold standard for cardiac resynchronization therapy (CRT). Thirty percent of patients do not respond to CRT. Conduction system pacing (CSP) represents a viable alternative. Interventricular conduction delay (IVCD), as electrical desynchrony marker, is a CRT response predictor. The aim of this study was to determine the incidence of CRT responders by selecting the best approach between BIV and CPS based on intraoperative IVCD measurement in patients with HFrEF and LBBB.Ninety‐six patients were randomly assigned in a 1:1 ratio to either a standard BIV group(control group, CG) or a group where the CRT approach was determined based on IVCD evaluation(study group, SG). If the right ventricular sensed electrogram (RVs)–left ventricular sensed electrogram (LVs) interval was ≥100 ms, the lead was left in its original position; otherwise, the LV lead was removed, and CSP was performed instead. Clinical, EKG, and echocardiographic features have been assessed pre‐ and 6 months post‐implant. Echocardiographic and clinical responder were evaluated.Thirty‐seven percent of patients in the SG underwent CSP, as the operative algorithm. The incidence of CRT responders was significantly higher in the SG (echocardiographic criterion: 92.5% vs. 69.8%, p:.009; clinical criterion 87.5% vs. 62.8%, p:.014). The SG showed a significantly greater difference in EF between pre‐ and post‐implant as well as reduced end‐diastolic and systolic volumes. Univariate and multivariate regression analysis indicated that enrollment in the SG was the only factor associated with CRT response.Intraoperative assessment of IVCD could help determine the optimal CRT approach between BIV and CSP, leading to a significant improvement in the rate of CRT responders. [ABSTRACT FROM AUTHOR]

Objective: To identify cardiovascular ultrasound predictors for brain anomalies in fetuses with heart disease. Methods: A literature search was performed in the following databases: MEDLINE through OVID, EMBASE, Cochrane Registry Center for Controlled Trials (CENTRAL), and LILACS, from their inception until May 2023. Clinical studies, cross‐sectional studies, case–control studies, cohorts, and systematic reviews were included. Data extraction was performed, and the risk of bias was assessed using the QUADAS‐2 tool. Results: Among 2705 studies evaluated, after filtering information, 10 articles were selected that met the inclusion criteria. These studies noted the following outcomes: a decrease in fetal head circumference, changes in brain maturation measured in days, decreased depth of brain fissures, and a decrease in total brain volume. The studies show a statistically significant correlation with the presence of the following cardiovascular predictors: low or mixed oxygen content in the ascending aorta (p < 0.001), retrograde flow in the aortic arch (p < 0.001), lower z values of the MCA‐PI (p < 0.05), higher UA‐PI z values (p < 0.01), and lower CPR (p < 0.05). In addition, lower values of left ventricular flow (p < 0.01), ductus arteriosus (p < 0.0001), and combined cardiac output index (p < 0.01) were reported. Conclusions: This review describes the most relevant evidence correlating the effects of hemodynamic changes that lead to states of chronic hypoxia related to the aforementioned changes in the central nervous system. [ABSTRACT FROM AUTHOR]

Purpose: Fetal growth restriction (FGR) is a common pregnancy complication that can be associated with several adverse perinatal outcomes. One of these negative outcomes is ductus arteriosus, especially in preterm babies. In this study, intrauterine heart function and ductus diameter were evaluated in babies with FGR. Methods: Thirty‐seven fetuses with FGR were compared with 37 normal‐weight fetuses at the same gestational week. In our study, ventricular diameters, aorta, pulmonary artery, ductus arteriosus (DA), aortic arch diameter, and flow traces were examined. In addition, the aorta and aortic isthmus diameters were proportioned to the ductus diameter, and the left ventricular myocardial performance index (MPI) [(ICT + IRT)/ET] was evaluated. Results: There was no difference in DA diameters between the patient and control groups. The intragroup comparison of the cases with early‐ and late‐onset FGR revealed no statistically significant difference between DA diameters. However, the ratios of the aortic annulus diameter/ductus diameter (AOD/DAD) and aortic isthmus diameter/ductus diameter (AID/DAD) were significantly lower in early‐onset FGR because the diameter of the DA was greater. In addition, the mod‐MPI values were higher in the patient group. Conclusions: In our study, although the ductal diameters did not change significantly in the patient group, the ductal diameter was greater in the early‐onset intrauterine growth restriction (FGR) group compared with other cardiac measurements. The mod‐MPI value, a cardiac function indicator, was higher in fetuses with FGR. These findings may be useful for evaluating postnatal cardiac functions in FGR. [ABSTRACT FROM AUTHOR]

Pseudoaneurysm of the mitral‐aortic intervalvular fibrosa is rare, particularly in children, and is potentially fatal. This article presents two cases of pediatric mitral‐aortic intervalvular fibrosa pseudoaneurysm: one secondary to infective endocarditis and the other confirmed to be congenital in nature. The characteristic echocardiographic manifestations of mitral‐aortic intervalvular fibrosa pseudoaneurysm demonstrated in this study will enhance diagnostic efficacy and guide early clinical intervention. [ABSTRACT FROM AUTHOR]

Aims: Risk stratification of patients with new‐onset acute heart failure (AHF) is important but remains challenging. In the present study, we evaluated the prognostic value of a new multiparameter right ventricular dysfunction (RVD) score. Methods and results: Patients (n = 210) hospitalized due to new‐onset AHF between 2015 and 2018 were retrospectively included. Mean age was 56 ± 10 years, 24% were female and median left ventricular ejection fraction was 28% (interquartile range 20; 34%). The RVD score, tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC) were determined at index hospitalization and after therapy titration. The 4‐point RVD score included reduced TAPSE, right ventricular enlargement, moderate or severe tricuspid regurgitation and increased central venous pressure. The study endpoint was a composite of all‐cause mortality, left ventricular assist device implantation, and heart transplantation. After 60 months median follow‐up time, 53 (25%) patients met the endpoint. At index hospitalization, there were no significant differences in any echocardiographic parameter between patients with and without the endpoint. After therapy titration, there were differences in TAPSE (16 vs. 19 mm, P = 0.001), FAC (33 vs. 40%, P < 0.001) and the proportion of patients with RVD score ≥2 (36 vs. 4%, P < 0.001). The presence of RVD despite therapy titration had different impact on survival depending on the parameter considered: the proportion of patients free from events after 1 year was 87% in patients with TAPSE <17 mm, 89% in patients with FAC <35% and 65% in patients with RVD score ≥2. In a multivariable analysis, RVD score ≥2 after therapy titration, but not TAPSE <17 mm or FAC < 35%, remained associated with a higher risk of the composite endpoint (hazard ratio 3.11, 95% confidence interval 1.44–6.74). Conclusions: A novel multiparametric RVD score might improve prognostic stratification in patients with new‐onset AHF. RVD after therapy titration, but not at index hospitalization is associated with a higher risk of the composite endpoint. [ABSTRACT FROM AUTHOR]

Aims: Arterial hypertension (aHTN) plays a fundamental role in the pathogenesis and prognosis of heart failure with preserved ejection fraction (HFpEF). The risk of heart failure increases with therapy‐resistant arterial hypertension (trHTN), defined as inadequate blood pressure (BP) control ≥140/90 mmHg despite taking ≥3 antihypertensive medications including a diuretic. This study investigates the effects of the BP lowering baroreflex activation therapy (BAT) on cardiac function and morphology in patients with trHTN with and without HFpEF. Methods: Sixty‐four consecutive patients who had been diagnosed with trHTN and received BAT implantation between 2012 and 2016 were prospectively observed. Office BP, electrocardiographic and echocardiographic data were collected before and after BAT implantation. Results: Mean patients' age was 59.1 years, 46.9% were male, and mean body mass index (BMI) was 33.2 kg/m2. The prevalence of diabetes mellitus was 38.8%, atrial fibrillation was 12.2%, and chronic kidney disease (CKD) stage ≥3 was 40.8%. Twenty‐eight patients had trHTN with HFpEF, and 21 patients had trHTN without HFpEF. Patients with HFpEF were significantly older (64.7 vs. 51.6 years, P < 0.0001), had a lower BMI (30.0 vs. 37.2 kg/m2, P < 0.0001), and suffered more often from CKD‐stage ≥3 (64 vs. 20%, P = 0.0032). After BAT implantation, mean office BP dropped in patients with and without HFpEF (from 169 ± 5/86 ± 4 to 143 ± 4/77 ± 3 mmHg [P = 0.0019 for systolic BP and 0.0403 for diastolic BP] and from 170 ± 5/95 ± 4 to 149 ± 6/88 ± 5 mmHg [P = 0.0019 for systolic BP and 0.0763 for diastolic BP]), while a significant reduction of the intake of calcium‐antagonists, α2‐agonists and direct vasodilators, as well as a decrease in average dosage of ACE‐inhibitors and α2‐agonists could be seen. Within the study population, a decrease in heart rate from 74 ± 2 to 67 ± 2 min−1 (P = 0.0062) and lengthening of QRS‐time from 96 ± 3 to 106 ± 4 ms (P = 0.0027) and QTc‐duration from 422 ± 5 to 432 ± 5 ms (P = 0.0184) were detectable. The PQ duration was virtually unchanged. In patients without HF, no significant changes of echocardiographic parameters could be seen. In patients with HFpEF, posterior wall diameter decreased significantly from 14.0 ± 0.5 to 12.7 ± 0.3 mm (P = 0.0125), left ventricular mass (LVM) declined from 278.1 ± 15.8 to 243.9 ± 13.4 g (P = 0.0203), and e′ lateral increased from 8.2 ± 0.4 to 9.0 ± 0.4 cm/s (P = 0.0471). Conclusions: BAT reduced systolic and diastolic BP and was associated with morphological and functional improvement of HFpEF. [ABSTRACT FROM AUTHOR]

Aims: We aim to integrate the parameters of two‐dimensional (2D) echocardiography and identify the high‐risk population for all‐cause mortality in patients with acute ST‐segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods: The study involved a retrospective cohort population with STEMI who were admitted to Yongchuan Hospital of Chongqing Medical University between January 2016 and January 2019. Baseline data were collected, including 2D echocardiography parameters and left ventricular ejection fraction (LVEF). The parameters of 2D echocardiography were subjected to cluster analysis. Logistic regression models were employed to assess univariate and multivariate adjusted odds ratios (ORs) of cluster information in relation to all‐cause mortality. Four logistic regression models were generated, utilizing cluster information, clinical variables, clinical variables in conjunction with LVEF, and clinical variables in conjunction with LVEF and cluster information as predictive variables, respectively. The area under the curve (AUC) were utilized to evaluate the incremental risk stratification value of cluster information. Results: The study included 633 participants with 28.8% female, a mean age of 65.68 ± 11.98 years. Over the course of a 3‐year follow‐up period, 108 (17.1%) patients experienced all‐cause mortality. Utilizing cluster analysis of 2D echocardiography parameters, the patients were categorized into two distinct clusters, with statistically significant differences observed in most clinical variables, echocardiography, and survival outcomes between the clusters. Multivariate regression analysis revealed that cluster information was independently associated with the risk of all‐cause mortality with adjusted OR 7.33 (95% confidence interval [CI] 3.99–14.06, P < 0.001). The inclusion of LVEF enhanced the predictive capacity of the model utilized with clinical variables with AUC 0.848 (95% CI 0.809–0.888) versus AUC 0.872 (95% CI 0.836–0.908) (P < 0.001), and the addition of cluster information further improved its predictive performance with AUC 0.906 (95% CI 0.878–0.934, P < 0.001). This cluster analysis was translated into a free available online calculator (https://app‐for‐mortality‐prediction‐cluster.streamlit.app/). Conclusions: The 2D echocardiographic diagnostic information based on cluster analysis had good prognostic value for STEMI population, which was helpful for risk stratification and individualized intervention. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to compare the changes in the left ventricle (LV) and right ventricle (RV) geometry and performance after the implantation of HeartMate II (HMII) and HeartMate 3 (HM3). In addition, we investigated whether the echocardiographic parameters LV sphericity index (LVSI) and the novel pressure‐dimension index (PDI) can predict post‐operative right ventricular failure (RVF). Methods and results: Between 2012 and 2020, 46 patients [HMII (n = 22) and HM3 (n = 24)] met the study's criteria and had echocardiography tests pre‐operatively, 6 and 12 months post‐operatively. The LVSI and PDI were calculated together with the standard LV and RV echocardiographic parameters. The mean follow‐up was 24 ± 7 months. In both groups, the LV end‐diastolic diameter (LVEDD) significantly decreased 12 months post‐operatively compared with the pre‐operative values (HMII: 6.4 ± 1.4 cm vs. 5.7 ± 0.9 cm, P = 0.040; HM3: 6.7 ± 1.3 cm vs. 5.5 ± 0.9 cm, P < 0.01, respectively). RV function 12 months post‐operatively was better in the HM3 group than in the HMII group, as indicated by a significantly higher RV fractional area change (RVFAC) in the HM3 group than in the HMII group 12 months post‐operatively (35 ± 12% vs. 26 ± 16%, P = 0.039), significantly higher tricuspid annular plane systolic excursion (TAPSE) in the HM3 group 12 months post‐operatively compared with the HMII group (13.9 ± 1.9 mm vs. 12.0 ± 2.1 mm, P = 0.002), and the tissue Doppler estimated tricuspid annular systolic velocity (TASV) was also significantly higher in the HM3 group 12 months post‐operatively compared with the HMII group (11.5 ± 2.7 mm/s vs. 9.9 ± 1.5 mm/s, P = 0.020). The LVSI value was significantly higher 12 months post‐operatively in the HMII group than in the HM3 group (1.2 ± 0.4 vs. 0.8 ± 0.2, P = 0.001, respectively), indicating worse geometric changes. The PDI decreased 12 months post‐operatively in the HM3‐group compared with the baseline (3.4 ± 1.4 mmHg/cm2 vs. 2.0 ± 0.8 mmHg/cm2, P < 0.001). In the univariate and multivariate analyses, only the pre‐operative PDI was a predictor of post‐operative RVF [odds ratio: 3.84 (95% CI: 1.53–18.16, P = 0.022)]. The area under the curve for pre‐operative PDI was 0.912. The 2 year survival was significantly better in the HM3 group (log‐rank, P = 0.042). Conclusions: The design of HM3 offered better geometrical preservation of the LV and enabled normal PDI values, leading to improved RV function, as indicated by better RVFAC, TAPSE, and TASV values. The use of pre‐operative PDI as an additional tool for established risk scores might offer a better pre‐operative predictor of RVF. [ABSTRACT FROM AUTHOR]

Aims: Clinical trials in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) commonly have detailed eligibility criteria. This may contribute to challenges with efficient enrolment and questions regarding the generalizability of trial findings. Methods and results: Patients with HFmrEF/HFpEF from a large US healthcare system were identified through a computable phenotype applied in linked imaging and electronic health record databases. We evaluated shared eligibility criteria from five recent/ongoing HFmrEF/HFpEF trials (PARAGON‐HF, EMPEROR‐Preserved, DELIVER, FINE‐ARTS, and SPIRRIT‐HFpEF) and compared clinical and echocardiographic features as well as outcomes between trial‐eligible and trial‐ineligible patients. Among 5552 patients with HFpEF/HFmrEF, 792 (14%) were eligible for trial consideration, having met all criteria assessed. Causes of ineligibility included lack of recent loop diuretics (37%), significant pulmonary disease (24%), reduced estimated glomerular filtration rate (17%), recent stroke/transient ischaemic attack (13%), or low natriuretic peptides (12%); 53% of ineligible patients had >1 reason for exclusion. Compared with eligible patients, ineligible patients were younger (age 71 vs. 75 years, P < 0.001) with higher rates of coronary artery disease (66% vs. 59%, P < 0.001) and peripheral vascular disease (40% vs. 33%, P < 0.001), but less mitral regurgitation, lower E/e′ ratio, and smaller left atrial sizes. Both eligible and ineligible patients demonstrated high rates of structural heart disease consistent with HFpEF [elevated left atrial size or left ventricular (LV) hypertrophy/increased LV mass], although this was slightly higher among eligible patients (95% vs. 92%, P = 0.001). The two cohorts demonstrated similar LV global longitudinal strain along with a similar prevalence of atrial fibrillation/flutter, hypertension, and obesity. Ineligible patients had similar all‐cause mortality (33% vs. 33% at 3 years) to those eligible but lower rates of heart failure hospitalization (20% vs. 28% at 3 years, P < 0.001). Conclusions: Among patients with HFmrEF/HFpEF from a large health system, approximately one in seven were eligible for major trials based on key criteria applied through a clinical computable phenotype. These findings highlight the large proportion of patients with HFmrEF/HFpEF ineligible for contemporary trials for whom the generalizability of trial findings may be questioned and further investigation would be beneficial. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate changes in echocardiographic right ventricular (RV) indices in relation to the degree of fluid accumulation between hemodialysis sessions, evaluated according to the recommended threshold of interdialytic‐weight‐gain corrected for dry weight (IDWG%). Methods: A post‐hoc analysis was performed using data from 41 maintenance hemodialysis patients. Patients were divided into a higher (>4.5%) and a lower (<4.5%) IDWG% group and underwent an echocardiographic assessment at the start and the end of the 3‐day and the 2‐day interdialytic interval. Results: RV systolic pressure (RVSP) increments were more pronounced in the higher compared to the lower IDWG% group (16.43 ± 5.37 vs. 14.11 ± 13.38 mm Hg respectively, p = 0.015) over the 3‐day interval, while changes in RV filling pressures, did not differ significantly between the groups (p = 0.84). Conclusions: During the 3‐day interdialytic interval, pulmonary circulation is particularly overloaded in patients with fluid accumulation higher than the recommended thresholds, as evidenced by higher RVSP elevations. [ABSTRACT FROM AUTHOR]

Background Objectives Animals Methods Results Conclusions and Clinical Importance Reference intervals for simple body weight‐independent measurements of right heart size and function are limited.Generate reference intervals for measurements of right heart size indexed to the long‐axis aortic valve diameter (AoD) or corresponding left heart structure (right heart ratios) and describe the reproducibility of these indices.Ninety healthy adult dogs of variable body weight.Prospective study. All dogs underwent an echocardiogram performed by the same operator. Numerous linear 2‐dimensional measurements of right heart size and function from different imaging planes were performed. Eight dogs underwent repeated echocardiograms by the same operator on 3 different days, and 3 different operators performed repeated echocardiograms on the same day. Reference intervals were generated using the Clinical Laboratory Standards Institute method. Reproducibility was quantitated using coefficients of variation (CVs) and reproducibility coefficients.Reference intervals for right heart ratios were generated and allow simple assessments of right heart size and function that do not require a scaling exponent or body weight table. Right heart ratios did not show clinically relevant associations with body weight. All CVs were <22.6%. In general, CVs for right heart measurements indexed to AoD were lower compared with right heart measurements indexed to the corresponding left heart structure.Reference intervals for simple body weight‐independent right heart ratios are available to help detect abnormalities of right heart size and function. Reproducibility coefficients might be useful to help identify meaningful changes in right heart size during serial evaluations. [ABSTRACT FROM AUTHOR]

Background Hypothesis Animals Methods Results Conclusions and Clinical Importance Reliability of echocardiographic calculations for stroke volume and mitral regurgitant fraction (RFMR) are affected by observer variability and lack of a gold standard. Variability is used to calculate critical change values (CCVs) that are thresholds representing real change in a measure not associated with observer variability.Observed intra‐ and interobserver accuracy and variability in healthy dogs help model CCV for RFMR.Reliability cohort of 34 healthy dogs; allometric scaling cohort of 99 dogs with heart disease and 25 healthy dogs.Accuracy, variability, and CCV of 2 observers using geometric and flow‐based echocardiography were prospectively compared against a standard of RFMR = 0% and extrapolated across a range of expected RFMR values in the reliability cohort partly derived from cardiac dimensions predicted by the allometric cohort.Accuracy of methods to determine RFMR in descending order was 4‐chamber bullet (Bullet4CH), mitral inflow, cube formula, and Simpson's method of disks. Intraobserver variability was relatively high. The CCV for RFMR ranged from 28% to 88% and was inversely related to RFMR when extrapolated for use in affected dogs. For both observers, the Bullet4CH method had the lowest intraobserver CCV (Operator 1:28%, Operator 2:41%). Interobserver strength of agreement was low with intraclass correlation coefficients ranging from 0.210 to 0.413.Echocardiographic volumetric methods used to calculate stroke volume and RFMR have low accuracy and high variability in healthy dogs. Extrapolation of observed CCV to a range of expected RFMR suggests observers and methods are not interchangeable and variability might hinder routine clinical usage. Individual observers should be aware of their own variability and CCV. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusions The incidence of heart failure hospitalization is higher in women than in men after myocardial infarction (MI). Sex‐related differences in left ventricular (LV) remodelling may contribute to the differences in post‐MI outcomes. The aim of this study was to assess sex differences in echocardiographic parameters post‐MI, and whether the relationship between echocardiographic parameters and clinical outcomes differs by sex.In the PARADISE‐MI trial, patients were randomized to sacubitril/valsartan or ramipril within 0.5 to 7 days of high‐risk MI. In the pre‐specified echocardiographic substudy, 544 patients underwent echocardiography at the time of randomization and after 8 months. We compared key echocardiographic parameters in men and women and their association with primary composite outcome (cardiovascular death or incident heart failure). At baseline, women had higher LV ejection fraction (LVEF), lower LV end‐diastolic volume (LVEDV) index, LV end‐systolic volume (LVESV) index, and LV mass index. After adjusting for baseline clinical differences, changes in these echocardiographic parameters from baseline to 8 months were not significantly different in women versus men. Lower LVEF, higher LVEDV, LVESV, left atrial volume index, and average E/e' were associated with a higher risk of the primary composite outcome. Sex did not modify the relationship between echocardiographic parameters and clinical outcome.Despite baseline differences in measures of cardiac function between men and women following acute high‐risk MI, there were no significant sex‐related changes in chamber size or LV function. Sex did not modify the association between echocardiographic parameters and clinical outcome. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Sample Methods Main Outcome Measures Results Conclusions To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR).Prospective longitudinal study.Fetal Medicine Unit.Thirty‐five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months).Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography.Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups.Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, p < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, p < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (−19.0 vs. −16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, p < 0.01 for all).Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long‐term cardiovascular complications in later life. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Initial data suggest that His Bundle Pacing (HBP) could preserve long‐term cardiac structure and function better than Right Ventricular Pacing (RVP), but evidence is limited.We studied consecutive patients with baseline ejection fraction (EF) ≥ 50% who underwent HBP attempt, either successful (HBP group) or failed (RVP group). Two‐dimensional (2D) and three‐dimensional (3D) echocardiography were carried out at baseline and after 6 months of ventricular pacing burden > 20%.Among 68 patients, 40 underwent successful HBP, and 28 RVP. The HBP and RVP groups did not differ for age, sex and pacing indication. At baseline, the HBP and RVP groups did not differ for 2D EF (62% vs. 62%), 3D EF (60% vs. 63%), 2D (−19% vs. −19%) and 3D global longitudinal strain (GLS) (−15% vs. −16%). After 6 months, 2D EF (−3.86%) and 3D EF (−5.71%) significantly decreased in the RVP group and did not change in the HBP group (p for interaction .006 and <.001, respectively). 2D GLS (3.08%) and 3D GLS (2.22%) significantly increased in the RVP group, but did not change in the HBP group (p for interaction .013 and <.016, respectively). Pacing induced cardiomyopathy (PICM) (EF drop ≥ 10% and EF < 50%) occurred in 14% (RVP) versus 0% (HBP) of patients (p = .025).Successful HBP was superior to RVP in preserving LV systolic function despite a high ventricular pacing burden, and was less frequently associated with PICM. [ABSTRACT FROM AUTHOR]

Inferior sinus venosus atrial septal defect (SVASD) is the rarest form of the atrial septal defect (ASD) and can sometimes go unnoticed. Although this defect can be associated with other congenital anomalies, its association with hypoplasia of the posterior mitral leaflet is extremely rare. In this case, we present a woman with a history of surgery for an ostium secundum ASD who exhibited persistent right heart chamber dilation. Echocardiography revealed hypoplasia of the posterior mitral leaflet, and cardiac magnetic resonance (CMR) imaging confirmed the presence of a previously undetected inferior sinus venosus ASD. [ABSTRACT FROM AUTHOR]

Background: While left ventricular ejection fraction (LVEF) is the primary variable utilized for prognosis following myocardial infarction (MI), it is relatively indiscriminate for survival in patients with mildly reduced (> 40%) or preserved LVEF (> 50%). Improving risk stratification in patients with mildly reduced or preserved LVEF remains an unmet need, and could be achieved by using a combination approach using prognostically validated measures of left‐ventricular (LV) size, geometry, and function. Aims: The aim of this study was to compare the prognostic utility of a Combined Echo‐Score for predicting all‐cause (ACM) and cardiac mortality (CM) following MI to LVEF alone, including the sub‐groups with LVEF > 40% and LVEF > 50%. Methods: Retrospective data on 3094 consecutive patients with MI from 2013 to 2021 who had inpatient echocardiography were included, including both patients with ST‐elevation MI (n = 869 [28.1%]) and non‐ST‐elevation MI (n = 2225 [71.9%]). Echo‐Score consisted of LVEF < 40% (2 points) or LVEF < 50% (1 point), and 1 point each for left atrial volume index > 34 mL/m2, septal E/eʹ > 15, abnormal LV mass‐index, tricuspid regurgitation velocity > 2.8 m/s, and abnormal LV end‐systolic volume‐index. Simple addition was used to derive a score out of 7. Results: At a median follow‐up of 4.5 years there were 445 deaths (130 cardiac deaths). On Cox proportional‐hazards multivariable analysis incorporating significant clinical and echocardiographic predictors, Echo‐Score was an independent predictor of both ACM (HR 1.34, p <.001) and CM (HR 1.59, p <.001). Inter‐model comparisons of model 훘2, Harrel's C and Somer's D, and Receiver operating curves confirmed the superior prognostic value of Echo‐Score for both endpoints compared to LVEF. In the subgroups with LVEF > 40% and LVEF > 50%, Echo‐Score was similarly superior to LVEF for predicting ACM and CM. Conclusions: An Echo‐Score composed of prognostically validated LV parameters is superior to LVEF alone for predicting survival in patients with MI, including the subgroups with mildly reduced and preserved LVEF. This could lead to improved patient risk stratification, better‐targeted therapies, and potentially more efficient use of device therapies. Further studies should be considered to define the benefit of further investigation and treatment in high‐risk subgroups. [ABSTRACT FROM AUTHOR]