Journal: J Am Soc Echocardiogr

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<div><h4>Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography.</h4><i>Lu JC, Riley A, Conlon T, Levine JC, ... Soni-Patel N, Slesnick T</i><br /><AbstractText>Cardiac point-of-care ultrasound has the potential to improve patient care, but its application to children requires consideration of anatomic and physiologic differences from adult populations, and corresponding technical aspects of performance. This document is the product of an American Society of Echocardiography task force composed of representatives from pediatric cardiology, pediatric critical care medicine, pediatric emergency medicine, pediatric anesthesiology, and others, assembled to provide expert guidance. This diverse group aimed to identify common considerations across disciplines to guide evolution of indications, and to identify common requirements and infrastructure necessary for optimal performance, training, and quality assurance in the practice of cardiac point-of-care ultrasound in children. The recommendations presented are intended to facilitate collaboration among subspecialties and with pediatric echocardiography laboratories by identifying key considerations regarding (1) indications, (2) imaging recommendations, (3) training and competency assessment, and (4) quality assurance.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 23 Jan 2023; epub ahead of print</small></div>
Lu JC, Riley A, Conlon T, Levine JC, ... Soni-Patel N, Slesnick T
J Am Soc Echocardiogr: 23 Jan 2023; epub ahead of print | PMID: 36697294
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<div><h4>Clinical and Echocardiographic Features of Patients with Infective Endocarditis and Bicuspid Aortic Valve According to Echocardiographic Definition of Valve Morphology.</h4><i>Benvenga RM, Tribouilloy C, Michelena HI, Silverio A, ... Citro R, Habib G</i><br /><b>Background</b><br />The influence of different bicuspid aortic valve (BAV) morphology in the clinical course of infective endocarditis (IE) has not yet been investigated. This study aimed to describe the clinical and echocardiographic features of IE in patients with BAV (BAVIE) according to valve morphology.<br /><b>Methods</b><br />Patients with definite BAVIE prospectively enrolled in 4 high-volume referral centers from 2000 to 2019, were evaluated and divided into two groups according to the echocardiographic definition of fused BAV morphology: right-left coronary (RL type) and right-non-coronary or left-non-coronary (non-RL type) cusp fusion. All patients were followed up for 1 year.<br /><b>Results</b><br />138 patients with BAVIE were included [male 77.7%; median age 52 (36.83-61.00 years)]: 112 patients with RL type (81%) and 26 patients with non-RL type BAV (19%), with no significant differences in age, sex and comorbidities between groups. Although 43% of the cohort had known BAV, the referral was late after symptom onset, particularly for the RL phenotype; time from symptom onset to hospitalization >30 days (31.3% vs 11.5%; p=0.032) and NYHA class ≥II (64.3% vs 42.3%; p=0.039) were more frequent in patients with RL type BAV than in patients with non-RL type BAV. Conversely, patients with non-RL type BAV had a higher incidence of hemorrhagic stroke (19.2% vs 5.4%; p=0.034) and high-grade atrio-ventricular block (11.5% vs 0.9%; p=0.021). Streptococcus viridans was more frequently isolated in patients with non-RL type BAV than in patients with RL type BAV (44% vs 24.1%; p=0.045). No difference in short- and intermediate-term mortality was observed between groups.<br /><b>Conclusions</b><br />Clinical profile and echocardiographic features in BAVIE patients may differ according to valve morphology and patients with BAVIE appear to be referred late, even when BAV disease is previously known.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 19 Jan 2023; epub ahead of print</small></div>
Benvenga RM, Tribouilloy C, Michelena HI, Silverio A, ... Citro R, Habib G
J Am Soc Echocardiogr: 19 Jan 2023; epub ahead of print | PMID: 36682434
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<div><h4>Pulmonary Hypertension Phenotype Can Be Identified in Heart Failure with Reduced Ejection Fraction Using Echocardiographic Assessment of Pulmonary Artery Pressure with Supportive Use of Pressure Reflection Variables.</h4><i>Bech-Hanssen O, Smith JG, Astengo M, Bollano E, ... Bergh N, Karason K</i><br /><b>Background</b><br />Pulmonary hypertension (PH) is frequent in patients with heart failure and reduced ejection fraction (HFrEF) with two different phenotypes: isolated post-capillary PH (IpcPH) and, with worst prognosis, combined pre- and post-capillary PH (CpcPH). The aims of the present echocardiography study were to investigate (1) the ability to identify PH-phenotype in patients with HFrEF using the newly adopted definition of PH (mean pulmonary artery pressure >20 mmHg), and (2) the relationship between PH-phenotype and right ventricular (RV) function.<br /><b>Methods</b><br />One hundred and twenty-four patients with HFrEF consecutively referred for heart transplant or heart failure work-up were included with echocardiography and right heart catheterization within 48 hours. We estimated systolic pulmonary artery pressure (sPAP<sub>Doppler</sub>) and used a method to detect increased pulmonary vascular resistance (PVR>3 Wood units) based on predefined thresholds of three pressure reflection (PRefl) variables (the acceleration time in the RV outflow tract (RVOT), the interval between peak RVOT- and peak tricuspid regurgitant velocity and the RV pressure augmentation following peak RVOT velocity).<br /><b>Results</b><br />Using ROC analysis in a derivation group (n=62) we identified sPAP<sub>Doppler</sub> ≥35 mmHg as a cutoff that in a test group (n=62) increased the likelihood of PH 6.6-fold. The presence of sPAP<sub>Doppler</sub> >40 mmHg and two or three positive PRefl variables increased the probability of CpcPH 6 to 8-fold. A two-step approach with primarily assessment of sPAP<sub>Doppler</sub> and the supportive use of PRefl variables in patients with mild/moderate PH (sPAP<sub>Doppler</sub> 41-59 mmHg), showed 76% observer agreement and a weighted kappa of 0.63. The steady state (PVR) and pulsatile (compliance, elastance) vascular loading are increased in both IpcPH and CpcPH with comparable degree of RV dysfunction.<br /><b>Conclusions</b><br />The PH phenotype can be identified in HFrEF using standard echocardiographic assessment of PA pressure with supportive use of PRefl variables in patients with mild to moderate PH.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 18 Jan 2023; epub ahead of print</small></div>
Bech-Hanssen O, Smith JG, Astengo M, Bollano E, ... Bergh N, Karason K
J Am Soc Echocardiogr: 18 Jan 2023; epub ahead of print | PMID: 36681129
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<div><h4>Prognostic Value of Baseline TAPSE to PASP Ratio in Mitral Transcatheter Edge-to-Edge Repair.</h4><i>Shechter A, Vaturi M, Kaewkes D, Koren O, ... Makkar RR, Siegel RJ</i><br /><b>Background</b><br />- A surrogate of right ventricular-pulmonary arterial coupling, the tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) ratio has been associated with outcomes across a wide range of cardiac pathologies and interventions. We aimed to assess the prognostic significance of baseline TAPSE/PASP in patients undergoing mitral transcatheter edge-to-edge repair (TEER).<br /><b>Methods</b><br />- This is a single-center, retrospective analysis encompassing 448 (IQR, 86-958) days of follow-up after 707 consecutive isolated, first-time mitral TEER procedures. Stratified by the cohort\'s median TAPSE/PASP of 0.37 mm/mmHg, eligible cases were examined for the occurrence of all-cause mortality and heart failure (HF) hospitalizations.<br /><b>Results</b><br />- Patients with low TAPSE/PASP ratios exhibited a greater prevalence of functional mitral regurgitation (FMR), a higher burden of comorbidities, and worse clinical and echocardiographic indices of cardiac function, as well as an attenuated rate of technical success. Post procedure, they experienced similar 1-month and 1-year improvement in MR grade and functional status but higher rates of death, HF hospitalizations and the composite of both at all timepoints explored (1-year - 15.3% vs 7.6%, 20.7% vs 10.2%, and 32.3% vs 16.1%, respectively, all p<0.001). Lower TAPSE/PASP was independently associated with a higher risk for the 1-year combined endpoint of death or HF hospitalizations (HR 2.84, 95% CI 1.09-7.43, p=0.033). A novel TAPSE/PASP-MitraScore risk model showed a better discriminative property than currently validated scores. Subgroup analysis produced similarly significant observations solely in patients with FMR (n=383, 54.2%), which remained when using subgroup-specific medians of the baseline TAPSE/PASP.<br /><b>Conclusion</b><br />- A low pre-TEER TAPSE/PASP ratio identifies higher-risk patients and predicts a less favorable outcome after the procedure.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 16 Jan 2023; epub ahead of print</small></div>
Shechter A, Vaturi M, Kaewkes D, Koren O, ... Makkar RR, Siegel RJ
J Am Soc Echocardiogr: 16 Jan 2023; epub ahead of print | PMID: 36657500
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<div><h4>Novel Utilization of Ultrasound Enhancing Agents in Complex Congenital Heart Disease Following Superior Cavopulmonary Connection.</h4><i>Chaszczewski KJ, Linder JR, Campbell MJ, Convery M, ... Kozyak BW, Quartermain MD</i><br /><b>Background</b><br />Children with single ventricle congenital heart disease (CHD) typically undergo a superior cavopulmonary connection (SCPC) as the second stage in their surgical palliation. Postoperatively, stenoses of the SCPC and branch pulmonary arteries (PAs) can occur. If there are clinical concerns and echocardiography is insufficient for diagnosis, patients undergo invasive evaluation with exposure to radiation and anesthesia. The use of ultrasound enhancing agents (UEAs) to improve echocardiographic diagnostic capabilities has not previously been described in this population.<br /><b>Methods</b><br />A single center, retrospective case review of children who underwent an echocardiogram with UEA, following SCPC from 3/1/2020 - 4/15/2022 at the Children\'s Hospital of Philadelphia. Twenty-two patients with hypoxemia or concern for obstruction following SCPC underwent UEA echocardiography. Extracted clinical data included patient demographics, echocardiographic images, angiography, surgical and transcatheter intervention as well as available follow-up data.<br /><b>Results</b><br />Six of the 22 UEA echocardiograms demonstrated stenosis or occlusion of either the SCPC or a PA. All six underwent cardiac catheterization - angioplasty was performed in 5 of these 6 patients, while one patient underwent surgical revision. Sixteen of 22 UEA echocardiograms demonstrated no evidence of stenosis. Ten of these 16 improved, while 6 experienced persistent hypoxemia prompting referral for cardiac catheterization. Angiography confirmed the UEA echocardiogram findings (absence of stenosis) in 4 of these 6 patients. There were no adverse reactions related to UEA administration.<br /><b>Conclusions</b><br />Echocardiography with UEAs is a valuable and safe adjunctive imaging modality following SCPC, particularly when 2D and color imaging is limited. This novel application of UEAs in complex CHD patients provides an \"angiogram-like\" image, better delineating vessel walls and improving assessment of postoperative obstruction. As experience with UEAs increases in the CHD population, there may be opportunities to decrease invasive and costly procedures, while expediting the care of patients in need of intervention.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 12 Jan 2023; epub ahead of print</small></div>
Chaszczewski KJ, Linder JR, Campbell MJ, Convery M, ... Kozyak BW, Quartermain MD
J Am Soc Echocardiogr: 12 Jan 2023; epub ahead of print | PMID: 36642236
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<div><h4>Automated Detection of Aortic Stenosis using Machine Learning.</h4><i>Wessler BS, Huang Z, Long G, Pacifici S, ... Patel AR, Hughes MC</i><br /><b>Aims</b><br />Aortic stenosis (AS) is a degenerative valve condition that is under-diagnosed and undertreated. Detection of AS using limited 2D echocardiography could enable screening and improve appropriate referral and treatment of this condition. We aimed to develop methods for automated detection of AS from limited imaging datasets.<br /><b>Methods</b><br />Convolutional neural networks were trained, validated, and tested using limited 2D transthoracic echocardiogram (TTE) datasets. Networks were developed to accomplish two sequential tasks; 1) view identification and 2) study-level grade of AS. Balanced accuracy and area under the receiver operator curve (AUROC) were the performance metrics used.<br /><b>Results</b><br />Annotated images from 577 patients were included. Neural networks were trained on data from 338 patients (average N = 10,253 labeled images), validated on 119 patients (average N = 3,505 labeled images), and performance was assessed on a test sets of 120 patients (average N = 3,511 labeled images). Fully automated screening for AS was achieved with AUROC 0.96. Networks can identify no significant (no, mild, mild/moderate) AS from significant (moderate, or severe) AS with an AUROC = 0.86 and between early (mild or mild/moderate AS) and significant (moderate or severe) AS with an AUROC of 0.75. External validation of these networks in a cohort of 8502 outpatient TTEs showed that screening for AS can be achieved using parasternal long-axis imaging only with an AUROC of 0.91.<br /><b>Conclusion</b><br />Fully-automated detection of AS using limited 2D datasets is achievable using modern neural networks. These methods lay the groundwork for a novel method for screening for AS.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 11 Jan 2023; epub ahead of print</small></div>
Wessler BS, Huang Z, Long G, Pacifici S, ... Patel AR, Hughes MC
J Am Soc Echocardiogr: 11 Jan 2023; epub ahead of print | PMID: 36641103
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<div><h4>Variation in Cost of Echocardiography Within and Across US Hospitals.</h4><i>Wei C, Milligan M, Lam M, Heidenreich PA, Sandhu A</i><br /><b>Background</b><br />While transthoracic echocardiography (TTE) is responsible for more Medicare spending than any other cardiovascular imaging procedure, little is known about its commercial cost footprint. The 2021 Hospital Price Transparency Final Rule mandated US hospitals publish their insurer-negotiated and self-pay prices for services. This study sought to characterize and assess factors contributing to variation in TTE prices.<br /><b>Methods</b><br />We used a commercial database containing hospital-disclosed prices to characterize variation in TTE prices within and across hospitals. We linked this price data to hospital and regional characteristics using Medicare Facility IDs.<br /><b>Results</b><br />1949 hospitals reported commercial prices. Among reporting hospitals, median commercial and self-pay prices were 2.93- and 3.06-times greater than the median Medicare price ($1313 and $1422, respectively, versus $464). Within hospitals, the 90th percentile payer-negotiated rate was 2.78 (IQR 1.80-5.09) times the 10th percentile rate (within-center ratio). Across hospitals within the same hospital referral region (HRR), the median price at the 90th percentile hospital was 2.47 (IQR 1.69-3.75) times that at the 10th percentile hospital (across-center ratio). On univariate analysis, for-profit (p=0.04), teaching (p<0.01), investor-owned (P<0.01), and higher-rated hospitals (p<0.01) charged higher prices, whereas rural referral centers (p=0.01) and disproportionate share hospitals (DSH) (p<0.01) charged less. On multivariate analysis, the association between these characteristics and TTE prices persisted, except investor ownership and rural referral centers.<br /><b>Conclusions</b><br />Self-pay and commercial TTE prices were higher than Medicare prices and varied significantly within and across hospitals. For-profit, teaching, and higher-rated hospitals had higher prices, in contrast to DSH hospitals. Better understanding the relationship between this cost variation and quality of care is critical given the impact of cost on healthcare access and affordability.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 10 Jan 2023; epub ahead of print</small></div>
Wei C, Milligan M, Lam M, Heidenreich PA, Sandhu A
J Am Soc Echocardiogr: 10 Jan 2023; epub ahead of print | PMID: 36638930
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<div><h4>Assessment of Early Diastolic Intraventricular Pressure Difference in Children by Blood Speckle Tracking Echocardiography.</h4><i>Sørensen K, Fadnes S, Mertens L, Henry M, ... Løvstakken L, Nyrnes SA</i><br /><b>Background</b><br />The lack of reliable echocardiographic techniques to assess diastolic function in children is a major clinical limitation. Our aim was to develop and validate intraventricular pressure difference (IVPD) calculation using blood speckle tracking (BST) and investigate the method`s potential role in the assessment of diastolic function in children.<br /><b>Methods</b><br />BST allows two-dimensional angle-independent blood flow velocity estimation. BST images of left ventricular (LV) inflow from the apical four-chamber view in 138 controls, 10 dilated cardiomyopathies (DCM) and 21 hypertrophic cardiomyopathies (HCM) < 18 years of age were analyzed to study LV IVPD during early diastole. Reproducibility of the IVPD analysis was assessed, IVPD estimates from BST and Color M Mode were compared and the validity of the BST-based IVPD calculations was tested in a computer flow model.<br /><b>Results</b><br />Mean IVPD was significantly higher in controls (-2.28 ± 0.62 mmHg) compared to DCM (-1.21 ± 0.39 mmHg, p<0.001) and HCM (-1.57 ± 0.47 mmHg, p<0.001) patients. Feasibility was 88.3% in controls, 80% in DCM and 90.4% in HCM respectively. The peak relative negative pressure occurred earlier at the apex than at the base and preceded the peak E-wave LV filling velocity, indicating that it represents diastolic suction. Intraclass correlation coefficients for intra- and inter-observer variability were 0.908 and 0.702 respectively. There was a non-significant mean difference of 0.15 mmHg between IVPD from BST and Color M Mode. Estimation from two-dimensional velocities revealed a difference in peak IVPD of 0.12 mmHg (6.6 %) when simulated in a three-dimensional fluid mechanics model.<br /><b>Conclusions</b><br />IVPD calculation from BST is highly feasible and provides information on diastolic suction and early filling in children with heart disease. IVPD was significantly reduced in children with DCM and HCM compared to controls, indicating reduced early-diastolic suction in these patient groups.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 09 Jan 2023; epub ahead of print</small></div>
Sørensen K, Fadnes S, Mertens L, Henry M, ... Løvstakken L, Nyrnes SA
J Am Soc Echocardiogr: 09 Jan 2023; epub ahead of print | PMID: 36632939
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<div><h4>Contribution of Ventricular Motion and Sampling Location to Discrepancies in 2D versus 3D Fetal Ventricular Strain Measures.</h4><i>Ren M, Chan WX, Green L, Armstrong A, ... Buist ML, Yap CH</i><br /><b>Background</b><br />Echocardiographic quantification of fetal cardiac strain is important to evaluate function and the need for intervention, with both 2D and 3D strain measurements currently feasible. However, discrepancies between 2D and 3D measurements have been reported, the etiologies of which are unclear. This study sought to determine the etiologies of the differences between 2D and 3D strain measurements.<br /><b>Methods</b><br />A validated cardiac motion tracking algorithm was used on 3D cine ultrasound images acquired in 26 healthy fetuses. Both 2D and 3D myocardial strain quantifications were performed on each image set for controlled comparisons. Finite Element (FE) modelling of two left ventricles (LV) models with minor geometrical differences were performed with various helix angle configurations for validating image processing results.<br /><b>Results</b><br />3D longitudinal strain (LS) was significantly lower than 2D LS for the LV free wall and septum, but not for the right ventricular (RV) free wall, while 3D circumferential strain (CS) was significantly higher than 2D CS for the LV, RV and septum. The LS discrepancy was due to 2D long-axis imaging not capturing the out-of-plane motions associated with LV twist, while the CS discrepancy was due to the systolic motion of the heart towards the apex that caused out-of-plane motions in 2D short-axis imaging. A timing mismatch between the occurrences of peak longitudinal and circumferential dimensions caused a deviation in zero-strain referencing between 2D and 3D strain measurements, contributing to further discrepancies between the two.<br /><b>Conclusion</b><br />Mechanisms for discrepancies between 2D and 3D strain measurements in fetal echocardiography were identified and, inaccuracies associated with 2D strains were highlighted. Understanding of this mechanism is useful and important for future standardization of fetal cardiac strain measurements, which we propose to be important in view of large discrepancies of measured values in the literature.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 06 Jan 2023; epub ahead of print</small></div>
Ren M, Chan WX, Green L, Armstrong A, ... Buist ML, Yap CH
J Am Soc Echocardiogr: 06 Jan 2023; epub ahead of print | PMID: 36623710
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<div><h4>Echocardiographic Markers in the Diagnosis of Cardiac Masses.</h4><i>Paolisso P, Foà A, Bergamaschi L, Graziosi M, ... Galiè N, Pizzi C</i><br /><b>Background</b><br />The echocardiographic parameters required for a comprehensive assessment of cardiac masses (CMs) are still largely unknown.<br /><b>Objectives</b><br />To identify and integrate the echocardiographic features of CMs that can accurately predict malignancy.<br /><b>Methods</b><br />Observational cohort study of 286 consecutive patients who underwent a standard echocardiographic assessment for suspected cardiac mass in Bologna University Hospital between 2004 and 2022. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of 6 echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numerical score, ranging from 0 to 6, with a cut-off of >3 balancing sensitivity and specificity with respect to the histological diagnosis of malignancy. Classification tree analysis (CTA) was used to determine the ability of echocardiographic parameters to discriminate sub-groups of patients with a differential risk of malignancy.<br /><b>Results</b><br />Benign masses were more frequently pedunculated, mobile, and adherent to the interatrial septum (p<0.001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (p<0.001). Infiltration, moderate-severe pericardial effusion, non-left localization, sessile, polylobate, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted count of >3 was very high (>0.90) and similar to that of the previously published weighted score. The CTA generated an algorithm in which infiltration was the best discriminator of malignancy, followed by non-left localization and sessile shape. The percentage correctly classified by the CTA as malignant was 87.5%. Agreement between observer readings and cardiac mass histology ranged between 85.1-91.5%. The presence of at least 3 echocardiographic parameters was associated with a lower survival.<br /><b>Conclusions</b><br />In the approach to CM, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 04 Jan 2023; epub ahead of print</small></div>
Paolisso P, Foà A, Bergamaschi L, Graziosi M, ... Galiè N, Pizzi C
J Am Soc Echocardiogr: 04 Jan 2023; epub ahead of print | PMID: 36610495
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<div><h4>Complications Associated with Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions.</h4><i>Hasnie A, Parcha V, Hawi R, Trump M, ... Arora P, Arora G</i><br /><b>Background</b><br />Transesophageal echocardiograms (TEEs) performed during transcatheter structural cardiac interventions may have higher complications than those performed in the non-operative setting or even those performed during cardiac surgery. However, there are limited data on complications associated with TEE during these procedures. We evaluated the prevalence of major complications among these patients in the United States (US).<br /><b>Methods</b><br />A retrospective cohort study was conducted using an electronic health record database (TriNetX Research Network) from large academic medical centers across the US for patients undergoing TEE during transcatheter structural interventions from January 2012 to January 2022. Using the American Society of Echocardiography endorsed ICD-10 codes, patients undergoing TEE during a transcatheter structural cardiac intervention, including transaortic, mitral or tricuspid valve repair, left atrial appendage occlusion, atrial septal defect closure, patent foramen ovale closure, and paravalvular leak repair were identified. The primary outcome was major complications within 72 hours of the procedure (composite of bleeding, esophageal and upper respiratory tract injury). The secondary aim was the frequency of major complications, death, or cardiac arrest within 72 hours of patients who completed intraoperative TEE during surgical valve replacement.<br /><b>Results</b><br />Among 12,043 adult patients (mean age: 74 years old, 42% females) undergoing TEE for transcatheter structural cardiac interventions, 429 (3.6%) patients had a major complication. Complication frequency was higher in patients on anticoagulation or antiplatelet therapy compared with those not on therapy (3.9% vs. 0.5%, RR: 8.09, p < 0.001). Compared with those aged <65 years, patients aged ≥ 65 years had a higher frequency of major complications (3.9% vs. 2.2%, RR: 1.75, p < 0.001). Complication frequency was similar among males and females (3.5% vs 3.7%, RR: 0.96, p = 0.67). Among 28,848 patients who completed surgical valve replacement with TEE guidance, 728 (2.5%) suffered a major complication.<br /><b>Conclusions</b><br />This study found that more than 3% of patients undergoing TEE during transcatheter structural cardiac interventions have a major complication which is more common among those on anticoagulant or antiplatelet therapy or who were elderly. With a shift of poor surgical candidates to less invasive percutaneous procedures, the future of TEE-guided procedures relies on comprehensive risk discussion and updating practices beyond conventional methods to minimize risk for TEE-related complications.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 04 Jan 2023; epub ahead of print</small></div>
Hasnie A, Parcha V, Hawi R, Trump M, ... Arora P, Arora G
J Am Soc Echocardiogr: 04 Jan 2023; epub ahead of print | PMID: 36610496
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<div><h4>Age-, Sex- and Race-based Normal Values for Left Ventricular Circumferential Strain from the World Alliance of Societies of Echocardiography Study.</h4><i>Singulane CC, Miyoshi T, Mor-Avi V, Cotella JI, ... Asch FM, Lang RM</i><br /><b>Background</b><br />Left ventricular (LV) circumferential strain has received less attention than longitudinal deformation, which has recently become part of routine clinical practice. Among other reasons, this is because of the lack of established normal values. Accordingly, we aimed to establish normative values for LV circumferential strain and determine sex-, age- and race-related differences in a large cohort of healthy adults.<br /><b>Methods</b><br />Complete 2D transthoracic echocardiograms were obtained in 1572 healthy subjects (51% male), enrolled in the World Alliance of Societies of Echocardiography (WASE) Study. Subjects were divided into 3 age groups (<35, 35-55, >55 years) and stratified by sex and by race. Vendor-independent semi-automated speckle tracking software was used to determine LV regional and global circumferential strain (GCS) values. Limits of normal for each measurement were defined as 95% of the corresponding sex and age group falling between the 2.5<sup>th</sup> and 97.5<sup>th</sup> percentiles. Intergroup differences were analyzed using unpaired t-tests.<br /><b>Results</b><br />Circumferential strain showed a gradient, with lower magnitude at the mitral valve level, increasing progressively towards the apex. Compared to men, women had statistically higher magnitude of regional and global strain. Older age was associated with a stepwise increase in GCS despite an unaffected EF, a decrease in LV volume and a relatively stable GLS in men with a small gradual decrease in women. Asian subjects demonstrated significantly higher GCS magnitudes than whites of both sexes and blacks in women only. In contrast, no significant differences in GCS were found between white and black subjects of either sex. Importantly, despite statistical significance of the above differences across sex-, age- and races, circumferential strain values were similar in all groups, with variations of the order of magnitude of 1-2%. Notably, no differences in GCS were found between brands of imaging equipment.<br /><b>Conclusions</b><br />This study established normal values of LV regional and global circumferential strain, and identified sex-, age- and race-related differences, where present.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 30 Dec 2022; epub ahead of print</small></div>
Singulane CC, Miyoshi T, Mor-Avi V, Cotella JI, ... Asch FM, Lang RM
J Am Soc Echocardiogr: 30 Dec 2022; epub ahead of print | PMID: 36592875
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<div><h4>Normal Values of Left Ventricular Mass by 2D and 3D Echocardiography: Results from the World Alliance Societies of Echocardiography Normal Values Study.</h4><i>Lee L, Cotella JI, Miyoshi T, Addetia K, ... Lang RM, WASE Study Investigators</i><br /><b>Background</b><br />Although increased left ventricular mass (LVM) is associated with adverse outcomes, measured values vary widely depending on the specific technique used. Moreover, the impact of sex, age, and race on LVM remains controversial, further limiting the clinical use of this parameter. Accordingly, we studied LVM using a variety of 2D and 3D echocardiographic techniques in a large population of normal subjects encompassing a wide range of ages.<br /><b>Methods</b><br />Transthoracic echocardiograms obtained in 1885 healthy adult subjects (52% men) enrolled in the World Alliance of Societies of Echocardiography (WASE) normal values study, were divided into three age groups (young, 18-35 years; middle aged, 36-55 years; and old, >55 years). LVM was obtained using 5 conventional techniques, including linear and 2D methods, as well as direct 3D measurement. All LVM values were indexed to body surface area (BSA), and differences according to sex, age, and race were analyzed for each technique.<br /><b>Results</b><br />LVM values differed significantly between the 5 techniques. 3D measurements were considerably smaller than those obtained using the other techniques and were closer to MRI normal values reported in the literature. For all techniques, LVM in men was significantly larger than in women, with and without BSA indexing. These technique- and sex-related differences were larger than measurement variability. In women, age differences in LVM were more pronounced and depicted significantly larger values in older age groups for all techniques, except 3D echocardiography (3DE) that showed essentially no differences. LV mass was overall larger in black subjects than in white or Asian subjects.<br /><b>Conclusion</b><br />Significant differences in LVM values exist across echocardiographic techniques, which are therefore not interchangeable. Sex-, race-, and age-related differences underscore the need for separate population specific normal values.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 27 Dec 2022; epub ahead of print</small></div>
Lee L, Cotella JI, Miyoshi T, Addetia K, ... Lang RM, WASE Study Investigators
J Am Soc Echocardiogr: 27 Dec 2022; epub ahead of print | PMID: 36584904
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<div><h4>Prediction of Coronary Artery Calcium Using Deep Learning of Echocardiograms.</h4><i>Yuan N, Kwan AC, Duffy G, Theurer J, ... Cheng S, Ouyang D</i><br /><b>Background</b><br />Coronary artery calcification (CAC), often assessed by computed tomography (CT), is a powerful marker of coronary artery disease (CAD) that can guide preventive therapies. CTs, however, are not always accessible or serially obtainable. It remains unclear if other widespread tests such as transthoracic echocardiograms (TTEs) can be used to predict CAC.<br /><b>Methods</b><br />Using a dataset of 2881 TTE videos paired with coronary calcium CTs, we trained a video-based artificial intelligence (AI) convolutional neural network to predict CAC scores from parasternal long axis (PLAX) views. We evaluated the model\'s ability to classify patients from a held-out sample as well as an external site sample into zero CAC and high CAC (CAC ≥400 Agatston units) groups by receiver operating characteristic (ROC) and precision-recall curves. We also investigated whether such classifications prognosticated significant differences in 1-year mortality rates by log-rank test of Kaplan-Meier curves.<br /><b>Results</b><br />TTE AI models had high discriminatory abilities in predicting zero CAC (ROC AUC 0.81 (95% CI 0.74-0.88), F1 0.95) and high CAC (AUC 0.74 (0.68-0.8), F1 0.74). This performance was confirmed in an external test dataset of 92 TTEs ((AUC 0.75 (0.65-0.85), F1 0.77), (AUC 0.85 (0.76-0.93), F1 0.59), respectively). Risk stratification by TTE-predicted CAC performed similarly to CT CAC scores in prognosticating significant differences in 1-year survival in high CAC patients (CT CAC≥400 vs. CT CAC<400 p=0.03, TTE-predicted CAC≥400 vs. TTE-predicted CAC<400 p=0.02).<br /><b>Conclusions</b><br />A video-based deep learning model successfully used TTE videos to predict zero CAC and high CAC with high accuracy. TTE-predicted CAC prognosticated differences in 1-year survival similar to CT CAC. Deep learning of TTEs holds promise for future adjunctive CAD risk stratification to guide preventive therapies.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 22 Dec 2022; epub ahead of print</small></div>
Yuan N, Kwan AC, Duffy G, Theurer J, ... Cheng S, Ouyang D
J Am Soc Echocardiogr: 22 Dec 2022; epub ahead of print | PMID: 36566995
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<div><h4>The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients with ST Elevation Acute Myocardial Infarction.</h4><i>Chiang HP, Aguiar MOD, Tavares BG, Rosa VEE, ... Mathias W, Tsutsui JM</i><br /><b>Background</b><br />The diagnostic ultrasound-guided high mechanical index (MI) impulses during an intravenous microbubble infusion (sonothrombolysis) improves myocardial perfusion in acute ST segment elevation myocardial infarction (STEMI), but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling are unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics.<br /><b>Methods</b><br />100 patients (59±10 years; 34% women) were randomized to receive either high MI impulses plus percutaneous coronary intervention (PCI) (therapy group), or receive PCI only (control group) (n=50 in each group). DD grade and LA mechanics were assessed immediately before and after PCI, 48-72 hours, 1 month and 6 months of follow-up. DD grades were classified as grade I, II and III. The LA mechanics was obtained by 2-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS).<br /><b>Results</b><br />As follow-up time progressed, increased DD grade was observed more frequently in the control group than the therapy at 1 month and 6 months of follow-up (all P<0.05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48-72 hours, 24.0±7.3 in therapy group vs 19.6%±7.2% in control group, P=0.005; at 1 month, 25.3±6.3 in therapy group vs 21.5% ± 8.3% in control group, P=0.020; and at 6 months, 26.2±8.7 in therapy group vs 21.6%±8.5% in control group, P = 0.015. The therapy group were less likely to experience LA remodeling (OR, 2.91 [1.10 to 7.73]; P=0.03). LA-GLS was the sole predictor of LA remodeling (OR, 0.79 [0.67 to 0.94]; P=0.006).<br /><b>Conclusion</b><br />Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 16 Dec 2022; epub ahead of print</small></div>
Chiang HP, Aguiar MOD, Tavares BG, Rosa VEE, ... Mathias W, Tsutsui JM
J Am Soc Echocardiogr: 16 Dec 2022; epub ahead of print | PMID: 36535625
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<div><h4>Systolic Anterior Motion of the Mitral Valve in the Presence of Annular Calcification.</h4><i>Friend EJ, Wiener PC, Murthy KS, Peterson E, Al-Sudani H, Pressman GS</i><br /><b>Background</b><br />Mitral annular calcification (MAC) has been reported as a possible cause of systolic anterior motion (SAM) of the mitral valve and dynamic left ventricular outflow tract (LVOT) obstruction. While morphologic features predisposing to SAM in other clinical settings have been described, patients with MAC+SAM have not been systematically investigated. We hypothesized that bulky calcium deposits in the mitral annulus could displace the valve towards the septum thus promoting development of SAM.<br /><b>Methods</b><br />We studied 30 patients with severe MAC who had SAM with septal contact. Three comparator groups (matched for age and sex) were developed: 30 controls without MAC or SAM, 30 with severe MAC but no SAM, and 30 with SAM but no MAC.<br /><b>Results</b><br />Significant differences were found across groups for mitral valve coaptation point- septal distance (CSD), anterior mitral leaflet (AML) length, LV diastolic dimension, and EF. Comparing all MAC subjects (n=60) with controls, CSD was less (20.5±4.1 vs. 23.2±3.7 mm, p=0.003) and EF higher (67.7±7.8 vs. 60.9±6.4%, p<0.0001) in MAC patients. Within MAC subjects AML was longer (21.9±3.0 vs. 17.4±2.2 mm, p<0.0001) and CSD was smaller (18.0±2.7 vs. 23.1±3.6 mm, p<0.0001) when SAM was present despite similar height of the calcium bar in the two MAC groups (12.4±2.9 vs. 11.1±3.1 mm, p=0.11). Regression analysis confirmed AML length and CSD as independent predictors of SAM. MAC+SAM patients also had more echocardiographic risk factors for SAM (acute aorto-mitral angle, small LVOT, long AML, small CSD, and presence of a septal bump) than MAC/no-SAM patients (3.4±0.9 vs. 1.8±1.0, p<0.0001).<br /><b>Conclusions</b><br />Bulky MAC appears to contribute to dynamic LVOT obstruction when it accumulates in such a way that the mitral valve is displaced anteriorly towards the septum. However, other features are also associated with SAM in these patients, particularly a long AML. A combination of morphologic features and favorable hemodynamics may be needed to for SAM to develop in patients with severe MAC.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 15 Dec 2022; epub ahead of print</small></div>
Friend EJ, Wiener PC, Murthy KS, Peterson E, Al-Sudani H, Pressman GS
J Am Soc Echocardiogr: 15 Dec 2022; epub ahead of print | PMID: 36529336
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<div><h4>A novel method for estimating right atrial pressure with point-of-care ultrasound.</h4><i>Istrail L, Kiernan J, Stepanova M</i><br /><b>Background</b><br />Current noninvasive estimation of right atrial pressure (RAP) by either bedside jugular venous pressure (JVP) exam or inferior vena cava (IVC) measurement during a comprehensive echocardiogram offer imprecise estimates of actual RAP.<br /><b>Methods</b><br />We enrolled 41 patients in a prospective, blinded study to validate a novel point-of-care ultrasound method using direct right atrial depth measurement and jugular venous ultrasound to estimate RAP. Two subjects were excluded and 39 were included in the final analysis. A parasternal long axis view was obtained and the depth of the non-coronary cusp attachment to the posterior LVOT was recorded as the right atrial depth (RAD). This was added to an estimate of the jugular venous pressure obtained during a jugular vein ultrasound to calculate an estimated RAP (RAP<sub>US</sub>). The RAP<sub>US</sub> was compared to the RAP measurement during right heart catheterization (RAP<sub>cath</sub>) both as measured and as corrected for where the catheter was zeroed.<br /><b>Results</b><br />The correlation coefficient between RAP<sub>cath</sub> and RAP<sub>US</sub> was +0.75, regression R<sup>2</sup> 0.56, bias -0.49 mmHg (95% CI, -1.42 to +0.43 mmHg) with the limits of agreement -5.56 to +7.24 mmHg, and accuracy of 3 mmHg or less in 29 (74%) of the subjects. For the RAP<sub>US</sub> corrected for the catheter zero point, the correlation coefficient between RAP<sub>cath</sub> and RAP<sub>US</sub> was +0.72, regression R<sup>2</sup> 0.52, bias -0.60 mmHg (95% confidence interval [CI], -1.60 to +0.39 mmHg) with the limits of agreement -5.56 to +7.24 mmHg, and accuracy of 3 mmHg or less in 26 (67%) of the subjects.<br /><b>Conclusion</b><br />This simple ultrasound evaluation of right atrial depth and the right jugular vein correlates well with actual right atrial pressure, and can accurately estimate RAP within 3mmHg in most patients. This has the potential to improve our bedside volume status exam, as well as improve the accuracy of right atrial pressure estimation during comprehensive echocardiogram.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 12 Dec 2022; epub ahead of print</small></div>
Istrail L, Kiernan J, Stepanova M
J Am Soc Echocardiogr: 12 Dec 2022; epub ahead of print | PMID: 36521834
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<div><h4>Prognostic Impact of Indeterminate Diastolic Function in Patients with Functionally Insignificant Coronary Stenosis.</h4><i>Chung YJ, Choi KH, Lee SH, Shin D, ... Gwon HC, Lee JM</i><br /><b>Background</b><br />Cardiac diastolic dysfunction is an independent predictor of mortality, regardless of LV systolic function. However, the current guidelines that define cardiac diastolic dysfunction may underrate the clinical implications of those with indeterminate diastolic function.<br /><b>Objectives</b><br />We sought to evaluate the prognostic implications of indeterminate diastolic function on echocardiography and its association with coronary microvascular dysfunction (CMD).<br /><b>Methods</b><br />A total of 330 patients without LV systolic dysfunction and significant epicardial coronary stenosis (fractional flow reserve>0.80) were analyzed from a prospective registry. Cardiac diastolic dysfunction was defined according to two algorithms depending on the presence of myocardial disease. First, the presence of myocardial disease and evidence of elevated LV filling pressure indicated diastolic dysfunction. Second, diastolic function in those without myocardial disease was defined using echocardiographic parameters (E/e\', e\' velocity, tricuspid regurgitation velocity, and left atrial volume index). Patients who did not meet half of the available criteria were classified as having indeterminate diastolic function. CMD was defined as coronary flow reserve<2.0 and index of microcirculatory resistance≥25U. The primary outcome was cardiovascular death or admission for heart failure at 5 years.<br /><b>Results</b><br />Coronary flow reserve was lower in patients with indeterminate diastolic function compared with those with no diastolic dysfunction (3.5±1.6 vs. 3.2±1.6, P=0.002). The prevalence of CMD was also higher in patients with indeterminate diastolic function than those with no diastolic dysfunction (10.6% vs. 4.9%, P<0.034). Patients with indeterminate diastolic function showed significantly higher risk of cardiovascular death or admission for heart failure than those without, but not greater than those with definite diastolic dysfunction (cumulative incidence: 12.6%, 27.2%, and 32.7%, respectively, log-rank P<0.001). Presence of CMD and elevated LV filling pressure (E/e\'>14) were independent predictors for cardiovascular death or admission for heart failure in patients with indeterminate diastolic function.<br /><b>Conclusion</b><br />Patients with indeterminate diastolic function on echocardiogram showed higher risk of cardiovascular death or admission for heart failure than those with no diastolic dysfunction. Presence of CMD and elevated LV filling pressure were independent predictors for cardiovascular death or admission for heart failure among patients with indeterminate diastolic function.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 02 Dec 2022; epub ahead of print</small></div>
Chung YJ, Choi KH, Lee SH, Shin D, ... Gwon HC, Lee JM
J Am Soc Echocardiogr: 02 Dec 2022; epub ahead of print | PMID: 36470507
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<div><h4>Correlation Between Echocardiographic Diastolic Parameters and Invasive Measurements of Left Ventricular Filling Pressure in Patients with Takotsubo Cardiomyopathy.</h4><i>Dayco JS, Kherallah RY, Epstein J, Adegbala O, ... Oviedo C, Afonso L</i><br /><b>Background</b><br />The extent of diastolic dysfunction is of clinical importance in the risk stratification and management of Takotsubo cardiomyopathy (TC) patients. Standard echocardiographic indices for diastolic dysfunction have robust predictive ability in other diseases, however, these have not been validated in TC. This study compares Doppler metrics of diastolic function against catheterization measured filling pressures in TC.<br /><b>Methods</b><br />Patients with TC who met our inclusion and exclusion criteria were evaluated with echocardiography and catheterization obtained within 24 hours. Both LVEDP (Left Ventricular End Diastolic Pressure) and LV Pre-A diastolic pressures were obtained from catheterization tracings. The echocardiographic parameters for diastolic function were extracted using the American Society of Echocardiography (ASE) recommendations and a previously validated regression equation for mean left atrial pressure (mLAP).<br /><b>Results</b><br />A total of 51 patients with TC were included. Patient were predominantly females (72.5%), with mean age 58 ± 13, and mean ejection fraction 24 ± 10%. The E/e\' (septal, average, and lateral), and calculated mean LAP correlated positively with catheterization LV pre-A, with fair to moderate correlation (coefficients range: 0.38 to 0.44). The t-test mean difference between the LV pre-A pressure and calculated mLAP was 0.77 ± 7.34 mmHg (95% CI ± 14.68 mmHg) suggesting inconsistent measures. The mLAP also exhibited poor diagnostic ability to discriminate elevated LV pre-A diastolic pressure with a ROC area under the curve of 0.69 (95% CI 0.50 - 0.88).<br /><b>Conclusions</b><br />Commonly used echocardiographic parameters for diastolic function demonstrated less than optimal correlation, with poor sensitivity and specificity, when compared to invasively measured LVEDP or LV-pre-A wave diastolic pressures in TC. Precise characterization of LV filling pressure in TC using contemporary noninvasive echocardiographic parameters appears challenging. Invasive measurements of filling pressure should remain the gold standard for optimal risk stratification and management of TC.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 25 Nov 2022; epub ahead of print</small></div>
Dayco JS, Kherallah RY, Epstein J, Adegbala O, ... Oviedo C, Afonso L
J Am Soc Echocardiogr: 25 Nov 2022; epub ahead of print | PMID: 36442765
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<div><h4>\"Association of Bulboventricular foramen size and need for early intervention in infants with tricuspid atresia or double inlet left ventricle with normally related great arteries\".</h4><i>Skaff AM, Parra DA, Soslow JH, Shuplock JM</i><br /><b>Introduction</b><br />The association of bulboventricular foramen (BVF) size and systemic outflow adequacy has been studied in patients with tricuspid atresia (TA) or double inlet left ventricle (DILV) with transposed great arteries (TGA). We aimed to determine the relationship between the initial BVF size and risk for progressive pulmonary outflow obstruction requiring intervention to increase pulmonary blood flow in patients with TA or DILV with normally related great arteries.<br /><b>Methods</b><br />Patients with TA or DILV with normally related great arteries were identified by retrospective chart review at a single center from 2005 to 2021. Patients were stratified by indexed BVF area (iBVFA) to determine the relationship of iBVFA size and the need for intervention prior to the Glenn operation to establish supplemental pulmonary blood flow with either a Blalock-Taussig-Thomas shunt (BTTS) or patent ductus arteriosus (PDA) stent. Patients were followed through the time of their Glenn operation. Logistic regression analysis was performed to determine optimal iBVFA cut-points.<br /><b>Results</b><br />Thirty-seven patients with TA or DILV with normally related great arteries were included. Sixteen had an iBVFA <1 cm<sup>2</sup>/m<sup>2</sup> with all 16 (100%) requiring either a BTTS or PDA stent to increase pulmonary blood flow prior to the Glenn operation. Seventeen had an iBVFA of 1-2 cm<sup>2</sup>/m<sup>2</sup> with 10 (59%) requiring either a BTTS or PDA stent. Nine of those 10 demonstrated flow acceleration across the BVF and/or pulmonary outflow tract. Four had an iBVFA >2 cm<sup>2</sup>/m<sup>2</sup> with only 1 patient (25%) requiring a BTTS. Among our cohort, an iBVFA less than 1.8 cm<sup>2</sup>/m<sup>2</sup> provided a sensitivity of 96% with good positive and negative predictive values (81% and 80% respectively) for requiring intervention with a BTTS or PDA stent prior to the Glenn operation.<br /><b>Conclusions</b><br />An iBVFA of 1.8 cm<sup>2</sup>/m<sup>2</sup> or less on the initial postnatal echocardiogram is associated with the development of subpulmonary obstruction requiring intervention with a BTTS or PDA stent prior to the Glenn operation, with the highest risk noted in those with an iBVFA of 1 cm<sup>2</sup>/m<sup>2</sup> or less. Factors such as BVF flow acceleration or pulmonary outflow tract narrowing should also be considered in the decision to augment pulmonary blood flow.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 25 Nov 2022; epub ahead of print</small></div>
Skaff AM, Parra DA, Soslow JH, Shuplock JM
J Am Soc Echocardiogr: 25 Nov 2022; epub ahead of print | PMID: 36442767
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<div><h4>Prognostic Value of Left Atrial Strain in Aortic Stenosis: A Competing Risk Analysis.</h4><i>Tan ESJ, Jin X, Oon YY, Chan SP, ... Richards AM, Ling LH</i><br /><b>Background</b><br />The role of left atrial (LA) strain as an imaging biomarker in aortic stenosis is not well established. The aim of this study was to investigate the prognostic performance of phasic LA strain in relation to clinical and echocardiographic variables and N-terminal pro-B-type natriuretic peptide in asymptomatic and minimally symptomatic patients with moderate to severe aortic stenosis and left ventricular ejection fraction > 50%.<br /><b>Methods</b><br />LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct) were measured using speckle-tracking echocardiography. The primary outcome was a composite of all-cause mortality, heart failure hospitalization, progression to New York Heart Association functional class III or IV, acute coronary syndrome, or syncope. Secondary outcomes 1 and 2 comprised the same end points but excluded acute coronary syndrome and additionally syncope, respectively. The prognostic performance of phasic LA strain cutoffs was evaluated in competing risk analyses, aortic valve replacement being the competing risk.<br /><b>Results</b><br />Among 173 patients (mean age, 69 ± 11 years; mean peak transaortic velocity, 4.0 ± 0.8 m/sec), median LASr, LAScd, and LASct were 27% (interquartile range [IQR], 22%-32%), 12% (IQR, 8%-15%), and 16% (IQR, 13%-18%), respectively. Over a median of 2.7 years (IQR, 1.4-4.6 years), the primary outcome and secondary outcomes 1 and 2 occurred in 66 (38%), 62 (36%), and 59 (34%) patients, respectively. LASr < 20%, LAScd < 6%, and LASct < 12% were identified as optimal cutoffs of the primary outcome. In competing risk analyses, progressing from echocardiographic to echocardiographic-clinical and combined models incorporating N-terminal pro-B-type natriuretic peptide, LA strain parameters outperformed other key echocardiographic variables and significantly predicted clinical outcomes. LASr < 20% was associated with the primary outcome and secondary outcome 1, LAScd < 6% with all clinical outcomes, and LASct < 12% with secondary outcome 2. LAScd < 6% had the highest specificity (95%) and positive predictive value (82%) for the primary outcome, and competing risk models incorporating LAScd < 6% had the best discriminative value.<br /><b>Conclusions</b><br />In well-compensated patients with moderate to severe aortic stenosis and preserved left ventricular ejection fractions, LA strain was superior to other echocardiographic indices and incremental to N-terminal pro-B-type natriuretic peptide for risk stratification. LAScd < 6%, LASr < 20%, and LASct < 12% identified patients at higher risk for adverse outcomes.<br /><br />Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Soc Echocardiogr: 22 Nov 2022; epub ahead of print</small></div>
Tan ESJ, Jin X, Oon YY, Chan SP, ... Richards AM, Ling LH
J Am Soc Echocardiogr: 22 Nov 2022; epub ahead of print | PMID: 36441088
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<div><h4>Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography.</h4><i>Pandian NG, Kim JK, Arias Godinez JA, Marx GR, ... Campos Vieira ML, Little SH</i><br /><AbstractText>Acute rheumatic fever and its chronic sequela, rheumatic heart disease (RHD), pose major health problems globally, and remain the most common cardiovascular disease in children and young people worldwide. Echocardiography is the most important diagnostic tool in recognizing this preventable and treatable disease and plays an invaluable role in detecting the presence of subclinical disease needing prompt therapy or follow-up assessment. This document provides recommendations for the comprehensive use of echocardiography in the diagnosis and therapeutic intervention of RHD. Echocardiographic diagnosis of RHD is made when typical findings of valvular and subvalvular abnormalities are seen, including commissural fusion, leaflet thickening, and restricted leaflet mobility, with varying degrees of calcification. The mitral valve is predominantly affected, most often leading to mitral stenosis. Mixed valve disease and associated cardiopulmonary pathology are common. The severity of valvular lesions and hemodynamic effects on the cardiac chambers and pulmonary artery pressures should be rigorously examined. It is essential to take advantage of all available modalities of echocardiography to obtain accurate anatomic and hemodynamic details of the affected valve lesion(s) for diagnostic and strategic pre-treatment planning. Intraprocedural echocardiographic guidance is critical during catheter-based or surgical treatment of RHD, as is echocardiographic surveillance for post-intervention complications or disease progression. The role of echocardiography is indispensable in the entire spectrum of RHD management.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 22 Nov 2022; epub ahead of print</small></div>
Pandian NG, Kim JK, Arias Godinez JA, Marx GR, ... Campos Vieira ML, Little SH
J Am Soc Echocardiogr: 22 Nov 2022; epub ahead of print | PMID: 36428195
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<div><h4>Pediatric Normal Values and Z-Score Equations for Left and Right Ventricular Strain by Two-Dimensional Speckle-Tracking Echocardiography Derived from a Large Cohort of Healthy Children.</h4><i>Romanowicz J, Ferraro AM, Harrington JK, Sleeper LA, ... Powell AJ, Harrild DM</i><br /><b>Background</b><br />Strain values vary with age in children and are both vendor- and platform-specific. Philips QLab 10.8 and Tomtec AutoStrain are two widely-utilized strain analysis platforms, and both incorporate recent EACVI-ASE-Industry Strain Standardization Task Force guidelines. We sought to establish normal strain values and Z-scores for both platforms using a large dataset of healthy children and to compare values among these two platforms and a previous version-QLab 10.5-which predated the Task Force guidelines.<br /><b>Methods</b><br />Echocardiograms from 1,032 subjects <21 years old with structurally and functionally normal hearts were included. Images were obtained on the Philips EPIQ platform. Left ventricular (LV) and right ventricular (RV) strain were analyzed using QLab 10.8 and AutoStrain and measurement reliability was assessed. Z-score equations were derived as a function of age for QLab 10.8 (LV longitudinal and circumferential strain) and AutoStrain (LV and RV longitudinal strain). A subset (n=309) was analyzed by QLab 10.5. Strain values were compared among the three platforms.<br /><b>Results</b><br />For both of the newer platforms, strain varied with age, with magnitude reaching a maximum at 4-5 years. For LV longitudinal strain, the largest differences in value were observed in the youngest patients when using QLab 10.5; the other two platforms were similar. LV circumferential strain measurements (QLab 10.5 vs 10.8) were different for all ages, as were measurements of RV longitudinal strain (QLab 10.8 vs AutoStrain). Reliability was greater for AutoStrain than for QLab 10.8, and greater for LV than for RV strain.<br /><b>Conclusions</b><br />We generated normal RV and LV strain values and Z-scores from a large cohort of children for two commonly-utilized platforms in pediatric echocardiography laboratories. Following incorporation of Task Force guidelines, the greatest improvement in standardization was seen in infants. Small differences persist between modern platforms; however, these results support the cautious consideration of comparing inter-platform measurements.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 19 Nov 2022; epub ahead of print</small></div>
Romanowicz J, Ferraro AM, Harrington JK, Sleeper LA, ... Powell AJ, Harrild DM
J Am Soc Echocardiogr: 19 Nov 2022; epub ahead of print | PMID: 36414123
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<div><h4>Recognized and Unrecognized Value of Echocardiography in Guideline and Consensus Documents Regarding Patients with Chest Pain.</h4><i>Sorrell VL, Lindner JR, Pellikka PA, Kirkpatrick JN, Muraru D</i><br /><AbstractText>Guideline and consensus documents have recently been published on the important topic of the noninvasive evaluation of patients presenting with chest pain or patients with known acute or chronic coronary syndromes<sup>1,2</sup>. Authors for these documents have included members representing multispecialty imaging societies. Yet, the process of generating consensus and the need to produce concise written documents have led to a situation where the particular advantages of echocardiography are overlooked. Broad guidelines such as these can be helpful when it comes to \"when to do\" noninvasive cardiac testing, but they do not pretend to offer nuances on \"how to do\" noninvasive cardiac testing. This report details the particular value of echocardiography and potential explanations for its understated role in recent guidelines. This report is categorized into the following sections: (1) impact of the level of evidence (LOE) in guideline creation; (2) versatility of echocardiography in the assessment of chest pain (CP) and the inimitable role for echo Doppler echocardiography in the assessment of dyspnea; (3) value of point-of-care ultrasound (POCUS) in assessing CP and dyspnea; and (4) the future role of echocardiography in ischemic heart disease.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 11 Nov 2022; epub ahead of print</small></div>
Sorrell VL, Lindner JR, Pellikka PA, Kirkpatrick JN, Muraru D
J Am Soc Echocardiogr: 11 Nov 2022; epub ahead of print | PMID: 36375734
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This program is still in alpha version.