<div><h4>American Society of Echocardiography COVID-19 Statement Update: Lessons Learned and Preparation for Future Pandemics.</h4><i>Kirkpatrick JN, Swaminathan M, Adedipe A, Garcia-Sayan E, ... West C, Wiener DH</i><br /><AbstractText>The COVID-19 pandemic has evolved since the publication of the initial American Society of Echocardiography (ASE) statements providing guidance to echocardiography laboratories. In light of new developments, the ASE convened a diverse, expert writing group to address the current state of the COVID-19 pandemic and to apply lessons learned to echocardiography laboratory operations in future pandemics. This statement addresses important areas specifically impacted by the current and future pandemics: (1) indications for echocardiography, (2) application of echocardiographic services in a pandemic, (3) infection/transmission mitigation strategies, (4) role of cardiac point-of-care ultrasound/critical care echocardiography, and (5) training in echocardiography.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 01 Nov 2023; 36:1127-1139</small></div>

<div><h4>The Pixel Variation Score: an Echocardiographic Index to Assess Temporal Variation of Mitral Regurgitant Flow.</h4><i>Verbeke J, Kamoen V, De Buyzere M, Claessens T, Timmermans F</i><br /><b>Background</b><br />In mitral regurgitation (MR), temporal variation of MR flow has been considered an important reason for inaccurate MR grading. Current echocardiographic methods for assessing temporal MR flow variation are complex, and their clinical relevance has not been investigated. In this study, we investigated whether assessing MR flow variation using a dimensionless index with echocardiography is feasible, clinically meaningful, and related to patient outcomes.<br /><b>Methods</b><br />Consecutive patients with mitral valve prolapse (MVP, n = 244) and functional MR (FMR, n = 396) underwent comprehensive echocardiography. MR severity was assessed using an integrated approach advocated by current guidelines. The MR continuous wave Doppler envelope was divided into three segments of equal duration. Each segment\'s pixel intensity was assessed to calculate the pixel variation score (PVS).<br /><b>Results</b><br />PVS was lower in FMR patients than MVP patients. Lower PVS was associated with worse MR, larger left atrial and left ventricular dimensions, lower ejection fraction, and higher pulmonary artery pressures. In MVP, PVS was significantly associated with postoperative left ventricular reverse remodeling and was able to reclassify most patients in which single-frame measures overestimated MR severity. Finally, PVS had incremental prognostic value on top of clinical and echocardiographic predictors of outcome.<br /><b>Conclusions</b><br />Temporal variation in MR flow can reliably be assessed with echocardiography through analysis of the CWD signal. A high PVS value may alert the echocardiographer to defer from single-frame MR grading and also suggests that the MR is probably not severe.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 30 Oct 2023; epub ahead of print</small></div>

<div><h4>Incidence of Severe Adverse Drug Reactions to Ultrasound Enhancement Agents in a Contemporary Echocardiography Practice.</h4><i>Ali MT, Johnson M, Irwin T, Henry S, ... Kane GC, Thaden JJ</i><br /><b>Objectives</b><br />Prior data indicate very rare risk of serious adverse drug reaction (ADR) to ultrasound enhancement agents (UEA). We sought to evaluate the frequency of ADR to UEA administration in contemporary practice.<br /><b>Methods</b><br />We retrospectively reviewed 4 U.S. Health Systems to characterize frequency and severity of ADR to UEA. ADR were considered severe when cardiopulmonary involvement was present and critical when there was loss of consciousness, loss of pulse, or ST-segment elevation. Rates of isolated back pain and headache were derived from the Mayo Clinic (MC) Rochester stress echocardiography database where systematic prospective reporting of ADR was performed.<br /><b>Results</b><br />Among 26,539 Definity and 11,579 Lumason administrations in the MC Rochester stress echocardiography database, isolated back pain or headache were more frequent with Definity (0.49% vs 0.04%, p<0.0001) but less common with Definity infusion versus bolus (0.08% vs 0.53%, p=0.007). Among all sites there were 201,834 Definity and 84,943 Lumason administrations. Severe and critical ADR were more frequent with Lumason than Definity (0.0848% versus 0.0114% and 0.0330% versus 0.0010%, respectively; p<0.001 for each). Among the 3 Health Systems with >2,000 Lumason administrations, the frequency of severe ADR with Lumason ranged from 0.0755% to 0.1093% and the frequency of critical ADR ranged from 0.0293% to 0.0525%. Severe ADR rates with Definity were stable over time but increased in more recent years with Lumason (p=0.02). Patients with ADR to Lumason since the beginning of 2021 were more likely to have received Covid-19 vaccination compared to matched controls (88% versus 75%; p=0.05) and more likely to have received Moderna than Pfizer-Biotech (71% vs 26%, p<0.001).<br /><b>Conclusions</b><br />Severe and critical ADR, while rare, were more frequent with Lumason and the frequency has increased in more recent years. Additional work is needed to better understand factors, including associations with recently developed mRNA vaccines, which may be contributing to the increased rates of ADR to UEA since 2021.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 23 Oct 2023; epub ahead of print</small></div>

<div><h4>2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease: A Summary for JASE.</h4><i>Chang IC, Pellikka PA, Winchester DE</i><br /><AbstractText>This report provides a descriptive summary of the ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease with an emphasis on the role of stress echocardiography.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 17 Oct 2023; epub ahead of print</small></div>

<div><h4>Use of 3D Intracardiac Echocardiography Catheter in the Evaluation of Prosthetic Pulmonary Valves After Transcatheter Replacement.</h4><i>Gonzalez de Alba C, Zablah JE, Burkett D, Jone PN, Rodriguez SA, Morgan GJ</i><br /><AbstractText>Transcatheter pulmonary valve replacement (TPVR) is commonly performed in patients with congenital heart disease as a safe alternative to replacement via open heart surgery. Intracardiac echocardiography (ICE) is a useful technique for evaluating multiple structures that are difficult to assess by other echocardiographic techniques, particularly the pulmonary valve. To our knowledge, the use of 3D ICE catheters to evaluate prosthetic valves after TPVR has not been reported. 3D-ICE catheters offer a comprehensive evaluation of transcatheter-deployed pulmonary valves through 3D, 3D-color, xPlane, and multiplane reconstruction. The aim of this study is to demonstrate the feasibility of using 3D ICE catheters, outline their role in evaluating post-TPVR deployment success and complications, consider their additive value to 2D-ICE, and present our institutional experience with it in 50 cases of TPVR.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 13 Oct 2023; epub ahead of print</small></div>

<div><h4>Doppler Echocardiographic Phenotypes in Suspected \'Severe\' Aortic Stenosis Matrix-based Approach to Diagnosis and Management.</h4><i>Marcus RH, Hamilton R, Ugwu J, Ahsan MJ, ... Narang A, Lang RM</i><br /><b>Background</b><br />Among patients with suspected severe aortic stenosis [AS], Doppler echocardiographic [DE] data are often discordant and further analysis is required for accurate diagnosis and optimal management. In this study an automated matrix-based approach was applied to an echocardiographic database of patients with AS that identified 5 discrete echocardiographic data patterns, 1 concordant and 4 discordant, each reflecting a particular pathophysiology/measurement error that guides further work-up and management.<br /><b>Methods</b><br />A primary/discovery cohort of consecutive echocardiographic studies with at least one DE parameter of severe AS and analogous data from an independent secondary/validation cohort were retrospectively analyzed. Parameter thresholds for inclusion were aortic valve area [AVA] <1.0 cm<sup>2</sup>, transaortic mean gradient [MG] >40 mmHg, and/or transaortic peak velocity >4.0 m/s. Doppler velocity index [DVI] was also determined. Logic provided by an in-line SQL query embedded within the database was used to assign each patient to one of five discrete matrix patterns, each reflecting one or more specific pathophysiologies. Feasibility of automated pattern-driven triage of discordant cases was also evaluated.<br /><b>Results</b><br />In both cohorts, data from each patient fitted only one data pattern. Of the 4643 primary cohort patients, 39% had concordant parameters for severe AS and DVI <0.30 (pattern 1). 35% had AVA <1.0 cm<sup>2</sup>, MG <40 mmHg, DVI <0.30 (pattern 2). 9% had MG >40 mmHg with DVI >0.30 (pattern 3). 10% had AVA <1.0 cm<sup>2</sup>, MG <40 mmHg, DVI >0.30, due to small left ventricular outflow tract (LVOT) measurements (pattern 4). 7% had MG >40 mmHg, AVA >1.0 cm<sup>2</sup>, DVI <0.30, due to large LVOT measurements (pattern 5). Findings were validated among the 387 secondary cohort patients in whom pattern distribution was remarkably similar.<br /><b>Conclusions</b><br />Matrix-based pattern recognition permits automated in-line identification of specific pathophysiology and/or measurement error among patients with suspected severe AS and discordant DE data.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 08 Oct 2023; epub ahead of print</small></div>

<div><h4>Strain assessment in aortic stenosis: pathophysiology and clinical utility.</h4><i>Meredith T, Roy D, Hayward C, Feneley M, ... Muller D, Namasivayam M</i><br /><AbstractText>Contemporary echocardiographic criteria for grading aortic stenosis severity have remained relatively unchanged despite significant advances in non-invasive imaging techniques over the last two decades. More recently, attention has shifted to the ventricular response to aortic stenosis and how this might be quantified. Global longitudinal strain (GLS), semi-automatically calculated from standard 2D echocardiographic images, has been the focus of extensive research. GLS is a sensitive marker of subtle hypertrophy-related impairment in left ventricular function and has shown promise as a relatively robust prognostic marker, both independently and when added to severity classification systems. Herein we review the pathophysiological basis underpinning the potential utility of GLS in the assessment of aortic stenosis, as well as its potential role in quantifying myocardial recovery and prognostic discrimination following aortic valve replacement.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 05 Oct 2023; epub ahead of print</small></div>

<div><h4>Association between left ventricular apical-to-basal strain ratio and conduction disorders after aortic valve replacement.</h4><i>Laenens D, Stassen J, Galloo X, Myagmardorj R, Marsan NA, Bax JJ</i><br /><b>Background</b><br />The aim of the study was to evaluate whether left ventricular apical-to-basal longitudinal strain differences, representing advanced basal interstitial fibrosis, are associated with conduction disorders after aortic valve replacement (AVR) in patients with severe aortic stenosis.<br /><b>Methods</b><br />Patients with aortic stenosis undergoing AVR were included. The apical-to-basal strain ratio was calculated by dividing the average strain of the basal segments by the average strain of the apical segments. Values >1.9 were considered abnormal, as previously described. All patients were followed-up for the occurrence of complete left or right bundle branch block, or permanent pacemaker implantation within 2 years after AVR. Subgroup analysis was performed in patients undergoing transcatheter AVR.<br /><b>Results</b><br />Two hundred seventy-four patients were included (74 years (IQR 65, 80), 46.4% male). During a median follow-up of 12.2 months (IQR 0.2, 24.3), 74 patients (27%) developed complete bundle branch block or were implanted with a permanent pacemaker. These patients more often had an abnormal apical-to-basal strain ratio. Cumulative event-free survival analysis showed worse outcome in patients with an abnormal apical-to-basal strain ratio (Log rank χ<sup>2</sup> 7.258, p = 0.007). In multivariable cox regression analysis, an abnormal apical-to-basal strain ratio was the only independent factor associated with the occurrence of complete bundle branch block or permanent pacemaker implantation after adjusting for other factors previously shown to be associated with conduction disorders after AVR. Subgroup analysis confirmed the independent association of an abnormal apical-to-basal strain ratio with conduction disorders after transcatheter AVR.<br /><b>Conclusion</b><br />The apical-to-basal strain ratio is independently associated with conduction disorders after AVR and could guide risk stratification in patients potentially at risk for pacemaker implantation.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 18 Sep 2023; epub ahead of print</small></div>

<div><h4>Global Longitudinal Strain as Predictor of Inducible Ischemia in No Obstructive Coronary Artery Disease in the CIAO-ISCHEMIA study.</h4><i>Davis EF, Crousillat DR, Peteiro J, Lopez-Sendon J, ... Reynolds HR, CIAO-ISCHEMIA Research Group</i><br /><b>Background</b><br />Global longitudinal strain (GLS) is a sensitive marker for identifying subclinical myocardial dysfunction in obstructive coronary artery disease (CAD). Little is known about the relationship between GLS and ischemia in patients with myocardial ischemia and no obstructive CAD (INOCA).<br /><b>Objectives</b><br />To investigate the relationship between resting GLS and ischemia on stress echocardiography (SE) in patients with INOCA.<br /><b>Methods</b><br />Left ventricular GLS was calculated offline on resting SE images at enrollment (n=144) and 1-year follow-up (n=120) in the CIAO-ISCHEMIA study, which enrolled participants with moderate or severe ischemia by local SE interpretation (>3 segments with new or worsening wall motion abnormality and no obstructive (<50% stenosis) CAD on coronary CT angiography.<br /><b>Results</b><br />GLS values were normal in 83.3% at enrollment and 94.2% at follow-up. GLS values were not associated with a positive SE at enrollment (GLS -21.5% positive SE vs. GLS -19.9% negative SE, p=0.443), or follow-up (GLS -23.2% positive SE vs. GLS -23.1% negative SE, p=0.859). Significant change in GLS was not associated with positive SE in follow-up (p=0.401). Regional strain was not associated with co-localizing ischemia at enrollment or follow-up. Changes in GLS and number of ischemic segments from enrollment to follow-up showed a modest but not clinically meaningful correlation (β=0.41, 95% CI 0.16, 0.67, p=0.002).<br /><b>Conclusions</b><br />In this cohort of INOCA patients, resting GLS values were largely normal and did not associate with the presence, severity or location of stress-induced ischemia. These findings may suggest the absence of subclinical myocardial dysfunction detectable by echocardiographic strain analysis at rest in INOCA.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 16 Sep 2023; epub ahead of print</small></div>