2D Transthoracic Echocardiography Research Articles

Risk assessment by acute bedside echocardiography prior to acute coronary angiography in patients with ST-elevation myocardial infarction: a feasibility study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation. Background Early risk assessment by hemodynamic measurements in patients with ST-elevation myocardial infarction (STEMI) could be useful for early detection of patients at risk of developing hemodynamic instability after primary percutaneous coronary intervention (pPCI). Anterior STEMI patients have larger infarct size and may be of particular interest. Transthoracic echocardiography (TTE) is a quick, non-invasive, and available tool, however, evidence regarding the use of acute TTE prior to acute coronary angiography (CAG) is limited. Purpose To assess the feasibility of acute bedside hemodynamic assessment in the cath. lab. by TTE in addition to clinical examination, and blood samples in STEMI patients without CS at arrival in the cath. lab. Methods STEMI patients without CS at hospital arrival and treated with pPCI were included in the study during a five week period. Clinical examination (Killip class), blood sampling (lactate, troponin T (TNT), proB-type natriuretic peptide (proBNP), and focused bedside 2D TTE with Doppler were performed prior to the acute CAG. The TTE protocol was focused (approx. 5 minutes) on hemodynamic measurements, infarction related complications, and differential diagnoses e.g. aortic dissection. The TTE was performed during preparation for the acute CAG. Patients were stratified in anterior- vs. non-anterior STEMI based on the culprit artery and prehospital ECG. Feasibility was estimated by all of the following echocardiographic parameters; left ventricular ejection fraction (LVEF), left ventricular outflow tract (LVOT) velocity time integral (VTI), and right ventricular function (tricuspid annular plane systolic excursion (TAPSE)). Results A total of 60 STEMI patients (aged mean 63 years, 18% female) were included, and 47% had an anterior STEMI. No differences in baseline characteristics between the two groups were found including comorbidities, clinical parameters, and time from cath. lab. arrival to first wire over the culprit lesion (median (IQR) 28 (23; 38) vs 32 (24; 40) minutes). Admission biomarkers of blood glucose, lactate, and proBNP plasma concentrations were similar between the two groups. Whereas admission TNT were higher for patients with anterior STEMI (median (IQR) 110 (37; 449) vs. 37 (20; 94) ng/L, p=0.01). The feasibility of TTE-study protocol was 93%. Patients with anterior STEMI had lower LVEF (mean: 36±11 vs. 48±9%, p=0.0003; missing: n=0), and a trend to lower LVOT VTI (19 (6.4) vs. 22 (5.0) cm, p=0.06; missing: n=4). No difference in parameters of diastolic function or TAPSE (missing: n=0) were found. None of the included patients had echocardiographic visible complications related to the infarction. Conclusion Acute TTE is to a high degree feasible and does not delay time to acute revascularization in STEMI patients. Patients with anterior STEMI have significantly higher admission TNT levels, lower LVEF, and a trend to lower LVOT VTI compared with non-anterior STEMI patients.

Effect of reperfusion time on right ventricular remodeling in inferior ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Background: Right ventricle (RV) remodeling and dysfunction are frequent in inferior ST-elevation myocardial infarction (STEMI) patients and possibly implicated to poor outcomes. Objective: The purpose of this study is to investigate the influence of reperfusion time on RV remodeling in patients with inferior STEMI who had primary percutaneous coronary intervention (PPCI).Methods: The subjects were patients with inferior STEMI who had undergone PPCI and met the inclusion and exclusion criteria. From September 2021 to April 2022, samples were taken in the order in which they arrived at the Dr. Sardjito Hospital in Yogyakarta, Indonesia. To investigate the occurrence of RV remodeling, 2D-transthoracic echocardiography was performed before PPCI as baseline and 3-months after PPCI. Confounding factors were investigated using bivariate and multivariate analysis.Results: The RV remodeling was observed in 12 (28.6%) of 42 inferior STEMI patients undergoing PPCI. The RV remodeling group had a longer median reperfusion time (798.5 vs 710 minutes, p=0.568). The baseline RV end-systolic area (RVESA) and RV end-diastolic area (RVEDA) had significant correlations with the occurrence of RV remodeling (p=0.046; p=0.008, respectively). The tricuspid annular plane systolic excursion (TAPSE) rose considerably in both groups during the 3-month follow up. There were significant variations in RVEDA and RV basal diameter in the RV remodeling group, but there was a substantial rise in fractional area change (FAC) and RVESA in the non-RV remodeling group.Conclusion: In patients with inferior STEMI undergoing PPCI, reperfusion time showed no significant effect on RV remodeling.

Echocardiography and Cardiac Magnetic Resonance in the Assessment of Left-Ventricle Remodeling: Differences Implying Clinical Decision.

Introduction: Transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) are the most important modalities used in clinical practice to assess cardiac chambers. However, different imaging techniques may affect their results and conclusions. The aim of our study was to compare left-ventricle (LV) remodeling assessed using TTE and CMR in the context of various cardiovascular diseases. Methods: A total of 202 consecutive patients sent for an elective cardiovascular diagnosis were scheduled for a 2D TTE and CMR, performed within 2 weeks. The study group was divided and analyzed based on the clinical indications for CMR, including coronary artery disease, heart failure, native aortic valve regurgitation or paravalvular leak after aortic valve replacement, or cardiomyopathies. Results: The mean LV mass index (LVMi) values calculated using TTE were significantly larger (127.1 ± 44.5 g/m²) compared to the LVMi assessed using CMR (77.1 ± 26.2 g/m²; p < 0.001). The LV end-diastolic volumes assessed using TTE were underestimated for all the study patients (78.6 ± 43 mL vs. 100.5 ± 39 mL; p < 0.0001) and subgroups, but a statistical trend was observed in patients with cardiomyopathy. Those differences in single parameters led to differences in LV remodeling and the final treatment decision. CMR and TTE provided similar conclusions on LV systolic dysfunction in 68% of the patients. Conclusions: Our results showed that the greater the degree of LV remodeling and dysfunction, the greater the difference between the modalities. Therefore, CMR should be introduced into routine clinical practice, especially for patients undergoing LV remodeling, which may change clinical decisions in a considerable number of cases.

Diagnostic capabilities of instrumental methods for studying early cardiovascular adverse events in patients with lymphoproliferative disorders, quality and safety issues

Aim. To study the possibilities of instrumental research methods in relation to the earliest detection of cardiovascular events in oncohematological patients receiving antitumor immunochemotherapy, as well as to deter­mine the requirements for documenting adverse events.Material and methods. For the study, 63 patients were prospectively selected with a diagnosis of indolent non-Hodgkin lymphoma, who were indicated for antitumor immunochemotherapy. The patients were examined in three stages (before treatment, after 3 and 6 cycles of therapy) and divided into 2 groups by simple randomization. Cardiovascular toxicity in the main group of patients was assessed using 3D transthoracic echocardiography, analysis of left ventricular (LV) global longitudinal systolic strain and electrocardiography. The control group underwent a standard 3D echocardiography with analysis of LV ejection fraction. Clinical manifestations of cardiovascular events were assessed in all patients during treatment.Results. According to the study, significant changes were obtained in LV ejection fraction on the third visit — a decrease from 58,9±1,07 to 48,1±0,73% (p&lt;0,05) and from 57,7±1,13 to 49,4±0,58% (p&lt;0,05) in patients of the main and control groups and global longitudinal LV strain from |21,1±1,18 to |14,0±1,61 |% (p&lt;0,05) in patients of the main group. A mixed clinical phenotype of cardiovascular toxicity was the most common among all patients. An integrated approach to the early diagnosis of cardiovascular events makes it possible to identify a larger percentage of patients with subclinical myocardial dysfunction.Conclusion. The long period of latent cardiovascular toxicity emphasizes the need for early verification of cardiovascular complications of antitumor therapy and expansion of the established paraclinical diagnostic minimum. In addition, taking into account the accumulated experience, recommendations are presented for the preparation of medical documentation in order to ensure the safety and quality of care.

Does Speckle Tracking Transthoracic Echocardiography Indicate Subtle Changes in Left Ventricular Function in Heart Failure Patients with Reduced Ejection Fraction Treated by Sacubitril-valsartan?

Abstract Background: In heart failure patients and reduced ejection fraction (HFrEF), assessing subtle changes in left ventricle (LV) function is crucial for monitoring treatment efficacy. This study aims to determine the effect of valsartan/sacubitril on LV ejection fraction (EF) assessed by two-dimensional (2D) transthoracic echocardiography (TTE) in comparison to that assessed by 2D TTE speckle tracking in patients with HFrEF ≤35% after 6 months of treatment. Patients and Methods: A prospective study will be conducted on 200 heart failure patients with reduced EF (HFrEF) undergoing sacubitril-valsartan treatment. Each participant underwent a comprehensive evaluation, including physical examination, history taking, serial 12-lead electrocardiogram, and 2D echo to evaluate cardiac parameters. In addition, 2D speckle tracking echocardiography (STE) assessments were conducted before and after 6 months of valsartan/sacubitril treatment. Results: The enrolled patients had an average age of 48 years with 63% females. At the beginning of the study, 9 (4.5%) patients were classified as New York Heart Association (NYHA) FC I, 120 (60%) as NYHA FC II, 64 (32%) as NYHA FC III, and 7 (3.5%) as FC IV. Following treatment, 82 (41%) patients improved to NYHA FC I, and 118 (59%) were in NYHA FC II. Notably, 82 (41%) patients showed improved left ventricular EF (LVEF), detected either by traditional TTE or STE, whereas 118 (59%) showed no improvement in EF through traditional TTE. In addition, 74 (37%) patients demonstrated improvement detected by STE. In contrast, 44 (22%) patients demonstrated no improvement in EF detected by either TTE or STE. Conclusion: STE was a more reliable diagnostic method for seeing early LVEF improvement in patients with HFrEF receiving valsartan/sacubitril treatment not seen by conventional TTE.

Three-dimensional (3D) transthoracic echocardiography in Cor Triatriatum Sinister: Make new friends but keep the old

AbstractCor Triatriatum Sinister (CTS) represents a rare congenital cardiac defect characterized by the presence of a fibro-muscular membrane separating the left atrium into two cavities. During adulthood CTS may be asymptomatic and incidentally found during imaging diagnostic workflow. Bidimensional (2D) transthoracic echocardiography (TTE) is considered the first-line imaging technique for the evaluation of CTS. Cardiac magnetic resonance (CMR) and transoesophageal echocardiography (TEE) are advanced diagnostic tools, usually required to obtain additional data. When these diagnostic techniques are contraindicated or not available, three-dimensional (3D) TTE may provide useful information which may help in the morphological assessment of CTS. Moreover, this widespread technique is safe and frequently available in the echocardiography laboratories, although the acoustic window and the training of the operator may be limiting factors. With this case report we sought to emphasize the usefulness of this technique as a valid alternative to CMR and TEE in selected settings.

STGA-MS: AI diagnosis model of regional wall motion abnormality based on 2D transthoracic echocardiography

Regional wall motion abnormality (RWMA) is a common manifestation of ischemic heart disease detected through echocardiography. Currently, RWMA diagnosis heavily relies on visual assessment by doctors, leading to limitations in experience-based dependence and suboptimal reproducibility among observers. Several RWMA diagnosis models were proposed, while RWMA diagnosis with more refined segments can provide more comprehensive wall motion information to better assist doctors in the diagnosis of ischemic heart disease. In this paper, we proposed the STGA-MS model which consists of three modules, the spatial-temporal grouping attention (STGA) module, the segment feature extraction module, and the multiscale downsampling module, for the diagnosis of RWMA for multiple myocardial segments. The STGA module captures global spatial and temporal information, enhancing the representation of myocardial motion characteristics. The segment feature extraction module focuses on specific segment regions, extracting relevant features. The multiscale downsampling module analyzes myocardial motion deformation across different receptive fields. Experimental results on a 2D transthoracic echocardiography dataset show that the proposed STGA-MS model achieves better performance compared to state-of-the-art models. It holds promise in improving the accuracy and reproducibility of RWMA diagnosis, assisting clinicians in diagnosing ischemic heart disease more reliably.

Assessment of atrial electromechanical delay and echocardiographic parameters in patients with multiple sclerosis

Objective: Data on cardiovascular dysfunction is limited in the previous literature on patients with multiple sclerosis. In this study, we aimed to elucidate the cardiovascular parameters in multiple sclerosis patients by comparing the systolic-diastolic functions and atrial electro-mechanical delay compared to the control group. Method: A total of 37 patients with a diagnosis of relapsing-remitting multiple sclerosis and had Expanded Disability Status Scale (EDSS) scores between 0 – 3, and 20 individuals in the control group were included in the study. Seventeen of the MS patients (n=17) were taking immunomodulatory drugs and the other 20 did not receive any immunomodulatory agents. Patients with a diagnosis or clinical suspicion of cardiac dysfunction and using cardiotoxic medications were excluded. The measurement of systolic and diastolic function parameters was performed via M – Mode 2D transthoracic echocardiography, and Atrial electro-mechanical delay (AEMD) measurements were performed with tissue Doppler. Results: E’ MV lateral and MV E/A values were determined to be higher in MS patients, who did not use immunomodulatory drugs, compared to the control group (p&lt;0.001, p=0.010 respectively). E/E’ MV lateral and MV AVmax values were determined to be significantly higher in the patient group using immunomodulators compared to the other two groups (p=0.009, p=0.012 respectively). PAs, PAI, left and right intraatrial EMG values were determined to be prolonged in MS patients using and not using drugs compared to the control group, but these values were not determined to be statistically significant. Conclusion: We found that left ventricular diastolic function was impaired in MS patients compared to the control group, and right-left intra- and interatrial AEMD were similar. Based on these results, we recommend echocardiographic assessment for early detection of left ventricular diastolic dysfunction in MS patients.

Multiparametric assessment of right ventricular function in heart transplant recipients by echocardiography and relations with pulmonary hemodynamics

AbstractObjectiveRight ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients.MethodsA total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two‐dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three‐dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated.ResultsDiastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR‐derived volumes and RVEF (r = .91, r = .79, r = .64; p &lt; .0001 for each, respectively). Among other parameters, RV fractional area change (r = .439; p &lt; .001) and RV free wall longitudinal strain (RVFW‐LS) (r = −.34; p &lt; .05) correlated moderately with CMR‐RVEF, whereas tricuspid annulus S’ velocity (r = .29; p &lt; .05) and tricuspid annular systolic plane excursion (r = .27; p &lt; .05) correlated weakly with CMR‐RVEF. Additionally, 3D‐RVEF and RVFW‐LS were significantly decreased in studies with mPAP ≥ 20 mm Hg in comparison to those with mPAP &lt; 20 mm Hg (47.7 ± 3.7 vs. 50.9 ± 5.3, p = .04 and −15.5 ± 3.1 vs. −17.5 ± 3, p = .03, respectively).ConclusionThe best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW‐LS and 3D‐RVEF in these patients.

Evaluation of the anatomic sinus after transcatheter aortic valve replacement

Abstract Background Transcatheter aortic valve replacement (TAVR) determines the creation of outer area between the cage and the aortic wall named the ‘anatomic sinus’ (Figure 1 A-B). This newly formed space of the sinuses of Valsalva (SOV) might disrupt the physiological currents of Valsalva and contribute to the formation of subclinical leaflets thrombosis (SLT). The evaluation of the root geometry after TAVR is generally performed with multi detector computer tomography (MDCT), and the role of transthoracic echocardiography (TTE) needs further validation. Purpose The aim of this study was to test reproducibility of 2D TTE assessment of the anatomic sinus dimension with MDCT as reference. We also investigated predictors for SLT. Methods We enrolled 90 patients who underwent TAVR with self-expandable prosthesis. 2D TTE was performed using Philips EPIQ-7, and echocardiograms analysed offline with Philips QLAB cardiac analysis. Both SOV and prosthesis diameters were assessed in long and short-axis parasternal view (PLAX / PSAX) and the bidimensional area of the anatomic sinus was calculated (Figure 2 A-B). Inter-observer (observer 1 – 2) reproducibility was assessed by the means of interclass correlation coefficient (ICC). MDCT was performed in 50 individuals to evaluate concordance (Bland Altman test) with the 2D TTE anatomic sinus area and also to detect SLT (Figure 2 C-D). Multivariable model was built to assess predictors of SLT. Results Mean follow-up was 13.1 months. There was excellent and good correlation with regard to the diameter of the SOV and the prosthesis measured in PLAX view by observer 1 and 2: ICC: 0.93, 95% Confidence Interval (CI) (0.76–0.97), p&amp;lt; 0.001; ICC: 0.87(0.63,0.96), p&amp;lt;0.001, SOV and prosthesis respectively. The correlation found with regard to the diameter of the SOV and the prosthesis measured in PSAX view was also excellent ICC: 0.90(0.68,0.97), p=0.001; and good ICC: 0.88(0.63,0.96), p &amp;lt;0.001, SOV and prosthesis respectively. The anatomic sinus areas assessed by 2D TTE were similar compared to areas derived by MDCT (4.1 ± 1.09 cm2 vs. 4.02 ± 1.55 cm2, respectively, p=0.57). Bland–Altman analysis of anatomic sinus area measured on 2D TTE and MDCT respectively, indicated high level of agreement and no fixed or proportional bias. Native bicuspid valve, but not the anatomic sinus area, was the only independent predictors for SLT. Conclusions Following TAVR, the newly formed anatomic sinus could be assessed with good reproducibility with 2D TTE. We found a significant association between native bicuspid valve and SLT diagnosed with MDCT.Figure 1A-BFigure 2A-D

3D trans-thoracic echocardiography in assessment and follow up of corrected tetralogy of Fallot patients : whether it is comparable to MRI or not ?

Abstract Background Nowadays with the increasing number of repaired Fallot patients , and the chronicity of pulmonary regurgitation leading to severe right ventricle dilatation and impairment of ventricular functions , we need a method for regular follow up for the appropriate timing for intervention for pulmonary valve replacement either surgical or per-cutaneous. Cardiac MRI is the gold standard however time consuming and more expensive. 3D trans-thoracic echocardiography has recently been developed and applied for assessment of RV volumes and functions. Aim To evaluate right ventricle (RV) volume , ejection fraction (EF) and pulmonary valve (PV) regurgitant fraction in patients post tetralogy of Fallot (TOF) repair by 3D trans-thoracic echocardiography (3DE) in comparison with the gold standard cardiac MRI regarding its accuracy and variability and whether it can be used for annual follow up. Methods The study group composed of 100 patients post TOF repair with mean age group (11.66 ± 4.65) , mean BSA (1.18 ± 0.36) underwent both 3D echo. and CMR within 2 to 3 days . 3D echo assessment of Right ventricle end diastolic volume (RV EDV) , end systolic volume (RV ESV) , ejection fraction (EF) , severity of pulmonary regurgitant and regurgitant fraction were carried out by two different operators using 3D echo compared with the cardiac MRI results for the same parameters done by the standard protocol according to ESC working group of cardiovascular imaging guidelines. Results On comparing the two groups , 3DE was comparable to the CMR in assessment of EF (52.69 ± 6.44 % by 3DE vs 51.38 ± 6.86 % by CMR) with p value (0.165) by the paired test, while the RV EDVI and RV EDVI was slightly elevated by CMR vs 3 DE (RVEDVI: 147.85 ± 40.77 ml/m2, RVESVI: 72.69 ± 27.70 ml/m2) by CMR vs (RVEDVI: 136.51 ± 34.40 ml/m2 , RVESVI 65.12 ± 22.44 ml/m2) by 3 DE with p value (0.035). however there was statistical difference when comparing regurgitant fraction(RF) by CMR vs 3DE which was technically difficult and time consuming when calculating by 3DE as the RF was significantly higher by CMR (46.44 ± 11.27 %) vs 3DE (40.57 ± 10.50 %) with P value (0.000). our study also noted positive linear correlation between regurgitant fraction and RV EDVI (p value 0.000), and RV ESVI (p value = 0.010), and pulmonary valve annulus (p value = 0.000) respectively. Conclusion Three dimensional echo when compared to cardiac MRI as a method for assessment of patients with repaired TOF showed quite agreement in assessment of ejection fraction with slight difference in assessment of ventricular volumes as the accuracy of the 3DE decreases in larger volumes, however the significant difference in assessment of regurgitant fraction by 3DE makes it used as a method for serial follow up however CMR should be done as baseline.comparing RV volumes and RFcorrelation of RF and CMR paramters

3D atrial stiffness in chronic mitral regurgitation: impact of sex, regurgitation mechanism and valve geometry - the 3D-PRIME study

Abstract Background Chronic mitral regurgitation (MR) is both a cause and a consequence of progressive left atrial (LA) remodeling. The degree of LA stiffness in relation to clinical risk factors as well as atrio-valvular remodeling has not been reported in patients with MR. Aims To assess the severity and determinants of 3D LA stiffness in chronic MR. Methods In the prospective 3D-PRIME (3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation) study, 100 patients with chronic MR (70±13years, 38% women, 55% with a history of atrial fibrillation (AF), 42% with severe MR) recruited at one heart valve center were investigated with 2D and 3D transthoracic and transesophageal echocardiography. MR severity was quantified by the regurgitant fraction and MR classified as primary (54%), atrial functional (26%) or ventricular functional (20%). 3D LA volume (LAV) was measured at end-diastole (min LAV) and end-systole (max LAV), and 3D LA function assessed in by the emptying fraction (EF) and the peak strain in the reservoir phase (LASr). LA stiffness was estimated from the ratio: mitral peak E-wave velocity divided by the mitral annular e’ velocity (E/e´) / LASr and classified as high for age if ≥ 0.55. Results High LA stiffness for age was present in 58% of patients and more often in those with a history of AF (73% vs. 45%) and in severe vs moderate MR (70% vs. 42%) (both p &amp;lt;0.01). Patients with high LA stiffness had larger LAVs with lower LA EF, lower right ventricular ejection fraction, increased mitral annulus area, and larger mitral valve leaflets (all p&amp;lt;0.05). Men had considerably larger LAVs in all MR subgroups, and highly stiff LAs in atrial functional MR compared to women (p &amp;lt;0.05, Figure) despite similar MR severity (regurgitation fraction 50% vs 52%, respectively). In multiple regression analysis, after stepwise removal of the following factors: MR severity, mitral leaflet to ring area ratio, and right ventricular ejection fraction, increased LA stiffness was independently associated with male sex, history of AF, lower LA EF and lower mitral intertrigonal diameter (R2 0.40, p &amp;lt;0.001, Table). Conclusion LA is stiff for age in over half of patients with chronic MR, excessively stiff in men with atrial functional MR, and associated with specific changes in mitral valve geometry and LA function. This gives mechanistic insights into the complex atrio-valvular interplay in chronic MR.Figure.Table.

Lower cardiorespiratory fitness is associated with left atrial structural, functional and electrical remodelling in patients with symptomatic atrial fibrillation

Abstract Background Preserved cardiorespiratory fitness (CRF) is associated with improved rhythm control in patients with symptomatic atrial fibrillation (AF). However, the pathophysiological features associated with low cardiorespiratory fitness are not well described. Purpose Evaluate the association between cardiorespiratory fitness and structural, functional and electroanatomical features of the left atrium (LA) amongst patients with symptomatic AF. Methods Consecutive patients with symptomatic paroxysmal or persistent AF undergoing AF ablation were recruited. CRF was assessed objectively by peak oxygen consumption (VO2peak) assessed during maximal cycle ergometry. Invasive assessment of LA remodelling involved direct assessment of resting LA pressures (LAP), LA stiffness during saline infusion and LA electrical function using high-density electroanatomical maps. Non-invasive assessment involved 2D transthoracic echocardiography at rest and during exercise. The association between VO2PEAK and atrial parameters were determined using multivariable linear regression models adjusted for age and sex. Results In total, 110 participants were recruited. Mean age was 63±11 and 74.5% of the cohort was male. In adjusted analyses, higher VO2PEAK was associated with lower mean LAP (p&amp;lt;0.001) and invasively assessed LA stiffness (p=0.005). On non-invasive testing, VO2PEAK was positively associated with left atrial emptying fraction (LAEF) (p=0.001) and reservoir strain (p&amp;lt;0.001) at rest. During exercise, VO2PEAK remained associated with LAEF (p&amp;lt;0.001) and LA reservoir strain (p=0.007). Higher VO2peak was positively associated with LA bipolar voltages (p=0.035) but not LA conduction velocities (p=0.131) or LA fractionation (p=0.452) Conclusions In patients with symptomatic AF, lower cardiorespiratory fitness is independently associated with extensive LA remodelling involving impaired LA haemodynamics, increased LA stiffness, LA mechanical dysfunction and LA electrical remodeling.

Abstract 12093: Bi-Ventricular Cardiac Adaptations to 20 Weeks of High-Intensity Resistance Training in Healthy Untrained Men: A 3D Echocardiography Longitudinal Study

Introduction: The historical description of cardiac remodelling between strength and endurance athletes, made by Morganroth in the 1970s, has been challenged with the advancements in our understanding of the protective effect of Valsalva manoeuvres and the emergence of sophisticated imaging techniques for cardiac function assessment. Objective: We aimed to analyze the kinetics of muscular and cardiac responses to 20 weeks of high-intensity resistance training in healthy untrained volunteers. Methods: A total of 27 young and healthy men with an average age of 22.8±3.2 years participated in a 20-week strength training program. The training program intensity was guided by 1-Repetition Maximum (RM) testing. Before and after 12 and 20 weeks of training, participants were assessed using body composition analysis, electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing ( V O 2peak ), and muscle isokinetic dynamometry. Anova was utilized to analyse time effect. Results: Among the initial cohort, 22 subjects completed the study protocol. Arterial blood pressure significantly decreased at both time points. Isokinetic evaluation confirmed increases in maximal strength for quadriceps (Δ 0-20wk =+46.8Nm, P&lt;0.001), hamstrings (Δ 0-20wk =+25.3Nm, P=0.025), triceps (Δ 0-20wk =+11.6Nm, P=0.005), and biceps (Δ 0-20wk =+9.2Nm, P=0.023). Regarding cardiac analysis, after 20 weeks of training 3D left ventricular (LV) mass increased (120.1±15.4 to 133.7±16.3 g, P=0.018), with an augmentation in both septal wall (6.1±1.1 to 7.2±1.4 mm, P=0.027) and posterior wall thickness (5.5±1.3 to 7.1±1.3 mm, P&lt;0.001). 3D LV end-diastolic volume increased by 7.28% without reaching a significant difference. Right ventricular (RV) wall thickness also increased (3.33±0.73 to 3.89±0.8 mm, P=0.04), with a slight non-significant augmentation of 3D RV end-diastolic volume by 7.89%. No significant changes were found in LV and RV systolic or diastolic function. Conclusions: This study demonstrated that our 20-week high-intensity strength training program resulted in a rapid and significant increase in muscular strength. The cardiac response to strength training showed a moderate biventricular response like that of endurance athlete

Abstract 11685: Effects of Pectus Excavatum Surgical Repair on Cardiac Volumes and Systolic Function as Assessed by 3D Transesophageal Echocardiography

Introduction: The consequences of external cardiovascular compression and cardiac displacement from pectus excavatum (PEx) are debated. The complex geometry of the right (RV) and left ventricle (LV) along with distortion from the extrinsic chest deformity pose significant limitations to reliable assessment of LV and RV volumes and function using transthoracic 2D-echocardiography in this population. Hypothesis: A 3D-echocardiography approach can reliably assess the effects of external cardiac compression and the benefits of surgical correction on RV and LV function in PEx patients. Methods: Adult patients undergoing minimally invasive repair of PEx between Oct-2021 and Feb-2023 were included in this prospective study. Intraoperative transesophageal (TEE) 6 beat full volume video loops incorporating LV and RV were captured and compared before and after surgical correction of the PEx. TomTec Software® was used for offline 3D/4D reconstruction ( Figure 1 shows changes in 3D RV and LV shape pre- and post-surgery). Result: The study included 102 patients (mean age of 32.1 ±11.8 years; Haller index 4.9 ±2.5; 60.8% males). Post PEx repair, there was a significant (p&lt;0.001) increase in the 3D RV volumes, RV ejection fraction (EF), RV stroke volume and RV strain ( Figure 1 ). Additionally, there was a significant improvement in 3D LVEF, 3D LV strain (longitudinal and circumferential), LV twist, and torsion ( Figure 1 ). Conclusion: In this PEx cohort, 3D/4D TEE imaging demonstrated significant increases in RV volumes and in RV and LV systolic function after surgical repair. These findings support the negative cardiovascular consequences of PEx compression and benefits of surgical repair.

Effects of a 20-Week High-Intensity Strength Training Program on Muscle Strength Gain and Cardiac Adaptation in Untrained Men: Preliminary Results of a Prospective Longitudinal Study.

As strength sports gain popularity, there is a growing need to explore the impact of sustained strength training on cardiac biventricular structure and function, an area that has received less attention compared to the well-established physiological cardiac adaptation to endurance training. This study aims to implement a 20-week high-intensity strength training program to enhance maximal muscle strength and evaluate its impact on cardiac biventricular adaptation in healthy, untrained men. A total of 27 healthy and untrained young men (mean age 22.8, SD 3.2 years) participated in a strength training program designed to increase muscle strength. The training program involved concentric, eccentric, and isometric exercise phases, conducted over a consecutive 20-week time frame with a frequency of 3 weekly training sessions. Participants were evaluated before and after 12 and 20 weeks of training through body composition analysis (bioelectrical impedance), a 12-lead resting electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing, and muscle isokinetic dynamometry. The progression of strength training loads was guided by 1-repetition maximum (RM) testing during the training program. Of the initial cohort, 22 participants completed the study protocol. No injuries were reported. The BMI (mean 69.8, SD 10.8 kg/m² vs mean 72, SD 11 kg/m²; P=.72) and the fat mass (mean 15.3%, SD 7.5% vs mean 16.5%, SD 7%; P=.87) remained unchanged after training. The strength training program led to significant gains in 1-RM exercise testing as early as 4 weeks into training for leg extension (mean 69.6, SD 17.7 kg vs mean 96.5, SD 31 kg; P<.001), leg curl (mean 43.2, SD 9.7 kg vs mean 52.8, SD 13.4 kg; P<.001), inclined press (mean 174.1, SD 41.1 kg vs mean 229.2, SD 50.4 kg; P<.001), butterfly (mean 26.3, SD 6.2 kg vs mean 32.5, SD 6.6 kg; P<.001), and curl biceps on desk (mean 22.9, SD 5.2 kg vs mean 29.6, SD 5.2 kg; P<.001). After 20 weeks, the 1-RM leg curl, bench press, pullover, butterfly, leg extension, curl biceps on desk, and inclined press showed significant mean percentage gains of +40%, +41.1%, +50.3%, +63.5%, +80.1%, +105%, and +106%, respectively (P<.001). Additionally, the isokinetic evaluation confirmed increases in maximal strength for the biceps (+9.2 Nm), triceps (+11.6 Nm), quadriceps (+46.8 Nm), and hamstrings (+25.3 Nm). In this paper, only the training and muscular aspects are presented; the cardiac analysis will be addressed separately. This study demonstrated that a short-term high-intensity strength training program was successful in achieving significant gains in muscle strength among previously untrained young men. We intend to use this protocol to gain a better understanding of the impact of high-intensity strength training on cardiac physiological remodeling, thereby providing new insights into the cardiac global response in strength athletes. ClinicalTrials.gov NCT04187170; https://clinicaltrials.gov/study/NCT04187170.

Association between non-alcoholic fatty liver disease and subclinical left ventricular dysfunction in the general population

Abstract Aims Emerging evidence suggests an association between non-alcoholic fatty liver disease (NAFLD) and heart failure (HF). We investigated the relationship between NAFLD and left ventricular (LV) functional remodelling in a general population sample without overt cardiac and liver disease. Methods and results We included 481 individuals without significant alcohol consumption who voluntarily underwent an extensive cardiovascular health check. The fatty liver index (FLI) was calculated for each participant, and NAFLD was defined as FLI ≥ 60. All participants underwent 2D transthoracic echocardiography; LV global longitudinal strain (LVGLS) was assessed with speckle-tracking analysis. Univariable and multivariable linear regression models were constructed to investigate the possible association between NAFLD and LVGLS. Seventy-one (14.8%) participants were diagnosed with NAFLD. Individuals with NAFLD exhibited larger LV size and LV mass index than those without NAFLD, although left atrial size and E/e′ ratio did not differ between groups. Left ventricular global longitudinal strain was significantly reduced in participants with vs. without NAFLD (17.1% ± 2.4% vs. 19.5% ± 3.1%, respectively; P &amp;lt; 0.001). The NAFLD group had a significantly higher frequency of abnormal LVGLS (&amp;lt;16%) than the non-NAFLD group (31.0% vs. 10.7%, respectively; P &amp;lt; 0.001). Multivariable linear regression analysis demonstrated that higher FLI score was significantly associated with impaired LVGLS independent of age, sex, conventional cardiovascular risk factors, and echocardiographic parameters (standardized β −0.11, P = 0.031). Conclusion In the general population without overt cardiac and liver disease, the presence of NAFLD was significantly associated with subclinical LV dysfunction, which may partly explain the elevated risk of HF in individuals with NAFLD.

Role of three-dimensional transesophageal echocardiography in cardiac myxomas: an imaging challenge.

Nowadays, the diagnosis of cardiac myxomas (CM), particularly the histological types, remains a challenge. Two-dimensional (2D) transthoracic (TT) and transesophageal (TEE) echocardiography (ECHO) represent the first steps in the imaging pathway. 3D ECHO, implemented in imaging practice, appears to be an emerging diagnostic technique that overcomes some of the limitations of 2D ECHO while integrating the information provided by magnetic resonance (MRI). However, its role in the imaging arena is still debatable. Analyzing 17 myxomas in 13 patients, the study uncovers a diverse anatomical spectrum. Classical CM morphology is a minority, with most myxomas being sessile and originating from unexpected locations (right ventricular outflow tract and left atrial appendage). Texture and size variations are also noted. Comparing imaging, 2D TEE outperforms 2D TT in visualizing anatomical features, especially attachment types. 3D TEE confirms 2D TT findings and offers more detailed assessments, identifying peduncles missed in four cases by 2D TEE. Two small recurrent myxomas were exclusively detected by 3D TEE, not by 2D TEE or MRI. Two patients have papillary myxomas, one has an embolism. Another patient with a solid myxoma also suffers an embolism, with a clot found at the apex during surgery. Our study showed that CM has a wide anatomical spectrum beyond the typical features, making the diagnosis challenging. Therefore, a multimodality imaging approach is essential for distinguishing CM from other cardiac masses and differentiating myxoma histological types. These findings stress the importance of incorporating 3D ECHO alongside other imaging techniques for a comprehensive evaluation.

Three-dimensional analysis of the tricuspid annular geometry in healthy subjects and in patients with different grades of functional tricuspid regurgitation

BackgroundAccurate sizing of the tricuspid valve annulus is essential for determining the optimal timing of tricuspid valve (TV) intervention. Two-dimensional (2D) echocardiography has limitations for comprehensive TV analysis. Three-dimensional (3D) imaging of the valve provides a better understanding of its spatial anatomy and enables more accurate measurements of TV structures.ObjectivesThe study aimed to analyze tricuspid annulus (TA) parameters in normal heart and in different grades of functional tricuspid regurgitation (TR); to compare TA measurements obtained by 2D and 3D echocardiography.MethodsOne hundred fifty-five patients (median age 65 years, 57% women) with normal TV and different functional TR grades underwent 2D and 3D transthoracic echocardiography. The severity of TR was estimated using multiparametric assessment according to the guidelines. Mid-systolic 3D TA parameters were calculated using TV dedicated software. The conventional 2D systolic TA measurements in a standard four-chamber view were performed.ResultsIn mid-systole, the normal TA area was 9.2 ± 2.0 cm2 for men and 7.4 ± 1.6 cm2 for women. When indexed to body surface area (BSA), there were no significant differences in the 3D parameters between genders. The 2D TA diameters were smaller than those measured in 3D. The ROC curve analysis identified that all 3D TA parameters can accurately differentiate between different functional TR grades. Additionally, the optimal cut-off values were identified for each TA parameter.ConclusionsGender, body size, and age have an impact on the TA parameters in healthy subjects. 2D measurements are smaller than 3D parameters. The reference values for 3D metrics according to TR severity can help in identifying TA dilation and distinguishing between different functional TR grades.Graphical

Current national availability of advanced echocardiography imaging: real world data from an Italian Society of Echocardiography and Cardiovascular Imaging survey

Abstract Aims Advanced echocardiographic imaging (AEI) techniques, such as three-dimensional (3D) and multi-chamber speckle-tracking deformation imaging (strain) analysis, have been shown to be more accurate in assessing heart chamber geometry and function when compared with conventional echocardiography providing additional prognostic value. However, incorporating AEI alongside standard examinations may be heterogeneous between echo laboratories (echo labs). Thus, our goal was to gain a better understanding of the many AEI modalities that are available and employed in Italy. Methods and results The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey over a month (November 2022) to describe the use of AEI in Italy. Data were retrieved via an electronic survey based on a structured questionnaire uploaded on the SIECVI website. Data obtained from 173 echo labs were divided into 3 groups, according to the numbers of echocardiograms performed: &amp;lt;250 exams (low-volume activity, 53 centres), between 251 and 550 exams (moderate-volume activity, 62 centres), and ≥550 exams (high-volume activity, 58 centres). Transthoracic echocardiography (TTE) 3D was in use in 75% of centres with a consistent difference between low (55%), medium (71%), and high activity volume (85%) (P = 0.002), while 3D transoesophageal echocardiography (TEE) was in use in 84% of centres, reaching the 95% in high activity volume echo labs (P = 0.006). In centres with available 3D TTE, it was used for the left ventricle (LV) analysis in 67%, for the right ventricle (RV) in 45%, and for the left atrium (LA) in 40%, showing greater use in high-volume centres compared with low- and medium-volume centres (all P &amp;lt; 0.04). Strain analysis was utilized in most echo labs (80%), with a trend towards greater use in high-volume centres than low- and medium-volume centres (77%, 74%, and 90%, respectively; P = 0.08). In centres with available strain analysis, it was mainly employed for the LV (80%) and much less frequently for the RV and LA (49% and 48%, respectively). Conclusion In Italy, the AEI modalities are more frequently available in centres with high-volume activity but employed only in a few applications, being more frequent in analysing the LV compared with the RV and LA. Therefore, the echocardiography community and SIECVI should promote uniformity and effective training across the Italian centres. Meanwhile, collaborations across centres with various resources and expertise should be encouraged to use the benefits of the AEI.