Three-dimensional Echocardiography Research Articles

Three-dimensional speckle tracking echocardiography for evaluation of ventricular function in patients with systemic lupus erythematosus: relationship between duration of lupus erythematosus and left ventricular dysfunction by using global longitudinal strain

BackgroundCardiovascular diseases are leading causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cardiac involvement in SLE can often go undetected. Three-dimensional (3D) speckle tracking echocardiography (STE) is a noninvasive imaging technique that can assess the function of the heart’s ventricles in an accurate and reproducible way. This makes it an attractive option for detecting early signs of heart disease in SLE patients. By identifying these subclinical cardiac abnormalities, 3D-STE may help reduce the negative impact of cardiovascular diseases in SLE population. Therefore, this study aimed to compare the left ventricular (LV) function between patients with SLE compared to age- and gender-matched controls using two-dimensional (2D) and 3D-STE.ResultsThe current study found no significant differences in left ventricle ejection fraction, left ventricle end-diastolic volume, left ventricle end-systolic volume, left ventricle end-diastolic mass, and left ventricle end-systolic mass between the two groups. However, the SLE group exhibited a significantly lower LV global longitudinal strain (GLS) compared to the control group according to all types of echocardiographic assessments, including 3D and 2D long-axis strain, apical 2-chamber, and apical 4-chamber assessments (all P values < 0.05). Furthermore, a good inter-rater reliability and intra-rater reliability were observed regarding the LVGLS measurement with 3D-STE. Additionally, the study identified a significant correlation between LVGLS and SLE duration (r (50) = 0.46, P < 0.001). The use of prednisolone and nephrology disorders was also found to impact LVGLS measurements.ConclusionsDespite a normal LVEF in patients with SLE, LVGLS measurements indicated that LV systolic dysfunction was observed more frequently in SLE patients compared to their healthy counterparts. Therefore, advanced 3D-STE techniques may be useful in identifying subtle abnormalities in LV function in SLE patients.

Two-dimensional transthoracic measure of mitral annulus in mitral valve prolapse and moderate to severe regurgitation: a method comparison analysis with three-dimensional transesophageal echocardiography

BackgroundMitral annulus (MA) area is derived during transthoracic echocardiography (TTE) assuming of a circular shape using the MA diameter from the apical 4 chamber (A4c) view. Since the MA is not a circular structure, we hypothesized that an elliptical model using parasternal long-axis (PLAX) and apical 2 chamber (A2c) view measured MA diameters would have better agreement with 3-dimensional transesophageal echocardiography (3D TEE) measured MA in degenerative mitral valve disease (DMVD).MethodsSeventy-six patients with moderate-to-severe DMVD had 2D TTE and 3D TEE performed. MA area was measured retrospectively using semi-automatic modeling of 3D data (3D TEEsa) and considered as the reference method. MA diameters were measured using different 2D TTE views. MA area was calculated using assumptions of a circular or an elliptical shape. 2D TTE derived and 3D TEEsa. MA areas were compared using linear regression and Bland-Altman analysis.ResultsThe median MA area measured at 3D TEEsa was 1,386 (1,293–1,673) mm2. With 2D TTE, the circular model using A4c view diameter resulted in a small systematic underestimation of MA area (6%), while the elliptical model using PLAX and A2c diameters resulted in 25% systematic underestimation. The standard deviations of the distributions of inter-method differences were wide for all 2D TTE methods (265–289 mm2) when compared to 3D TEEsa, indicating imprecision.ConclusionsWhen compared with 3D TEEsa modeling of the MA as the reference, the assumption of a circular shape using A4c TTE view diameter was the method with the least systematic error to assess MA area in DMVD and moderate to severe regurgitation.

Use of two- and three-dimensional echocardiography for assessment of the left ventricular outflow tract and aortic orifice areas in dogs

Introduction/objectivesIn clinical practice, dogs are screened for subaortic stenosis (SAS) using two-dimensional (2DE) and Doppler echocardiography. There is no accepted antemortem diagnostic criterion to distinguish between mild SAS and unaffected, therefore additional means of evaluating the left ventricular outflow tract (LVOT) and aorta may be desirable. This study sought to determine and compare LVOT and aortic orifice areas using 2DE and three-dimensional echocardiography (3DE) in apparently healthy dogs of various breeds and somatotypes. Animals, materials, and methodsSixty-nine healthy, privately-owned dogs. The LVOT and aortic orifice areas were determined using 2DE aortic valve (AV) diameter-derived area; the continuity equation (CE); and 3DE planimetry of the LVOT, AV, sinus of Valsalva, and sinotubular junction. Orifice areas were indexed to body surface area (BSA). ResultsObtaining 3DE images and performing planimetry were feasible in all dogs. The mean indexed area measured using the 2DE AV diameter (2.85 cm2/m2) was significantly lower than that derived from 3DE AV planimetry (3.85 cm2/m2; mean difference, 1.00 cm2/m2; P<0.001). There was poor agreement between the effective area calculated using the CE and the anatomic areas calculated using 2DE AV diameter and 3DE planimetry. The area calculated using the CE was less than all other calculations of area. Interobserver and intraobserver repeatability and reproducibility for 3DE planimetry were excellent. ConclusionsMethods for determining aortic orifice areas in dogs are not interchangeable, and this must be taken into account if these methods are investigated in the evaluation of dogs with SAS in the future.

Sex-specific reference values for automated three-dimensional echocardiography across healthy and physically active individuals with different fitness levels

Sex-specific reference values for automated three-dimensional echocardiography across healthy and physically active individuals with different fitness levels

Multimodal echocardiography for assessing whether left ventricular geometry affects right atrial phasic function in patients with obstructive sleep apnea syndrome: A cross-sectional observational study.

Recent studies have shown that right atrial (RA) function are important predictors of cardiovascular morbidity and mortality. However, the study data about RA phasic function in obstructive sleep apnea syndrome (OSAS) patients are scarce, especially based on the left ventricular geometry. So, we aimed to assess the influence of left ventricular geometry on RA phasic function in OSAS patients via a multimodal echocardiographic approach. Total of 235 OSAS patients were enrolled in this cross-section study and underwent complete clinical, polysomnography, and echocardiography examinations. The OSAS patients were divided into four groups based on left ventricular mass index (LVMI) and relative wall thickness (RWT): normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). RA phasic function was evaluated via multimodal echocardiography approach (two-dimensional echocardiography biplane method [2DE]; two-dimensional speckle-tracking echocardiography [2D-STE]; and three-dimensional echocardiography [3DE]). The multiple linear regression analysis was used to determine the relationship between left ventricular geometry and RA phasic function. The RA volume and indices increased from NG to CR to EH to CH. RA total emptying fraction and RA strain during systole decreased from NG to CR to EH to CH. RA passive emptying fraction and RA strain during early diastole similarly decreased. RA active emptying fraction and RA strain during late diastole also gradually increased similarly. In analyses that adjusted for gender, age, body mass index, systolic blood pressure, apnea-hypopnea index, LVMI, systolic pulmonary artery pressure, and right ventricular free wall thickness, CH was associated with RA reservoir and conduit function via 2DE area-length method, whereas CH and EH were associated with RA reservoir and conduit function via 2D-STE and 3DE method. Further, CH was associated with RA booster pump function via 2DE area-length method, 2D-STE, and 3DE method. The RA volumes and phasic function varied with left ventricular geometry via multimodal echocardiography approach. CH had the apparent negative effect on RA phasic function.

#482 Implementation of trans-esophageal echocardiography in pre-transplant recipient's basic preparation

Abstract Background and Aims Kidney transplantation is the module of choice to reduce mortality in comparison with dialysis [1]. Many patients on transplant waiting list undergoing haemodialysis via central venous catheters [2]. Cardiovascular morbidity control is one of the pillars of successful transplantation outcome [3]. Tans-thoracic echocardiographic abnormalities can be used to identify renal transplant recipients at high risk of cardiovascular disease [4]. Trans-oesophageal echocardiography is superior to trans-thoracic echocardiography in detecting vegetations. Endocarditis complicating central venous catheters often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires Trans-oesophageal echocardiography for diagnosis [5]. Three-dimensional trans-oesophageal echocardiography is considered the missed module for clear vegetations visualization [6]. Method Evaluation of Transoesophageal echocardiography results in 377 haemodialysis patients with central venous dialysis access planned for kidney transplantation. All patients were examined by transthoracic echocardiography and stated absent vegetations from our registry. Candidates were re-evaluated by real time trans-oesophageal procedure to diagnose possibility of silent vegetations. Informed consent was obtained. Results Among 377 patients undergoing haemodialysis via central venous access and recorded in transplantation waiting list. All of them were having absent vegetations stated by transthoracic echocardiography. Our patients were subjected to transoesophageal echocardiography. Results showed 13 patients with variable sized right sided 4-6 mm vegetations (3.4%). Among our positive group of patients six patients were founded with 6 mm vegetation (1.6%), four patients with 5 mm (0.5%) and finally three patients with 4 mm vegetations (0.7%). Conclusion Trans-oesophageal echocardiography may be implemented in renal transplant recipient basic preparation checklist for evaluation of silent vegetations associated with central access of dialysis.

Echocardiographic Measurements in Normal Chinese Adults (EMINCA) II focusing on left ventricular and left atrial size and function by three-dimensional echocardiography.

Current guidelines encourage large studies in a diverse population to establish normal reference ranges for three-dimensional (3D) echocardiography for different ethnic groups. This study was designed to establish the normal values of 3D-left ventricular (LV) and left atrial (LA) volume and function in a nationwide, population-based cohort of healthy Han Chinese adults. A total of 1117 healthy volunteers aged 18-89 years were enrolled from 28 collaborating laboratories in China. Two sets of 3D echocardiographic instruments were used, and full-volume echocardiographic images were recorded and transmitted to a core laboratory for image analysis with a vendor-independent off-line workstation. Finally, 866 volunteers (mean age of 48.4 years, 402 men) were qualified for final analysis. Most parameters exhibited substantial differences between different sex and age groups, even after indexation by body surface area. The normal ranges of 3D-LV and 3D-LA volume and function differed from those recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines, presented by the World Alliance Societies of Echocardiography (WASE) study, and from the 2D values in the EMINCA study. The normal reference values of 3D echocardiography-derived LV and LA volume and function were established for the first time in healthy Han Chinese adults. Normal ranges of 3D-LV and 3D-LA echocardiographic measurements stratified with sex, age, and race should be recommended for clinical applications.

Global left ventricular strains and left atrial volumes are not associated in healthy adults – Detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

IntroductionDuring the heart cycle, left ventricular (LV) contractility is characterized by complex deformation and rotational mechanics, resulting in LV ejection. The present study seeks to expand our knowledge by examining dependence of LV strains representing LV deformation on left atrial (LA) volumes in healthy circumstances. Therefore, the aim of this study was to evaluate the associations between LA volumes and LV strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) in normal healthy adults. MethodsThe present study consisted of 302 healthy adults, but according to exclusion criteria, 137 subjects were excluded due to inferior image quality. The final population comprised 165 individuals (mean age: 33.1 ± 12.3 years, 75 males) who were voluntarily recruited for screening. Two-dimensional echocardiography extended with 3DSTE was performed in all subjects for detailed LV/LA analysis. ResultsOverall feasibility for simultaneous assessment of LV strains and LA volumes proved to be 55 % with excellent intra- and interobserver correlations. All global LV strains were similar, regardless of the LA volumes examined. All LA volumes and volume-based functional properties respecting the cardiac cycle were similar, regardless the global LV strains examined. ConclusionsLV strains and LA volumes can be simultaneously assessed by 3DSTE. Global LV strains and LA volumes are not associated in healthy adults.

Mild renal dysfunction causes aggravated cardiac damage in type 2 diabetic patients: a comprehensive echocardiography study.

We sought to detect left ventricular (LV) adverse alterations in structure and function in type 2 diabetes mellitus (T2DM) patients with or without mild renal dysfunction (MRD) using comprehensive echocardiography techniques and to explore the independent risk factors for LV remodeling (LVR) and dysfunction in these patients. The study included 82 T2DM patients with normal LV ejection fraction (presence (n = 42)/absence (n = 40) of MRD). Age- and gender-matched controls (n = 40) were also recruited. LV structure and function were evaluated using conventional echocardiography and three-dimensional speckle tracking echocardiography (3DSTE). Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were all measured using 3DSTE. Compared with the controls with absolute advantage of LV normal geometry, LVR was more frequently present in the two T2DM groups, with the largest proportion in those with T2DM and MRD (P < 0.001). Fasting plasma glucose (FPG) and MRD were both significant risk factors for LVR in T2DM patients. The detection rates of LV diastolic dysfunction and subclinical systolic dysfunction were significantly higher in the T2DM groups than in the controls (P = 0.000). Moreover, the two case groups also showed significantly lower strain values in multiple directions than the controls (all P < 0.05). FPG was significantly associated with LV diastolic dysfunction, whereas FPG and MRD were both significantly associated with subclinical LV systolic dysfunction in T2DM patients. The combined use of conventional echocardiography and 3DSTE allowed the timely detection of early cardiac damage in T2DM patients with or without MRD.

Accuracy of Shunt Volume Measured by Three-Dimensional Echocardiography and Cardiac Magnetic Resonance in Patients With an Atrial Septal Defect and a Dilated Right Ventricle

The accuracy of right ventricular (RV) quantification by three-dimensional echocardiography (3DE) has been reported mainly in patients with a normal right ventricle (RV). However, there are no data regarding the accuracy of 3DE in patients with a dilated RV, as in shunt diseases. In this study, we evaluated the accuracy of 3DE and that of volumetric (Vol) cardiac magnetic resonance (CMR) for assessment of RV and left ventricular (LV) stroke volume (SV) and the pulmonary (Qp)/systemic (Qs) blood flow ratio in patients with an atrial septal defect (ASD) using the two-dimensional phase contrast (2DPC) method as the gold standard. We retrospectively investigated 83 patients with ASD who underwent transcatheter closure and clinically indicated CMR and 3DE examinations. The ratio Qp/Qs was calculated using RV and LV SV measured by full-volume volumetric 3DE (Vol-3DE) and CMR (Vol-CMR) and by two-dimensional pulsed Doppler quantification (2D-Dop); the parameters were compared using 2DPC-CMR as the gold standard. There was no significant difference in the Qp/Qs value between 2DPC-CMR and Vol-3DE (2.29±0.70 vs 2.21±0.63, P=.79) and 2D-Dop (vs 2.21±0.65, P=1.00); however, a significant difference was found between 2DPC-CMR and Vol-CMR (P<.001). The Qp/Qs value obtained using Vol-3DE showed the best correlation with 2DPC-CMR (r=0.93, P<.001). The RV and LV SV values obtained by Vol-3DE showed the best correlation with 2DPC-CMR (RV SV, r=0.82, P<.001; LV SV, r=0.73, P<.001), although the absolute values were underestimated. Qp/Qs was more accurately evaluated by Vol-3DE than by Vol-CMR or 2D-Dop. Three-dimensional echocardiography assessment was feasible and reproducible even in a dilated RV.

ASSESSMENT OF RIGHT VENTRICULAR FUNCTION FOLLOWING PERMANENT PACEMAKER IMPLANTATION BY ECHOCARDIOGRAPHY (INCLUDING 3D ECHOCARDIOGRAPHY)

Objective: Several studies have shown that unfavorable ventricular remodelling &amp; mechanical dyssynchrony caused by Right ventricular (RV) pacing leading to development of Left Ventricular dysfunction. Nevertheless, impact of RV pacing on Right Ventricle function has not been thoroughly assessed. Hence, prospective study was done to assess RV dimensions &amp; function by 2D and three-dimensional (3D) echocardiography at 3 months &amp; 6 months after pacemaker implantation Design and method: This study was a prospective single-centre study. All patients who underwent pacemaker implantation were assessed for RV function by 2D and 3D Echocardiography at baseline (pre-procedure), 3 months &amp; 6 months after pacemaker implantation. The change in follow-up period was evaluated by using single factor analysis of variance ANOVA with repeated measures in normally distributed data &amp; Bonferroni post-hoc test. A p value of &lt;0.05 is considered to be statistically significant Results: From January 2022 to December 2022, a total of 66 patients with permanent pacemaker were enrolled in the study. There was statistically non-significant changes in mean LVEF (%) during follow up (62.13±3.92(Baseline) vs. 62.21±4.15(3-month) vs 62.03+3.83 (6-months), p value&gt;0.05).However, there was statistically significant changes in mean PASP (mm Hg) during follow up (18.45±3.45 (Baseline) vs. 22.18±3.76 (3-month) vs 26.45+3.97, p value &lt;0.05). Also, there was statistically significant changes in mean RIMP during follow up (0.48±0.04(Baseline) vs. 0.50±0.04(3-month) vs 0.50+0.03(6-month),p value&lt;0.05).Likewise, there was statistically significant changes in mean RV E/E’ during follow up (4.47±0.57(Baseline) vs. 4.70±0.74(3-month) vs 4.95+0.82(6-month),p value &lt;0.05).In addition, there was statistically significant changes in mean TR Jet Area (cm2) during follow up (1.68±0.26(Baseline) vs. 2.22±0.43(3-month) vs 2.56+0.53(6-month), p value &lt;0.05). But, there was statistically non-significant changes in mean RVEF % (3D Echo) during follow up (53.51± 2.75(Baseline) vs. 53.02±2.64 (3-month) vs 53.48+2.34 (6-month), p value &gt;0.05).Other echocardiographic parameters of RV function did not show any change in 3-months &amp; 6-months follow-up. Conclusions: There is change in Right Ventricular function after Pacemaker implantation which can be documented as early as 6 months post implantation. Permanent pacemaker was associated with changes in RIMP, RV E/E’, PASP, TR JET AREA during 6 months after Right ventricular pacing

Right ventricular volume and function by three-dimensional echocardiography: results of the echocardiographic measurements in normal Chinese adults (EMINCA) II.

Three-dimensional (3D) echocardiography is an emerging technique for assessing right ventricular (RV) volume and function, but 3D-RV normal values from a large Chinese population are still lacking. The aim of the present study was to establish normal values of 3D-RV volume and function in healthy Chinese volunteers. A total of 1117 Han Chinese volunteers from 28 laboratories in 20 provinces of China were enrolled, and 3D-RV images of 747 volunteers with optimal image quality were ultimately analyzed by a core laboratory. Both vendor-dependent and vendor-independent software platforms were used to analyze the 3D-RV images. We found that men had larger RV volumes than women did in the whole population, even after indexing to body surface area, and older individuals had smaller RV volumes. The normal RV volume was significantly smaller than that recommended by the American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines in both sexes. There were significant differences in 3D-RV measurements between the two vendor ultrasound systems and the different software platforms. The echocardiographic measurements in normal Chinese adults II study revealed normal 3D-RV volume and function in a large Chinese population, and there were significant differences between the sexes, ages, races, and vendor groups. Thus, normal 3D-RV values should be stratified by sex, age, race, and vendor.

Significant Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Detection of Right Ventricular Systolic Dysfunction and Its Association With Outcomes

Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes. We analyzed two- and three-dimensional echocardiography data from 2 centers including 750 patients followed up for all-cause mortality. Right ventricular dysfunction was defined as RVEF <45%, with guideline-recommended thresholds (TAPSE <17mm, FAC <35%, FWLS >-20%) considered. Among patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using receiver-operating characteristic analysis, FWLS exhibited the highest area under the curve of discrimination for RV dysfunction (RVEF <45%) with 59% sensitivity and 92% specificity. Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least 2 parameters are impaired and gradually better if only one or none of them are impaired (log-rank P<.005). Guideline-recommended cutoff values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cutoff. Our results emphasize a multiparametric approach in the assessment of RV function, especially if 3D echocardiography is not available.

Biventricular function in preterm infants with patent ductus arteriosus ligation: A three-dimensional echocardiographic study

BackgroundThe detailed hemodynamics after patent ductus arteriosus (PDA) ligation in preterm infants remain unknown. We aimed to clarify the effect of surgical ligation on left ventricular (LV) and right ventricular (RV) volume and function.MethodsEchocardiography was performed in 41 preterm infants (median gestational age: 25 weeks) before and after PDA ligation. Global longitudinal strain was determined using three-dimensional speckle-tracking echocardiography. These values were compared with those in 36 preterm infants without PDA (non-PDA).ResultsPreoperatively, the PDA group had greater end-diastolic volume (EDV) and cardiac output (CO) in both ventricles, a higher LV ejection fraction (LVEF) (53% vs 44%) and LV global longitudinal strain, and a lower RVEF (47% vs 52%) than the non-PDA group. At 4–8 h postoperatively, the two groups had a similar LVEDV and RVEDV. However, the PDA group had a lower EF and CO in both ventricles than the non-PDA group. At 24–48 h postoperatively, the RVEF was increased, but the LVEF remained decreased, and LVCO was increased.ConclusionsPDA induces biventricular loading and functional abnormalities in preterm infants, and they dramatically change after surgery. Three-dimensional echocardiography may be beneficial to understand the status of both ventricles.ImpactPreterm infants are at high risk of hemodynamic compromise following a sudden change in loading conditions after PDA ligation.Three-dimensional echocardiography enables quantitative and serial evaluation of ventricular function and volume in preterm infants with PDA.PDA induces biventricular loading and functional abnormalities in preterm infants, and they dramatically change after surgery.

Appraised Value of 3D Echocardiography Combined with the Triglyceride–Glucose Index to Evaluate the Long-Term Prognosis of Patients after Percutaneous Coronary Intervention

Objective: This study analyzed three-dimensional echocardiography (3DE) combined with the triglyceride–glucose (TYG) index to evaluate the long-term prognosis of patients after percutaneous coronary intervention (PCI). Methods: The clinical data of 102 patients who were treated with PCI after admission to our hospital from January 2020 to December 2020 were retrospectively analyzed. All the patients were followed up for 24 months to evaluate their long-term prognosis. The occurrence of cardiovascular and cerebrovascular events in all the patients was recorded. Cardiovascular and cerebrovascular events refer to a series of diseases or conditions of the heart and the cerebrovascular system, including sudden cardiac death. Patients with cardiovascular events were assigned to the exposed group, while those without cardiovascular events were included in the nonexposed group. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular mass index (LVMI), left ventricular remodeling index (LVRI), left ventricular ejection fraction (LVEF), standard deviation of time to peak of left ventricular 16 segments (Tmsv16-SD), maximum time difference (Tmsv16-Dif), and difference between the 3DE index and the TYG index were collected. Logistic regression analysis was performed on the indicators with differences to analyze the influencing factors of the long-term prognosis of patients after PCI. The receiver operating characteristic (ROC) curve was drawn. The sensitivity, specificity, area under the curve (AUC), and Youden index were calculated. The best predictive cutoff value was determined. The predictive value of the 3DE index and the TYG index, either alone or in combination, was observed for long-term prognosis after PCI. The relationship between the 3DE index and the TYG index was explored. Result: The 2-year follow-up results showed that 22 patients experienced cardiovascular events, and they were included in the exposed group, accounting for 21.57%. The remaining 80 patients without cardiovascular events were included in the nonexposed group, accounting for 78.43%. A significant difference was found in creatinine (Cr), high-density lipoprotein cholesterol (HDL-C), LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index between the exposed group and nonexposed group (p &lt; 0.05). Cr, HDL-C, LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-Dif, and the TYG index in the exposed group were higher than those in the nonexposed group (p &lt; 0.05). The exposed group also had lower LVRI and LVEF than the nonexposed group (p &lt; 0.05). Logistic regression analysis of the indicators with differences showed that Cr, HDL-C, LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index were the major factors that affect the long-term prognosis of patients after PCI, with odds ratio values &gt;1. Correlation analysis showed that the TYG index was positively correlated with LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-Dif, and the TYG index (r = 0.565, 0.678, 0.696, 0.702, 0.788, 0.804, p &lt; 0.05). Moreover, it was negatively correlated with LVRI and LVEF (r = –0.580, –0.674, p &lt; 0.05). The sensitivity and specificity of the 3DE index combined with the TYG index in predicting long-term prognosis after PCI were 0.818 and 0.950, respectively, which were significantly higher than those of the 3DE index or the TYG index alone. The Youden index was 0.768, the AUC value was 0.922, and the optimal threshold was 36.64. Conclusion: The 3DE index and the TYG index were influencing factors for the long-term prognosis of patients after PCI, and a correlation existed between the 3DE index and the TYG index. The 3DE index combined with the TYG index can improve the predictive efficiency of the long-term prognosis of patients after PCI.

Autonomic function and specific right atrial functions - Is there a relationship? Correlations from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study.

Similarly to the ventricles, the atria are under sympathetic/parasympathetic neural regulation. Accordingly, correlations were investigated between Ewing's standard cardiovascular reflex tests (SCRTs) and three-dimensional speckle-tracking echocardiography (3DSTE)-derived right atrial (RA) volumes and strains in healthy subjects. The study comprised 45 healthy adults, but 5 subjects were excluded due to inferior image quality for 3DSTE-derived RA assessments. The remaining 40 individuals being in sinus rhythm had a mean age of 35.1 ± 3.5 years (20 men). Two-dimensional, Doppler, 3DSTE and SCRTs were performed in all cases. RA maximum volume and total and passive RA stroke volumes correlated with the Valsalva ratio. Active RA stroke volume and emptying fraction showed correlations with 30/15 ratio. Peak global and mean segmental RA circumferential (CS) and longitudinal strains (LS) showed correlation with the Valsalva ratio. At atrial contraction, global RA-LS and mean segmental RA-CS showed correlations with the Valsalva ratio. Moreover, mean segmental RA-CS correlated with 30/15 ratio and mean segmental RA radial strain showed correlations with systolic blood pressure in response to standing. Autonomic neuropathy score correlated with peak global RA-LS. Autonomic function parameters have significant associations with specific RA functions in healthy adults, making the latter possible indicators of autonomic dysregulation.

Role and application of three-dimensional transthoracic echocardiography in the assessment of left and right ventricular volumes and ejection fraction: a UK nationwide survey

Three-dimensional echocardiography (3DE) imaging has permitted advancements in the quantification of left ventricular (LV) and right ventricular (RV) volumes and ejection fraction. We evaluated the availability of 3DE equipment / analysis software, the integration of 3DE assessment of the LV and RV in routine clinical practice, current training provisions in 3DE, and aimed to ascertain barriers preventing the routine use of 3DE for volumetric analysis. Through the British Society of Echocardiography (BSE) regional representatives’ network, echocardiographers were invited to participate in an open online survey. A total of 181 participants from echocardiography departments in the United Kingdom (UK), the majority from tertiary centres (61%), completed the 28-question survey. For 3DE quantification, 3DE-LV was adopted more frequently than 3DE-RV (48% vs 11%, respectively). Imaging feasibility was a recognised factor in 3DE RV and LV adoption. Many respondents had access to 3D probes (93%). The largest observed barriers to 3DE routine use were training deficiencies, with 83% reporting they would benefit from additional training opportunities and the duration of time permitted for the scan, with 68% of responders reporting allowances of less than the BSE standard of 45–60 min per patient (8% < 30-min). Furthermore, of those respondents who had undertaken professional accreditation, competence in 3DE was not formally assessed in 89%. This UK survey also reported good accessibility to magnetic resonance imaging (72%), which was related to overall 3DE adoption. In summary, although 3DE is now readily available, it remains underutilised. Further training opportunities, integrated formal assessment, improved adoption of BSE minimum recommended scanning times, alongside industry and societal support, may increase 3DE utilisation in routine practice.

How Right is the Right Ventricle in Predicting Cardiac Mortality in Cardiac Failure: A 6-year Prospective Cohort Study.

Two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D-STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6-year follow-up. The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D-STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded. The study sample comprised a total of 54 participants. During the period of follow-up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6-year follow-up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end-diastolic volume and 3DE RV end-systolic volume were associated with cardiac mortality over 6-year follow-up. This study provides evidence that RV dysfunction as seen on 2D-STE and 3DE could be associated with increased risk of cardiac-related mortality in patients with heart failure over 6 years.

Left atrial reservoir longitudinal strain and its incremental value to the left ventricular global longitudinal strain in predicting anthracycline-induced cardiotoxicity.

Left ventricular global longitudinal strain (LVGLS) has been recommended by current guidelines for diagnosing anthracycline-induced cardiotoxicity. However, little is known about the early changes in left atrial (LA) morphology and function in this population. Our study aimed to evaluate the potential usefulness of LA indices and their incremental value to LVGLS with three-dimensional echocardiography (3DE) in the early detection of subclinical cardiotoxicity in patients with lymphoma receiving anthracycline. A total of 80 patients with diffuse large B-cell lymphoma who received six cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline (T0), after four cycles (T1), and after the completion of six cycles of chemotherapy (T2). Left ventricular ejection fraction (LVEF), LVGLS, LA volumes, LA emptying fraction (LAEF), LA active emptying fraction (LAAEF), and LA reservoir longitudinal strain (LASr) were quantified with 3DE. Left atrioventricular global longitudinal strain (LAVGLS) was calculated as the sum of peak LASr and the absolute value of peak LVGLS (LAVGLS=LASr+|LVGLS|). LV cardiotoxicity was defined as a new LVEF reduction by ≥10 percentage points to an LVEF of ≤50%. Fourteen (17.5%) patients developed LV cardiotoxicity at T2. LA volumes, LAEF, and LAAEF remained stable over time. Impairment of LASr (28.35±5.03vs. 25.04±4.10, p<.001), LVGLS (-22.77±2.45vs. -20.44±2.62, p<.001), and LAVGLS (51.12±5.63vs. 45.61±5.22, p<.001) was observed by the end of the fourth cycle of chemotherapy (T1). Statistically significant declines in LVEF (61.30±4.73vs. 57.08±5.83, p<.001) were only observed at T2. The relative decrease in LASr (ΔLASr), LVGLS (ΔLVGLS), and LAVGLS (ΔLAVGLS) from T0 to T1 were predictors of LV cardiotoxicity. A ΔLASr of>19.75% (sensitivity, 71.4%; specificity, 87.9%; area under the curve (AUC),.842; p<.001), a ΔLVGLS of>13.19% (sensitivity, 78.6%; specificity, 74.2%; AUC,.763; p<.001), and a ΔLAVGLS of>16.80% (sensitivity, 78.6%; specificity, 93.9%; AUC,.905; p<.001) predicted subsequent LV cardiotoxicity at T2, with the AUC of ΔLAVGLS significantly larger than that of ΔLVGLS (.905vs..763, p=.027). Compared to ΔLVGLS, ΔLAVGLS showed improved specificity (93.9%vs. 74.2%, p=.002) and maintained sensitivity in predicting LV cardiotoxicity. LASr could predict anthracycline-induced LV cardiotoxicity with excellent diagnostic performance. Incorporating LASr into LVGLS (LAVGLS) led to a significantly improved specificity and maintained sensitivity in predicting LV cardiotoxicity.

Potential Underestimation of Left Ventricular Mechanical Dyssynchrony in Dyssynchrony and Outcomes Assessment.

Left ventricular (LV) mechanical dyssynchrony (LVMD) is fundamental to the progression of heart failure and ventricular remodeling. The status of LVMD in different patterns of bundle branch blocks (BBB) is unclear. In this study, we analyzed the relationship between LVMD and left ventricular systolic dysfunction using real-time three-dimensional echocardiography (RT-3DE). RT-3DE and conventional two-dimensional echocardiography were performed on 68 patients with left bundle branch block (LBBB group), 106 patients with right bundle branch block (RBBB group), and 103 patients without BBB (Normal group). The RT-3DE data sets provided time-volume analysis for global and segmental LV volumes. The LV systolic dyssynchrony index (LVSDI) was calculated using the standard deviation (SD) and maximal difference (Dif) of time to minimum segmental volume (tmsv) for LV segments adjusted by the R-R interval. LVMD was considered if the LVSDI (Tmsv-16-SD) was greater than or equal to 5%. LVSDI is negatively and significantly correlated with left ventricular ejection fraction (LVEF), but not with BBB or QRS duration. The proportion of LVMD in the LBBB, RBBB, and Normal group was 30.88%, 28.30%, and 25.24%, respectively, and there was no significant difference. In dilated cardiomyopathy, LVMD is more closely related to LVEF reduction than QRS morphology and duration.