Transthoracic Echocardiographic Parameters Research Articles

Neural network-based prediction of incident atrial fibrillation using the trans-thoracic echocardiography parameters: a prospective study

Background: Myocardial remodeling facilitates the development and maintenance of atrial fibrillation (AF). Trans-thoracic echocardiography (TTE) is an available and easily reproducible method for assessment of patients with cardiovascular disorders. The evaluation of TTE parameters with a neural network-based program (NN) could be used for early detection of AF in asymptomatic patients. Aim: To establish the potential of a previously developed NN to predict the incident AF in the patients with no past history of heart arrhythmias. Methods: The study was based on the electrocardiographic data from electronic case record forms of 256 patients (mean age 63.47 ± 16.21 years, 151 (58.98%) women) with no past history of AF, who were treated in the in-patient Department of Cardiology in 2022. The TTE parameters (ascending aorta and left atrium diameters, left ventricular end-diastolic size, pulmonary artery diameter, maximal thickness of the anterior and posterior left ventricular walls in the diastole, transverse diameter of the right atrium, aortal, mitral and tricuspid valve regurgitation grade, left ventricular ejection fraction) were processed by the NN “Prediction of atrial fibrillation based on the trans-thoracic echocardiography data” (Russian state registration certificate for the computer software #2023662423 from 07.06.2023). Depending on the NN output values, the patients were divided into three groups: with a high probability of incident AF (n = 48; NN output value ≤ 0.33), with an intermediate probability of incident AF (n = 185, NN output value 0.34 to 0.66), and with a low probability (n = 23, NN output values ≥ 0.67). The patients were followed up to March 1, 2024 based on their electronic medical records (endpoints: referrals due to AF, AF mentioned as a complication of the underlying disease or as a concomitant disorder, cardiovascular death). Results: The median time of the follow-up was 16 [14; 21] months. During the study period, AF developed in 8/48 (16%) patients with the NN values ≤ 0.33 and in 4/185 (2.16%) patients with the NN values of 0.34 to 0.66, whereas no AF cases were registered in those with the NN values ≥ 0.67 (0/23). The cardiovascular death rate in the study groups was 17/48 (31.25%), 13/185 (3.78%), and 0/23 (0%), respectively (р 0.05). The area under the ROC curve (AUC) for incident AF was 0.85, for death 0.84, and for the combination endpoint of incident AF + death 0.86. Conclusion: The NN used in the study meets the goal of the binary differentiation, i. e. it allows to differentiate the heart structure and function typical for AF from those not typical for AF. Heart chamber dilatation, left ventricular systolic function and valvular regurgitation grade are associated with an increased risk of AF and death. The analysis of TTE parameters by the NN can be used for identification of patients at risk of incident AF with the goal of their additional work-up and monitoring.

Impact of pre-ablation cardiorespiratory fitness and echocardiographic parameters on atrial fibrillation ablation outcomes.

Studies have shown a correlation between greater cardiorespiratory fitness (CRF) and lower risk of incident and recurrent atrial fibrillation (AF). Transthoracic echocardiographic (TTE) parameters correlate to CRF and risk of AF. However, there is scarce data regarding the interplay of CRF, echocardiographic parameters, and AF ablation outcomes. Our study sought to investigate how CRF and echocardiographic parameters impact AF ablation outcomes. We evaluated the Mayo Clinic Cardiorespiratory Exercise database from January 1, 2013, through December 31, 2017, to include all patients who underwent cardiopulmonary exercise testing and an AF ablation in temporal proximity. A total of 205 patients (mean age 61.2years, 74% male) were included for analysis. Fitness was calculated with peak VO2 when available and exercise time when VO2 was not available. Lower baseline fitness correlated to larger left atrial volumes, lower medial mitral e' values, and higher E/e' ratios. Lower baseline fitness correlated to higher risk of AF recurrence post-ablation in a simple model, but lost significance when multiple variables were accounted for. Lower baseline fitness also correlated to a higher AF burden post-ablation at one year. Lower baseline CRF likely correlates to more malignant and difficult to treat AF. Lower fitness also correlated to larger left atria and TTE parameters suggestive of diastolic dysfunction.

Correlations between trans-thoracic echocardiographic parameters and serum biomarkers levels in 25 professional football players before and after cardiopulmonary exercise testing

Abstract Background Sudden cardiac death (SCD) is a rare but tragic event which can involve young and apparently healthy individuals. Several heart conditions, such as hypertrophic cardiomyopathy (HCM), the most frequent cause of SCD in young adults, may not be diagnosed as early as needed. Therefore, proper screening methods and protocols are required for athletes and individuals who engage in chronic intense physical activity. Purpose Current guidelines recommend a screening for athletes and healthy individuals who engage in high-intensity physical activities based on patient history and symptoms, clinical examination and resting 12-lead electrocardiography (ECG). While trans-thoracic echocardiography (TTE) is an useful tool in showing and differentiating pathological patterns from physiological adaptive changes, there is not enough evidence to include it as a standard screening method. Therefore we conducted a study in which we evaluated the use of a complex screening protocol involving the afore-mentioned screening tools, together with TTE, with the aim of better highlighting potential life-threatening cardiac anomalies which may cause adverse events during physical activity. Materials and Methods In the years 2021–2023, we evaluated 25 male professional football players, all between the ages of 18 and 21. They underwent physical examination, resting 12-lead ECG, (TTE) examination, using the M-mode, Continuous wave Doppler (CWD) and the pulse wave Doppler (PWD), as well as serum biomarkers determinations (D-Dimers, Myoglobin, CK-MB, Troponin I and NT-proBNP), before and after cardiopulmonary exercise testing (CPET). Results All of the athletes' echocardiographies showed the "athlete's heart" pattern, with a slightly enlarged left ventricular cavity and mild concentric left ventricular hypertrophy (LVH). Additionally, the myocardium's contractility was within normal bounds and the ejection fraction was on upper limit of the normal values. Two of the examinations showed a mild tricuspid regurgitation, while other four displayed a mitral valve prolapse, regarded to be minor physiological variations in a well-trained individual. No aspects suggestive of dilated cardiomyopathy, hypertrophic cardiomyopathy or isolated left ventricular non-compaction were observed. Most correlations were between the myoglobin levels and the TTE parameters, showing how the overall changes comprising of left ventricular hypertrophy, enlarged cavities and increased cardiac performance may be translated also through the increased serum myoglobin levels in athletes, both at rest and after CPET. Conclusion TTE remains the most precise way to differentiate between physiological LVH and HCM among other pathological patterns. The "athlete's heart" pattern and the morpho-functional changes it encompasses in young individuals were correlated to increased levels of serum biomarkers such as myoglobin, both at rest and after CPET.

Impact of percutaneous coronary intervention on acute echocardiographic parameters in patients with ST-segment elevation myocardial infarction

Abstract Background Transthoracic echocardiography (TTE) provides a rapid, non-invasive, bedside assessment of the cardiac function and hemodynamic condition. It is a valuable tool for the acute clinical evaluation in patients with ST-elevation myocardial infarction (STEMI) at arrival in the catheterization laboratory (cath lab). Purpose To examine the relationship between TTE parameters obtained before and after primary percutaneous coronary intervention (pPCI) in STEMI patients. Method From September 2023 STEMI patients at one tertiary heart center underwent acute bedside TTE examination before pPCI in the cath lab. Patients in cardiogenic shock before leaving the cath lab were excluded. The 5-min focused acute TTE protocol included: LV ejection fraction (LVEF), valvulopathy, mechanical complications, LV outflow tract velocity time integral (LVOT VTI), and diastolic dysfunction (mitral inflow (E and E/A), mitral deceleration time, and mitral annular early diastolic velocity é lateral). The LVEF was categorized in groups: LVEF>45%, moderately reduced (LVEF 35-45%), and severely reduced (LVEF<35%). A full protocol TTE examination was performed before discharge. Results A total of 133 STEMI patients (mean age 63 years, 21% women) were included. Prior to admission, 49% had hypertension, 40% hyperlipidemia, 16% diabetes, 17% chronic ischemic heart disease, and 71% were active or previous smokers. Anterior STEMI was present in 39%, and the median time from cath lab arrival to first wire crossing the culprit lesion was 28 min (IQR 24;38). Vital parameters upon admission were: heart rate 75 bpm (IQR: 66;85), Killip Class 1 (96%), lactate levels 1.6 mM (IQR: 1.2;2.3), and systolic blood pressure of 134±27 mmHg. Considering TTE parameters LVEF and E/A ratio changed significantly from before vs after pPCI (LVEFbefore: 45% vs LVEFafter: 50%, p<0.001 and E/Abefore: 1.1 vs E/Aafter: 0.93, p<0.001), Figure 1. Before pPCI severely reduced LVEF was seen in 17% of patients with improvement in 44% to moderately reduced LVEF, and 4% to normal-slightly reduced LVEF. Before PCI, moderately reduced LVEF was seen in 40% of patients with improvement in 38% to normal-slightly reduced LVEF after PCI. Patients who experienced a decline in LVEF had a longer, though not statistically significant, ECG-to-wire crossing time (119 min [IQR 94;213] vs 102 min [IQR 75;142], p=0.10). Conclusion This study shows that in STEMI patients, the TTE parameters LVEF and E/A ratio were altered after pPCI. Despite a significant decrease in one of the diastolic dysfunction parameters, the E/A ratio remained within the normal range before and after PCI. The increase in LVEF was small, however it may be clinically significant, indicating improved heart function, potentially leading to less symptoms, adjusted treatment plans, and a more favorable prognosis for the patient. However, the parameters should be cautiously interpreted due to measurement uncertainty and validated with a larger sample size. Figure 1. ANCOVA plot

Hemodynamic forces assessment in severe aortic stenosis undergoing transcatheter aortic valve intervention

Abstract Background Estimated hemodynamic forces (HDFs) are a novel and validated marker of cardiac function evaluation computed by standard echocardiography. They have been demonstrated to be altered in many cardiac diseases, such as heart failure. However, their application in valvular disease is still not completely known. Aim to analyze left ventricular (LV) HDFs in patients with severe aortic stenosis before and immediately after transcatheter aortic valve implantation to reveal whether cardiac changes occur early after the procedure. Methods All the patients with severe aortic stenosis referred to ourutively enrolled. Transthoracic echocardiography (TTE) was performed before and early after the procedure (within five days). Standard TTE parameters for volume dimension and function were collected along with peak and mean aortic gradients and aortic valve area. TTE cine loops in 3-2 and 4 chambers were analyzed offline with a dedicated speckle tracking echocardiography (STE) software to compute global longitudinal strain (GLS) and HDFs using LV endocardial displacement and the estimated mitral and aortic valve areas as input. HDFs were computed during the entire cardiac cycle, in systole and diastole, in their two main directions: apex-to-base (AB) and lateral-septal (LS). The LS over AB ratio was also calculated, representing HDFs’ distribution into the LV. HDFs were normalized with LV volumes and expressed as a percentage of the force of gravity. Results 31 patients undergoing TAVI were enrolled (mean age 82 years ± 7, 45 % females, Euroscore II 4.2% ± 2.1, 71% history of CAD). Baseline standard and advanced TTE parameters are described in the table. After the procedure, no significant changes in ejection fraction (55±9 vs. 57±10, p=0.105) were observed, while a trend in GLS improvement was observed even without statistical significance (-16.6±9.1 vs -19.1±5.8, p=0.63). HDFs in the entire cycle showed a significant improvement in terms of magnitude, apical-base (p=0.08) and lateral septal (p=0.01), but no significant changes in the LS/AB ratio were observed, even if there was a slight reduction (p=0.670). A slight improvement in HDFs AB and LS and a reduction in LS/AB ratios were observed in both systole and diastole, even if they were not statistically significant (Table). Conclusions Preliminary data suggest that HDFs by TTE, representing advanced LV function evaluation, showed a trend in improvement after acute pressure unloading in TAVI patients. A greater cohort is needed to expand these data. Figure 1 Table 1

Immediately improved diastolic function as determined by pulmonic vein Doppler-intraoperative TEE in TAVR patients and the impact of valvulo-arterial impedance

Abstract Background A recent study demonstrates that most TAVR patients experience immediate improvement in diastolic function as determined by pulmonic vein Doppler (PvD) measurements. Valvulo-arterial impedance (Zva) is a marker of global LV load and represents both valvular and arterial load. Zva > 3.5 has been shown as a predictor of poor adverse outcomes. We hypothesize that Zva might have an effect on the change in pulmonic vein Doppler after TAVR. Purpose This study aims to demonstrate the impact of valvulo-arterial impedance and the immediate improvement of diastolic function in TAVR patients as assessed by pulmonic vein Doppler-intraoperative TEE. Materials and Methods Patients who underwent TAVR from January 2020 to September 2023 and were performed pulmonic vein Doppler by intraoperative TEE (right upper pulmonic vein from 90-110° mid-esophageal view) during TAVR and measured S-, D-, and A- wave velocity. We obtained the blood pressure and transthoracic echocardiographic parameters to calculate the Zva [(systolic blood pressure + mean pressure gradient across the aortic valve)/stroke volume index by LVOT doppler]. To compare the PvD change between Zva < 3.5 and Zva ≥ 3.5, use chi-square for categorical data and a paired t-test for continuous data. Results 79 patients (mean age was 80.6 ± 5.6 years, 43 female) were enrolled in this study. S-wave was the only parameter with significantly increased velocity from baseline (33.2 ± 13.8 cm/s vs. 49.1 ± 18.6 cm/s, p < 0.001), whereas D-wave and A-wave did not significantly change from baseline (33.1 ± 14.5 cm/s vs. 33.3 ± 12.0 cm/s, p = 0.88; and 12.7 ± 7.8 cm/s vs. 13.3 ± 7.3 cm/s, p = 0.52, respectively). Of the 37 patients who had an S/D ratio < 1 at baseline, 26 of them converted to an S/D ratio > 1 immediately post-TAVR (Figure 1). In the group of Zva < 3.5, the number of patients who had PvD changed significantly compared with the group of Zva ≥ 3.5 (Figure 2). Conclusion The majority of patients in this study demonstrated that diastolic function improved immediately following TAVR using a pulmonic vein Doppler. S/D > 1 has improved significantly in the group with normal valvulo-arterial impedance (Zva < 3.5). Figure 1 Figure 2

Unfavorable systemic and coronary hemodynamic profile of left ventricular hypercontractile phenotype in hypertrophic cardiomyopathy

Abstract Background The left ventricular (LV) hypercontractile phenotype (HP) plays a critical role in hypertrophic cardiomyopathy (HCM) and is usually identified with the left ventricular outflow tract gradient (LVOTG). Purpose To assess the systemic and coronary hemodynamic profile associated with HP identified with increased LV elastance (also known as force) at rest in patients with HCM. Methods We enrolled 1248 HCM patients (age 50 ± 15 years, 798 males, 64%) with ejection fraction (EF) ≥50%, referred for rest transthoracic echocardiography (TTE) in 14 quality-controlled sites from 7 countries TTE assessment included LVOTG, EF, and LV force (systolic blood pressure + LVOTG/LV end-systolic volume, mmHg/mL). Volumetric echocardiography with Simpson’s method was used to measure EF from end-diastolic volume (EDV) and end-systolic volume (ESV), stroke volume (SV), arterial elastance (AE) and ventricular-arterial coupling (VAC). We also assessed resting peak diastolic coronary flow velocity (D-CFV) in the mid-distal left anterior descending artery in a subset of 275 patients. Results EF equaled 68 ± 7%, force = 6.8 ± 5.3 mmHg/ml and LVOTG = 22 ± 28 mmHg. HP was identified as the highest quartile of force (> 7.85 mmHg/ml, mean value= 13.3 ± 7.0). HP showed the lowest SV (46 ± 18 ml) and EDV (61 ± 20 ml), with the highest AE (3.19 ± 1.35 mmHg/ml) and VAC (3.46 ± 1.59) compared to other quartiles (p<0.001) ( see Picture) . D-CFV was not higher in patients with HP (n = 65) compared to those (n = 210) without HP (41± 11 vs 38 ± 14 cm/s, p=ns, but higher in comparison to joint first and second Force quartile (n=122) vs 37 ±14 p =0.0472). Table displays the demografic, clinical and TTE parameters related to HP (Table). In multivariate logistic analysis 4 independent predictors of HP were identified: SBP >130 mmHg with OR 2.5, female sex with OR 5.4, LV EF >70% with OR 6.1 and LVOTG >30 mmHg with the highest OR = 6.3. Conclusion: HCM patients with HP exhibit a distinctive systemic hemodynamic and coronary physiology profile, characterized by low SV, high VAC, and supranormal baseline D-CFV compared to non-HP patients. These findings suggest reduced cardiovascular efficiency and increased myocardial oxygen demand, possibly detrimental over time.

β-alanine supplementation in adults with overweight and obesity: a randomized controlled feasibility trial.

Overweight and obesity are characterized by excess adiposity and systemic, chronic, low-grade inflammation, which is associated with several metabolic disorders. The aim of this study was to assess the feasibility and tolerability of β-alanine supplementation and to explore the effects on cardiometabolic health and cardiovascular, hepatic, and renal function in adults with overweight and obesity. A total of 27 adults (44% female; mean [SD], age: 58 [10] years, BMI: 31.1 [2.9] kg/m2, hemoglobin A1c: 39.8 [4.3] mmol/mol) received β-alanine (4.8 g/day) or a matched placebo for 3 months. Feasibility and tolerability outcomes included adherence, side effects, recruitment, attrition, and blinding, and exploratory outcomes included biochemical markers, blood pressures, and transthoracic echocardiography parameters. Data were analyzed using a Bayesian approach presented with 95% credible intervals (CrI). β-alanine was well tolerated and adhered to (adherence: placebo, 0.91 [95% CrI: 0.84-0.95]; β-alanine, 0.92 [95% CrI: 0.85-0.95]), and side effects remained at or below baseline throughout. The probability that β-alanine supplementation affected cardiometabolic, cardiovascular, or clinical biochemical outcomes was low. Sustained-release β-alanine supplementation is well tolerated and adhered to in adults with overweight and obesity. Future research should consider more advanced metabolic conditions, which may benefit from longer duration supplementation.

Utility of an Echocardiographic Machine Learning Model to Predict Outcomes in Intensive Cardiac Care Unit Patients.

The risk stratification at admission to the intensive cardiac care unit (ICCU) is crucial and remains challenging. We aimed to investigate the accuracy of a machine learning (ML)-model based on initial transthoracic echocardiography (TTE) to predict in-hospital major adverse events (MAEs) in a broad spectrum of patients admitted to ICCU. All consecutive patients hospitalized in ICCUs with a complete TTE performed within the first 24hours of admission were included in this prospective multicenter study (39 centers). Sixteen TTE parameters were evaluated. The ML model involved automated feature selection by random survival forest and model building with an extreme gradient boosting (XGBoost) algorithm. The primary outcome was in-hospital MAEs defined as all-cause death, resuscitated cardiac arrest, or cardiogenic shock. Of 1,499 consecutive patients (63±15years, 70% male), MAEs occurred in 67 patients (4.5%). The 5 TTE parameters selected in the model were left ventricular outflow tract velocity-time integral, E/e' ratio, systolic pulmonary artery pressure, tricuspid annular plane systolic excursion, and left ventricular ejection fraction. Using the XGBoost, the ML model exhibited a higher area under the receiver operating curve compared with any existing scores (ML model, 0.83 vs logistic regression, 0.76, ACUTE-HF score:,0.66; thrombolysis in myocardial infarction score, 0.60; Global Registry of Acute Coronary Events score, 0.58, all P<.001). The ML model had an incremental prognostic value for predicting MAE over a traditional model including clinical and biological data (C index 0.80 vs 0.73, P=.012; chi-square 59.7 vs 32.4; P<.001). The ML model based on initial TTE exhibited a higher prognostic value to predict in-hospital MAEs compared with existing scores or clinical and biological data in the ICCU.

Abstract 4137958: Transthoracic Echocardiography-based Differentiation of Hypertrophic Cardiomyopathy and Cardiac Amyloidosis

Introduction: Hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA) have similar features on transthoracic echocardiography (TTE) which may make the two difficult to distinguish. However, it is recognized that CA presents at an older age compared to HCM. Our aim was to determine optimal TTE parameters for differentiating HCM from CA and the incremental value of age at the time of diagnosis for differentiation of these two disorders. Methods: Patients with CA (N=121) and HCM (N=227)—diagnosed in accordance with guidelines—who underwent TTE were retrospectively identified. TTE parameters—including left ventricular global longitudinal strain (LVGLS), apical sparing ratio (ASR), AMYLoidosis Index (AMYLI), relative wall thickness (RWT) and ejection fraction to strain ratio (EFSR)—were calculated using artificial intelligence software (US2.AI) and validated by a level III echocardiography reader. Univariate and multivariable logistic regressions were used to compare TTE parameters between CA and HCM patients. Receiver operating characteristic curve (ROC) analysis was conducted to determine performance of echo parameters in distinguishing CA and HCM. Findings: CA patients were older compared to HCM ( Figure 1A ). With respect to TTE parameters, CA was associated with lower magnitude of LVGLS and higher value of ASR, AMYLI, and EFSR. LVGLS (AUC 0.865, 95% CI 0.81-0.91) outperformed AMYLI, RWT, and EFSR for differentiation of HCM from CA ( Figure 1B ). For all five TTE parameters, age provided incremental predictive value for LVGLS (p&lt;0.001), ASR (p&lt;0.001), AMYLI (p=0.007), RWT (p&lt;0.001), and EFSR (p&lt;0.001), Figure 2A-C ). LVGLS &lt;-15.8% was 85% sensitive and 79% specific for CA. Conclusion: LVGLS is an optimal echo parameter for differentiating CA from HCM, outperforming all other traditional CA diagnostic markers. Age provides incremental diagnostic value in the differentiation of these two groups with TTE.

Electrical cardiometry significance in postoperative cardiac ICU; a single center study

BackgroundHemodynamic monitoring is a cornerstone of critical care; in fact, the techniques available for this purpose are either unreliable or operator-dependent or intermittent (echocardiography) and invasive (thermodilution). Objectives: To evaluate the effectiveness of electrical cardiometry (EC) in assessing hemodynamics in pediatric postoperative cardiac intensive care unit (ICU) and the agreement between EC and trans-thoracic echocardiography (TTE) as bedside tools for hemodynamic monitoring and early diagnosis of cardiovascular compromise. We included 70 pediatric patients from the postoperative cardiac ICU. All participants underwent history-taking and clinical examination. emphasising vital signs, manifestations or signs of hemodynamic instability, calculation of RACH score and vasoactive inotropic score. EC was applied for all patients, and TTE.ResultsThe study included 40 males and 30 females with a mean age of 2.6 ± 3.49 years, ranging between 2 weeks and 13 years, with a male to female ratio of 1.3:1. The median of EC parameters were comparable to TTE parameters stroke volume (SV) (9 vs. 8 p = 0.2), stroke index (SI) (23.5 vs. 22 p = 0.2), cardiac output (CO) (1.25 vs. 1.1 p = 0.3), and cardiac index (CI) (3.2 vs. 3.15 p = 0.2). Hemodynamic parameters correlated significantly between EC and echocardiography, with significantly observed agreement between them. Four equations were postulated successfully based on a linear regression model to predict echocardiographic hemodynamic parameters in comparable groups of children, i.e., SV, SI, CO, and CI.ConclusionEC is an excellent alternative to echocardiography in hemodynamic assessment of cardiac patients in the postoperative ICU.

Echocardiographic predictors of mortality in cardiac intensive care unit patients with pulmonary hypertension

Abstract Background Pulmonary Hypertension (PH) is a diverse condition associated with elevated mortality. We sought to determine the association of Transthoracic Echocardiography (TTE) parameters with in-hospital mortality in patients with PH admitted to Cardiac Intensive Care Unit (CICU). Methods We included 1 Clinic CICU admissions from 2007 to 2018, with available TTE parameters within the first day of CICU admission who had PH defined as an estimated right ventricular systolic pressure (RVSP) ≥36 mmHg. The primary outcome was in-hospital mortality, evaluated using logistic regression. Results We included 3085 unique CICU patients with PH, predominantly WHO group 2 and 3. Median age was 73.7 (63.8, 82.4) years, and 1343 (43.5%) were females. Heart failure (65.6%) and respiratory failure (34.0%) were the most common admission diagnoses. The median RVSP was 47 (41, 56) mmHg, and 1314 (42.6%) had RVSP ≥50 mmHg. A total of 337 (10.9%) patients died during hospitalization. In-hospital deaths had higher RVSP (51 versus 47 mmHg, p &amp;lt;0.001), reflecting higher right atrial (RA) pressure (14 versus 10 mmHg, p &amp;lt;0.001) (Figure). In-hospital mortality increased with worse TTE parameters reflecting Right Ventricle-Pulmonary Artery (RV-PA) coupling, such as Tricuspid Annular Plane Systolic Excursion/ Right Ventricular Systolic Pressure (RVSP), Tricuspid Annular Systolic Velocity (TASV)/RVSP and TASV/ Tricuspid Regurgitation velocity ratios. Conclusion In CICU patients with PH, we have identified the specific Doppler TTE parameters with strong associations with outcomes. Specifically, RA pressure and parameters of RV-PA coupling had the highest discrimination for in-hospital mortality. Comprehensive Doppler TTE is valuable for identification of high-risk PH patients to facilitate further investigation plans, management, and prognostication. Figure: In-hospital mortality in association with right ventricular (RV) function and right atrial pressure (RAP).In-hospital mortality in association wit

Echocardiographic findings in newborns with inadequate intrauterine growth during pregnancy

Abstract Background Infants born small for gestational age (SGA) or diagnosed with fetal growth restriction (FGR) are at increased risk of neonatal mortality as well as cardiovascular disease later in life. Previous studies based on smaller cohorts (n&amp;lt;200) of newborns with SGA and FGR (n&amp;lt;200) have demonstrated structural and morphological alterations in the heart compared to infants born appropriate for gestational age (AGA). However, to our knowledge no previous study has systematically investigated the effect of SGA and FGR on echocardiographic parameters in the infant heart. Purpose To investigate whether echocardiographic parameters differ among infants born SGA or with FGR, in comparison to infants born AGA. Methods This study is a population-based cohort study of infants (n&amp;gt;25,000) offering postnatal cardiac examination including transthoracic echocardiography (TTE) between 2016-2018. We compared left ventricular (LV) TTE parameters in infants born SGA (birthweight ≥3rd and &amp;lt;10th percentile, n=2,106) and with FGR (birthweight &amp;lt;3rd percentile, n=972) with infants born AGA (birthweight ≥10th and &amp;lt;90th percentile, n=20,468) using a multiple linear regression analysis. We have investigated LV volumes, systolic function, diastolic function, and LV structure. All analyses were adjusted for sex, gestational age at birth, weight, length, and age at cardiac examination. Results Infants born SGA had higher heart rates compared with infants born AGA. Both infants born SGA and infants with FGR had significantly smaller LV dimensions including septal and posterior wall thicknesses (IVSd and LVPWd), and LV internal diameters (LVIDd and LVIDs). Infants born SGA had smaller end-diastolic and end-systolic volumes compared with infants born AGA (Table 1). Infants born SGA or with FGR had significantly higher mitral valve early peak velocities, compared with infants born AGA, and infants born SGA showed increased mitral valve atrial peak velocities indicating altered diastolic function (Table 1). Conclusion Infants born with inadequate intrauterine growth had smaller LV dimensions compared with infants born AGA, even when adjusting for infant size and age. Infants born SGA and with FGR both exhibited altered diastolic function. Longitudinal studies of children with inadequate intrauterine growth are needed to determine the impact on adult cardiac health.

Left atrial reservoir strain as a prognostic indicator for cardiovascular events after mitral valvuloplasty

Abstract Background In patients after mitral valvuloplasty (MVP), assessing valve function and heart failure (HF) is crucial for prognostic predictions. Left ventricular diastolic function assessed by transthoracic echocardiography (TTE) plays an important role in the evaluation of HF in general practice. However, post-mitral valve surgery patients are excluded from the left ventricular diastolic function assessment guidelines proposed by the American Society of Echocardiography in 2016 due to their low correlation with left ventricular diastolic function indices. On the contrary, the left atrial reservoir strain (LARS) before MVP is considered as a prognostic factor, reflecting left atrial dysfunction caused by mitral regurgitation. Nevertheless, there are limited reports on the relationship between LARS and cardiovascular (CV) events after MVP. Purpose The study aims to investigate the utility of LARS in predicting CV events after MVP. Methods The study included 249 patients who underwent TTE between January 2011 and January 2023 after MVP at our hospital. Patient background data, including NYHA classification, medical history, medications, blood tests, and TTE data, were collected at the time of follow-up TTE. LARS, left ventricular global longitudinal strain (LV-GLS), and right ventricular free wall strain (RV-FWSL) analysis were performed using a vender-independent external strain analysis software for all patients in the cohort. The primary endpoints were cardiovascular death and HF rehospitalization. The predictor of cardiovascular events was assessed using the Cox proportional hazards model and Kaplan-Meier curve (KMC). Results The mean age was 61±14 years, and 159 patients (64%) were male. The median time from surgery to TTE was 4.8 (1.0-6.8) years, 32 patients (13%) had events within 8.5 (3.7-10.8) years after TTE. The event groups had higher age, NYHA classification, and NT-pro BNP compared to the non-event group. TTE parameters such as left ventricular mass index, left ventricular end-diastolic volume and end-systolic volume were larger, and LV-GLS and LARS were significantly lower in the event group. In multivariate Cox proportional hazards models showed that LARS was also a prognostic indicator even after adjustment for several variables (Table 1). The KMC showed that LARS was associated with events regardless of left atrial volume index (Log-rank p &amp;lt;0.001, chi-square:31.03) (Figure 1). Conclusion LARS was strongly associated with CV events after MVP. We consider LARS to be a useful prognostic indicator after MVP.

Comparative Study between Corrected Carotid Flow Time, Femoral Arterial Doppler and Aortic Velocity Time Index Assessment in Septic Shock Patients

Abstract Background Septic shock is a serious infectious condition characterized by low blood pressure and multiple organ damage. One of the traditional recommendations is to administer intravenous fluids as the first step to improve blood pressure. However, studies have shown that not every patient benefits from aggressive intravenous hydration. Only about 40% of hypotensive patients with sepsis respond to fluid infusion with improvement in blood pressure and outcomes. Aim of the Work to compare between corrected carotid flow time, femoral artery doppler and aortic VTI in fluid responsiveness assessment in septic shock patients. Patients and Methods This is prospective, cohort study conducted on 45 Septic shock patients assessed to detect aortic VTI, corrected carotid flow time and femoral artery Doppler to assess fluid responsiveness, patients attended to intensive care unit of Ain Shams University Hospitals during the period from January 2021 to January 2022. Results 1-Comparative study between corrected carotid flow time, femoral arterial doppler and aortic velocity time index in fluid responsiveness assessment in septic shock patients not differ significantly among sex, age. The vasopressor support Norepinephrine and Dopamine, MV (mechanical ventilation), APACHE II and SOFA, not show any significant changes between the responder and non-responder group. The WBCs, PCT and CRP not show any significant changes between responder and non-responder groups. The hemodynamic parameters HR T0 (beats/min), HR T1 (beats/min), MAP T0 (mm Hg), MAP T1 (mm Hg), PP T0 (mm Hg) and PP T1 (mm Hg) not show any significant changes between responder and no responder groups. The Trans-thoracic echocardiography parameters cleared that, all parameters of Eco that includes LVEF (30 – 49 %) and &amp;gt; 50 %, CO T0 (L/m), CO T1 (L/m), SV T0 (mL), SV T1 (mL), VTIAo T0 (cm) and VTIAo T1 (cm). not differ significantly among responder and non responder groups (P &amp;gt; 0.05) and this variables. While, the VTIAo (%) differ significantly (P &amp;lt; 0.01) between responder and non-responder group. As its level in responder group was 35.34 ± 3.11 and in non-responder group was 8.14±1.15. Conclusion Femoral Doppler parameters is a good tool to assess hemodynamic response to PRL in septic shock. The increase in VFmax over 8% and VTIF over 11% are accurate tool to distinguish fluid responders (R) from non-responders (NR) so, it could be taken as an alternative approach to TTE in monitoring fluid responsiveness. In patients with early, undifferentiated shock, ΔCAVTI and %ccFT induced by a PLR maneuver was able to predict fluid responsiveness. It compares favorably with %VTIAo by Echocardiography, with an AUC of 0.88 suggesting that it is an alternative to other methods. Its effectiveness is not affected by mechanical ventilation, respiratory rate, or PEEP &amp;gt;5mmH2O.

Unlocking the power of echocardiography: strategies in risk stratification of patients with PE using echocardiography

Objectives: Pulmonary embolism (PE) is challenging to diagnose due to nonspecific symptoms. While computed tomography pulmonary angiography (CTPA) is the gold standard, transthoracic echocardiography (TTE) is frequently used first. This study aimed to evaluate the accuracy of TTE findings in predicting the severity of CTPA-confirmed PE. Methods: This retrospective study in 2023, analyzed 124 patients who underwent CTPA for suspected PE at Seyed Al Shohada Hospital of Urmia, Iran. The Pulmonary Embolism Severity Index (PESI), as a risk stratification tool for pulmonary embolism, was measured in the first hours of hospitalization. TTE was performed 48 hours following hospital admission, with an emphasis on Key TTE parameters, including McConnell’s sign, D-shape septum sign, right ventricular (RV) dimensions, left ventricular dimensions, pulmonary artery (PA) diameter, tricuspid regurgitation gradient (TRG), Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time (PaACT). Sensitivity, specificity and predictive value were all calculated. Results: Most patients were women (53.23%) over 60 (38.71%). Several TTE measures showed promise for predicting PE: RV dilation (sensitivity 84%, specificity 77%), PA diameter (84% and 28%), TRG (66% and 58%), and PA acceleration time (92% and 62%). However, McConnell’s sign had low accuracy (area under ROC curve 0.62). Tricuspid annular plane systolic excursion (TAPSE) and PA acceleration time showed the best predictive performance (AUC 0.95-0.92) and can be used as screening tools for life-threatening massive PE.PESI index test, when compared to the gold standard CT scan (which shows lung involvement), does not provide additional valuable information and accurate predictions about the severity of PE. Conclusions: TAPSE and PaACT showed excellent predictive ability to CTPA-detected PE. RV dilation and PA diameter also showed good predictive capability. Findings support using some TTE indices to screen for PE severity and risk assessment before CTPA when access is limited.

Heart failure with preserved ejection fraction management: a systematic review of clinical practice guidelines and recommendations.

Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and recommendations, developed by national and international medical organizations, on the management of HFpEF in adults to aid clinical decision-making. We searched MEDLINE and EMBASE on 28 February 2024 for publications over the last 10 years as well as websites of organizations relevant to guideline development. Of the 10 guidelines and recommendations retrieved, 7 showed considerable rigour of development and were subsequently retained for analysis. There was consensus on the definition of HFpEF and the diagnostic role of serum natriuretic peptides and resting transthoracic echocardiography. Discrepancies were identified in the thresholds of serum natriuretic peptides and transthoracic echocardiography parameters used to diagnose HFpEF. There was agreement on the general pharmacological and supportive management of acute and chronic HFpEF. However, differences exist in strategies to identify and address specific phenotypes. Contemporary guidelines for HFpEF management agree on measures to avoid its development and the consideration of cardiac transplantation in advanced diseases. There were discrepancies in recommended frequency of surveillance for patients with HFpEF and sparse recommendations on screening for HFpEF in the general population, use of diagnostic scoring systems, and the role of newly emerging therapies.

Heterogeneity of right ventricular echocardiographic parameters in systemic lupus erythematosus among four clinical subgroups, as stratified by clinical organ involvement in observational cohort

BackgroundSystemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease. Cardiac involvement in SLE is rare but plays an important prognostic role. The degree of cardiac involvement according to SLE subsets...

How to use echocardiography to manage patients with shock?

Echocardiography enables the intensivist to assess the patient with circulatory failure. It allows the clinician to identify rapidly the type and the cause of shock in order to develop an effective management strategy. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied. Early and repeated echocardiography is a valuable tool for the management of shock in the intensive care unit. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography.The four core types of shock (cardiogenic, hypovolemic, obstructive, and septic) can readily be identified by echocardiography. Echocardiography can differentiate the different pathologies that may be the cause of each type of shock. More importantly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock, which emphasises on the added value of transthoracic echocardiography (TTE) in such population of patients.In this review we aimed to provide to clinicians a bedside strategy of the use of TTE parameters to manage patients with shock. In the first part of this overview, we detailed the different TTE parameters and how to use them to identify the type of shock. And in the second part, we focused on the use of these parameters to evaluate the effect of treatments, in different types of shock.

Accuracy and Efficacy of Artificial Intelligence-Derived Automatic Measurements of Transthoracic Echocardiography in Routine Clinical Practice.

Background: Transthoracic echocardiography (TTE) is the gold standard modality for evaluating cardiac morphology, function, and hemodynamics in clinical practice. While artificial intelligence (AI) is expected to contribute to improved accuracy and is being applied clinically, its impact on daily clinical practice has not been fully evaluated. Methods: We retrospectively examined 30 consecutive patients who underwent AI-equipped TTE at a single institution. All patients underwent manual and automatic measurements of TTE parameters using the AI-equipped TTE. Measurements were performed by three sonographers with varying experience levels: beginner, intermediate, and expert. Results: A comparison between the manual and automatic measurements assessed by the experts showed extremely high agreement in the left ventricular (LV) filling velocities (E wave: r = 0.998, A wave: r = 0.996; both p < 0.001). The automated measurements of LV end-diastolic and end-systolic diameters were slightly smaller (-2.41 mm and -1.19 mm) than the manual measurements, although without significant differences, and both methods showing high agreement (r = 0.942 and 0.977, both p < 0.001). However, LV wall thickness showed low agreement between the automated and manual measurements (septum: r = 0.670, posterior: r = 0.561; both p < 0.01), with automated measurements tending to be larger. Regarding interobserver variabilities, statistically significant agreement was observed among the measurements of expert, intermediate, and beginner sonographers for all the measurements. In terms of measurement time, automatic measurement significantly reduced measurement time compared to manual measurement (p < 0.001). Conclusions: This preliminary study confirms the accuracy and efficacy of AI-equipped TTE in routine clinical practice. A multicenter study with a larger sample size is warranted.