Echo Research and Practice

Normal cut-off values for left atrial (LA) size and function may be altered by aging and ethnic differences. No age-related reference values for LA volumetric measurements or LA strain exist in Africans. We aimed to establish normal age-appropriate values of LA size and function in black Africans. Additionally, we studied the correlation between age, LA strain and volumetric parameters.In this prospective, cross-sectional study of 120 individuals (mean age 38.7 ± 12.8 years, 50% men), subjects were classified into four age groups: 18-29, 30-39, 40-49 and 50-70 years. LA volumes were measured by biplane Simpson's method, and Philips QLAB 9 (Amsterdam, The Netherlands) speckle-tracking software was used to measure LA peak strain in the reservoir (ƐR) and contractile phase (ƐCT).No significant differences in the maximum and minimum LAVi were noted among the four age categories (P = 0.1, P = 0.2). LA volumetric function assessment showed no difference in reservoir function between age groups (P > 0.05), conduit function decreased with advancing age (r = -0.3, P < 0.001) and booster function displayed a significant increase with age (LA active emptying volume index, P = 0.001). There was a significant decrease in LA ƐR (P < 0.0001) in the older age groups, whereas ƐCT remained unchanged (P = 0.27).Age-related changes in LA reservoir, conduit and contractile function in black Africans are similar to those observed in other populations, as was the trend of declining ƐR with advancing age. The preservation of ƐCT with increasing age requires further analysis.

Ruchika Meel

Bijoy K. Khandheria

Ferande Peters

Elena Libhaber

Samantha Nel

Mohammed R. Essop

Effects of age on left atrial volume and strain parameters using echocardiography in a normal black population

正常黑人群体中年龄对左心房容积和应变参数的回声心动图影响

Abstract Background Following the publication of international cardio-oncology (CO) imaging guidelines, standard echocardiographic monitoring parameters of left ventricular systolic function have been endorsed. Recommendations highlight that either two-dimensional (2D) or three-dimensional (3D) left ventricular ejection fraction (LVEF), alongside global longitudinal strain (GLS) should be routinely performed for surveillance of patients at risk of cancer therapy-related cardiac dysfunction (CTRCD). We studied the feasibility of 3D-LVEF, 2D-GLS and 2D-LVEF in a dedicated CO service. Methods This was a single-centre prospective analysis of consecutive all-comer patients (n = 105) referred to an NHS CO clinic. Using a dedicated Philips EPIQ CVx v7.0, with X5-1 3D-transducer and 3DQA software, we sought to acquire and analyse 2D- and 3D-LVEF and 2D-GLS, adhering to the British Society of Echocardiography (BSE) and British Cardio-Oncology Society (BCOS) transthoracic echocardiography protocol. Results A total of 105 patients were enrolled in the study; 5 were excluded due to carcinoid heart disease (n = 5). Calculation of 3D-LVEF was achieved in 40% (n = 40), 2D-GLS in 73% (n = 73), and 2D-LVEF in 81% (n = 81). LV quantification was not possible in 19% (n = 19) due to poor myocardial border definition. Strong correlation existed between 2D-LVEF and 3D-LVEF (r = 0.94, p &lt; 0.0001). Bland–Altman plot demonstrated no statistical differences in that the mean deviation between 2D-LVEF and 3D-LVEF were consistent throughout a range of LVEF values. The most persistent obstacle to 3D-LVEF acquisition was insufficient myocardial border tracking (n = 30, 50%). Conclusion This study demonstrates the high feasibility of 2D-GLS and 2D-LVEF, even in those with challenging echocardiographic windows. The lower feasibility of 3D-LVEF limits its real-world clinical application, even though only a small difference in agreement with 2D-LVEF calculation was found when successfully performed.

Patrick O’Driscoll

David Gent

Liam Corbett

Rod Stables

Rebecca Dobson

Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS cardio-oncology clinic

三维及应变经胸超声心动图在单一中心NHS心脏肿瘤诊所中的可行性

Abstract Background Cardiac resynchronization therapy (CRT) has an additive therapeutic influence on left ventricular function in heart failure patients, but the underlying mechanisms through which it works are not completely explained. Our aim was to further elucidate the role of this intervention via rotational mechanics using 2D speckle tracking echocardiography (2D-STE). Results We investigated 46 patients (65 ± 9 years) who received CRT. All enrolled patients were assessed on admission by 2D-STE and 6 min walk test (6 min WT) and followed in the outpatient device clinic by 2D-STE (at 1 week and 6 months post-implantation) and 6 min WT (at 6 months post-implantation). On their first appointment all biventricular systems were optimised by atrioventricular delay optimisation and by changing the temporal activation of ventricular electrodes aiming to reach the highest left ventricular effective stroke volume across all activation options. A new 2D-STE based index (twist integral) targeting to assess the rotational mechanics of the whole cardiac cycle was also measured to further explain the CRT response. Twenty-two (48%) patients were responders at 6-month follow-up and most of them had dilated cardiomyopathy. The commonest selected mode that was related with the greatest left ventricular performance response was the simultaneous activation of the 2 ventricular leads (39%). The strongest predictor of CRT response was the improvement of effective stroke volume between admission and first appointment at clinic, followed by the improvement of twist integral, the absence of coronary artery disease, and the improvement of peak systolic twist. Conclusions Additional CRT optimisation via changing the temporal activation of ventricular electrodes is beneficial for left ventricular performance in heart failure patients. The success of biventricular pacing may also be explained by the improvement of left ventricular rotational mechanics.

Alexandros Stefanidis

Paraskevi Korlou

Panagiotis Margos

Ignatios Ikonomidis

Ioannis Paraskevaidis

Konstantinos Gatzoulis

Evmorfia Aivalioti

Konstantinos Kostopoulos

The implementation of speckle tracking echocardiography for cardiac resynchronization therapy optimisation. A rotational myocardial mechanics interpretation

斑点追踪超声心动图在心脏再同步治疗优化中的应用：一种旋转心肌力学解释

While the visual estimation of systolic left ventricular function by experienced examiners closely aligns with quantitative methodologies, the accuracy of visual estimation in determining the severity of valvular regurgitation using colour flow Doppler assessment of native heart valves remains largely unexplored. This study analysed the ability of 262 physicians to visually estimate the severity of 12 native valve regurgitations by grading colour Doppler transthoracic echocardiography loops in an online questionnaire. The assessments of the participants were compared to standardized quantitative evaluations conducted by certified echocardiography experts. Of the three valves to assess, evaluations by the participants showed the best correlation (Rs = 0.75, p < 0.0001) and agreement (percent agreement: 66.4%) with those of the experts in mitral valve regurgitation (MR). High agreement was observed for mild regurgitation across all valves (MR 94.5%, AR 80.3% and TR 88.7%), while consensus diminished in moderate (MR 55.9%, AR 49.5% and TR 55.0%) and severe regurgitation (MR 57.6%, AR 67.4%, TR 14.6%). The study underscores the potential utility of visual estimation of valvular regurgitation in clinical settings for identifying clinically relevant regurgitations. However, our findings also highlight the importance of integrating visual estimation with quantitative methods, particularly in moderate and severe cases of regurgitation.

Ozan Demirel

Paolo Di Stefano

Elke Boxhammer

Thomas Wuppinger

Christina Granitz

Björn Goebel

Uta C. Hoppe

Michael Lichtenauer

Moritz Mirna

Visual grading of valvular regurgitation is inferior to measurement – results from the VIAVA-study (VIsual Assessment of VAlvular Regurgitation)

视觉评估瓣膜反流不如测量准确——VIAVA研究结果（视觉评估瓣膜反流）

Abstract In this paper we discuss the relevance of continuity equation based aortic valve area (AVA) calculation as a robust parameter suitable for accurate grading of aortic stenosis (AS) irrespective of flow conditions. Combining the AVA-based grading and echocardiography-based staging , can provide with the most comprehensive clinical assessment of patients with AS and preserved left ventricular systolic function to streamline management decisions.

Attila Kardos

Mani A. Vannan

A proposal of a simplified grading and echo-based staging of aortic valve stenosis to streamline management

简化主动脉瓣狭窄分级和基于回声的分期建议，以简化管理流程

Abstract Background The left atrial (LA) volume has been demonstrated to be an important predictor of adverse outcome in patients with various cardiac conditions, including acute myocardial infarction (AMI). However, new treatment strategies in patients with AMI have led to better patient outcomes. We hypothesised that increased LA size could still predict mortality in patients with AMI despite improved treatment strategies. Methods We included patients with AMI in a prospective multicenter cohort study and the study patients were enrolled from 2014 to 2022. We recorded echocardiographic and clinical data during their index hospitalisation. Indexed LA volume (LAVi) was assessed in all patients and was used as a continuous variable in the univariate and multivariate Cox regression analysis. The study took place over a period of five years and median follow-up time was 3.8 years (range 3.1 to 5.0 years). The primary study outcomes were all-cause mortality and major adverse cardiac events (MACE). MACE was defined as hospital readmission due to myocardial infarction, cardiac arrest, stroke, heart failure, or onset of new atrial fibrillation. Results We included 487 patients (69 ± 12 years old, 26% female) with AMI. During the follow-up period all-cause mortality was 50 (10.3%) and patients who reached the primary outcomes were 153 (31.4%). The deceased patients had higher LAVi compared to survivors (40.0 ± 12.9 mL/m 2 vs. 29.7 ± 11.2 mL/m 2 , p &lt; 0.001). Factors associated with all-cause mortality and MACE were age, year of enrollment, left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), LV filling pressure, moderate or severe mitral regurgitation and LAVi. GLS and EF were segregated into two distinct models due to their moderately high correlation ( r = 0.57, p &lt; 0.001). LAVi remained as an independent echocardiographic predictor of primary outcomes after adjusting for the covariates above in two separates multivariable Cox regression models (hazard ratio 1.02/1.02 mL/m 2 [95% CI 1.01–1.03/1.01–1.03], p = 0.006/0.003). Conclusions Our study demonstrated that LA dilatation is an independent echocardiographic predictor of mortality and MACE in patients with AMI despite improved treatment strategies. This finding highlights the potential of using LAVi as a marker for prognostication in these patients.

Jorun Tangen

Thuy Mi Nguyen

Daniela Melichova

Lars Gunnar Klaeboe

Marianne Forsa

Kristoffer Andresen

Adrien Al Wazzan

Oyvind Lie

Fatih Kizilaslan

Kristina Haugaa

Helge Skulstad

Harald Brunvand

Thor Edvardsen

Left atrial volume assessed by echocardiography identifies patients with high risk of adverse outcome after acute myocardial infarction

通过超声心动图评估的左心房容积可识别急性心肌梗死后不良结局高风险患者

Abbreviation	Echo Res Pract
Journal Impact	3.05
Quartiles(Global)	CARDIAC & CARDIOVASCULAR SYSTEMS(Q2)

ISSN	2055-0456, 2055-0464
h-index	23

Publication Information	Publisher: BioMed Central Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2014，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Echo Research and Practice

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Effects of age on left atrial volume and strain parameters using echocardiography in a normal black population

Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS cardio-oncology clinic

The implementation of speckle tracking echocardiography for cardiac resynchronization therapy optimisation. A rotational myocardial mechanics interpretation

Visual grading of valvular regurgitation is inferior to measurement – results from the VIAVA-study (VIsual Assessment of VAlvular Regurgitation)

A proposal of a simplified grading and echo-based staging of aortic valve stenosis to streamline management

Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS cardio-oncology clinic

The implementation of speckle tracking echocardiography for cardiac resynchronization therapy optimisation. A rotational myocardial mechanics interpretation

Visual grading of valvular regurgitation is inferior to measurement – results from the VIAVA-study (VIsual Assessment of VAlvular Regurgitation)

A proposal of a simplified grading and echo-based staging of aortic valve stenosis to streamline management

Left atrial volume assessed by echocardiography identifies patients with high risk of adverse outcome after acute myocardial infarction