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Echocardiography in Cardiovascular Disease

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A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Imaging".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 44009

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Dr. Kenya Kusunose

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Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan
Interests: echocardiography; heart failure; imaging; artificial intelligence

Special Issue Information

Dear Colleagues,

Echocardiography plays a central role in the diagnosis and treatment of cardiovascular diseases. Novel techniques have continued to develop for diagnosis and management in the fields of ischemic, non-ischemic cardiomyopathy, diastolic dysfunction, pulmonary hypertension, coronary artery disease, heart failure, vascular disease, structure heart disease including valvular heart disease, systemic disease, and cardio-oncology. Echocardiography with deformation imaging, 3-dimentional imaging, stress echocardiography, and artificial intelligence enable comprehensive analysis of data, and we can clarify the new knowledge of these diseases and treatment strategies.

The aim of this Special Issue is to cover topics on echocardiography in cardiovascular disease, in particular focusing on novel techniques and findings. The submissions presented in this Special Issue will include review articles, research manuscripts, short contributions, and case reports. This may be also an opportunity for surgeons, cardiologists, sonographers, fellows, and trainees to contribute to showcase their area of expertise.

Dr. Kenya Kusunose
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

coronary artery disease
cardiomyopathy
valvular heart disease
pericardial disease
atrial fibrillation
diastolic function
machine learning
strain imaging
three-dimensional echocardiography
stress echocardiography

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Published Papers (10 papers)

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Research

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15 pages, 1588 KiB

Open AccessArticle

Left Atrial Strain Imaging by Speckle Tracking Echocardiography: The Supportive Diagnostic Value in Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

by Ines Paola Monte, Denise Cristiana Faro, Giancarlo Trimarchi, Fabrizio de Gaetano, Mariapaola Campisi, Valentina Losi, Lucio Teresi, Gianluca Di Bella, Corrado Tamburino and Cesare de Gregorio

J. Cardiovasc. Dev. Dis. 2023, 10(6), 261; https://doi.org/10.3390/jcdd10060261 - 15 Jun 2023

Cited by 30 | Viewed by 3370

Abstract

Background: Left atrial (LA) function is crucial for assessing left ventricular filling in various cardiovascular conditions. Cardiac Amyloidosis (CA) is characterized by atrial myopathy and LA function impairment, with diastolic dysfunction up to restrictive filling pattern, leading to progressive heart failure and arrhythmias. This study evaluates LA function and deformation using speckle tracking echocardiography (STE) in patients with CA compared to a cohort of patients with sarcomeric Hypertrophic Cardiomyopathy (HCM) and a control group. Methods: We conducted a retrospective, observational study (from January 2019 to December 2022) including a total of 100 patients: 33 with ATTR-CA, 34 with HCMs, and 33 controls. Clinical evaluation, electrocardiograms, and transthoracic echocardiography were performed. Echocardiogram images were analyzed in post-processing using EchoPac software for LA strain quantification, including LA-reservoir, LA-conduit, and LA-contraction strain. Results: The CA group exhibited significantly impaired LA function compared to HCMs and control groups, with LA-reservoir median values of −9%, LA-conduit −6.7%, and LA-contraction −3%; this impairment was consistent even in the CA subgroup with preserved ejection fraction. LA strain parameters correlated with LV mass index, LA volume index, E/e’, and LV-global longitudinal strain and were found to be associated with atrial fibrillation and exertional dyspnea. Conclusions: LA function assessed by STE is significantly impaired in CA patients compared to HCMs patients and healthy controls. These findings highlight the potential supportive role of STE in the early detection and management of the disease. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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12 pages, 1288 KiB

Open AccessArticle

Spatial and Temporal Non-Uniform Changes in Left Ventricular Myocardial Strain in Dogs with Duchenne Muscular Dystrophy

by Bijan Ghaleh, Inès Barthélemy, Lucien Sambin, Alain Bizé, Daphné Corboz, Luc Hittinger, Stéphane Blot and Jin Bo Su

J. Cardiovasc. Dev. Dis. 2023, 10(5), 217; https://doi.org/10.3390/jcdd10050217 - 16 May 2023

Viewed by 1515

Abstract

Background: Understanding and effectively treating dystrophin-deficient cardiomyopathy is of high importance for Duchenne muscular dystrophy (DMD) patients due to their prolonged lifespan. We used two-dimensional speckle tracking echocardiography to analyze more deeply the non-uniformity of myocardial strain within the left ventricle during the progression of cardiomyopathy in golden retriever muscular dystrophy (GRMD) dogs. Methods: The circumferential strain (CS) and longitudinal strain (LS) of left ventricular (LV) endocardial, middle and epicardial layers were analyzed from three parasternal short-axis views and three apical views, respectively, in GRMD (n = 22) and healthy control dogs (n = 7) from 2 to 24 months of age. Results: In GRMD dogs, despite normal global systolic function (normal LV fractional shortening and ejection fraction), a reduction in systolic CS was detected in the three layers of the LV apex but not in the LV middle-chamber and base at 2 months of age. This spatial heterogeneity in CS progressed with age, whereas a decrease in systolic LS could be detected early at 2 months of age in the three layers of the LV wall from three apical views. Conclusions: Analyzing the evolution of myocardial CS and LS in GRMD dogs reveals spatial and temporal non-uniform alterations of LV myocardial strain, providing new insights into the progression of dystrophin-deficient cardiomyopathy in this relevant model of DMD. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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12 pages, 1890 KiB

Open AccessArticle

The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation

by Alon Shechter, Steele C. Butcher, Robert J. Siegel, Jenan Awesat, Merry Abitbol, Mordehay Vaturi, Alex Sagie, Ran Kornowski, Yaron Shapira and Idit Yedidya

J. Cardiovasc. Dev. Dis. 2023, 10(2), 49; https://doi.org/10.3390/jcdd10020049 - 28 Jan 2023

Viewed by 5797

Abstract

Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: We retrospectively analyzed consecutive patients referred to a tertiary center for evaluation of dMR of greater than moderate degree, who had normal sinus rhythm, had a left ventricular ejection fraction of above 60%, and did not suffer from any other major valvular disorders. The primary outcome was the combined rate of all-cause mortality, mitral intervention, or new-onset atrial fibrillation (AF) at 5 years following index echocardiogram. Secondary outcomes included individual components of the primary outcome. Results: Overall, 135 patients (median age 68 (IQR, 58–74) years; 93 (68.9%) males; 89 (65.9%) with severe MR) met the inclusion criteria and were followed for 115.2 (IQR, 60.0–155.0) months. Patients with a reversed PV flow pattern (PVFP) (n = 34) more often presented with severe MR compared to those with a normal (n = 49) and non-reversed PVFP (n = 101) (RR = 2.03 and 1.59, respectively, all p < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, p = 0.008 and 0.018, respectively). Furthermore, a reversed PVFP was independently associated with a higher risk of the primary outcome compared to normal PVFP (HR 2.53, 95% CI 1.21–5.31, p = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, p = 0.022). Conclusion: PV flow reversal is associated with a worse 5-year composite of mortality, mitral intervention, or AF in patients with significant dMR. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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12 pages, 1317 KiB

Open AccessArticle

Diagnostic Accuracy of Global Longitudinal Strain for Detecting Exercise Intolerance in Patients with Ischemic Heart Disease

by Sisi Zhang, Yujian Liu, Luying Jiang, Zhaozhao Wang, Wanjun Liu and Houjuan Zuo

J. Cardiovasc. Dev. Dis. 2023, 10(1), 10; https://doi.org/10.3390/jcdd10010010 - 28 Dec 2022

Cited by 3 | Viewed by 2721

Abstract

Objective: Global longitudinal strain (GLS) is a sensitive and reproducible predictive factor in patients with ischemic heart disease (IHD), although its correlation with exercise tolerance is unknown. We aimed to identify the correlation between global longitudinal strain (GLS) and cardiopulmonary exercise testing (CPX) parameters and assess the prognostic implications and accuracy of GLS in predicting exercise intolerance in populations with ischemic heart disease (IHD) using CPET criteria. Methods: Prospectively, 108 patients with IHD underwent CPX and 2D speckle-tracking echocardiography. Correlation between GLS and multiple CPX variables was assessed using Spearman’s correlation analysis and univariate regression analysis. A receiver operating characteristic (ROC) curve analysis was performed on GLS to detect exercise intolerance. Results: GLS was correlated with peak oxygen uptake (peak VO₂; r = −0.438, p = 0.000), %PPeak VO₂ (−0.369, p = 0.000), peak metabolic equivalents (METs@peak; r = −0.438, p < 0.01), and the minute ventilation–carbon dioxide production (VE/VCO₂) slope (r = 0.257, p < 0.01). Weak-to-moderate correlations were also identified for the respiratory exchange rate at the anaerobic threshold (RER@AT), end-tidal carbon dioxide at the anaerobic threshold (PETCO₂@AT), oxygen consumption at the anaerobic threshold (VO₂@AT), carbon dioxide production at the anaerobic threshold (VCO₂@AT), and metabolic equivalents at the anaerobic threshold (METs@AT; p < 0.01). On multivariate analysis, the results showed that age, the BMI, and GLS are independent predictors for reduced exercise capacity in patients with IHD (p < 0.01). The area under the ROC curve value of GLS for identifying patients with a peak VO₂ of <14 mL/kg/min was 0.73 (p = 0.000). Conclusion: As a sensitive echocardiographic assessment of patients with ischemic heart disease, global longitudinal strain is an independent predictor of reduced exercise capacity and has a sensitivity of 74.2% and a specificity of 66.7% to detect exercise intolerance. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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14 pages, 1012 KiB

Open AccessArticle

Athlete’s Heart in Elite Biathlon, Nordic Cross—Country and Ski-Mountaineering Athletes: Cardiac Adaptions Determined Using Echocardiographic Data

by Paul Zimmermann, Othmar Moser, Max L. Eckstein, Jan Wüstenfeld, Volker Schöffl, Lukas Zimmermann, Martin Braun and Isabelle Schöffl

J. Cardiovasc. Dev. Dis. 2022, 9(1), 8; https://doi.org/10.3390/jcdd9010008 - 29 Dec 2021

Cited by 5 | Viewed by 3425

Abstract

Twelve world elite Biathlon (Bia), ten Nordic Cross Country (NCC) and ten ski-mountaineering (Ski-Mo) athletes were evaluated for pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, sports-related cardiac remodeling was analyzed by performing two-dimensional echocardiography including speckle tracking analysis as left ventricular global longitudinal strain (LV-GLS). A multicenter retrospective analysis of echocardiographic data was performed in 32 elite world winter sports athletes, which were obtained between 2020 and 2021 during the annual medical examination. The matched data of the elite world winter sports athletes (14 women, 18 male athletes, age: 18–35 years) were compared for different echocardiographic parameters. Significant differences could be revealed for left ventricular systolic function (LV-EF, p = 0.0001), left ventricular mass index (LV Mass index, p = 0.0078), left atrial remodeling by left atrial volume index (LAVI, p = 0.0052), and LV-GLS (p = 0.0003) between the three professional winter sports disciplines. This report provides new evidence that resting measures of cardiac structure and function in elite winter sport professionals can identify sport specific remodeling of the left heart, against the background of training schedule and training frequency. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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10 pages, 965 KiB

Open AccessArticle

Use of Echocardiography and Heart Failure In-Hospital Mortality from Registry Data in Japan

by Kenya Kusunose, Yuichiro Okushi, Yoshihiro Okayama, Robert Zheng, Michikazu Nakai, Yoko Sumita, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Daiju Fukuda, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki and Masataka Sata

J. Cardiovasc. Dev. Dis. 2021, 8(10), 124; https://doi.org/10.3390/jcdd8100124 - 30 Sep 2021

Cited by 4 | Viewed by 2904

Abstract

Background: Echocardiography requires a high degree of skill on the part of the examiner, and the skill may be more improved in larger volume centers. This study investigated trends and outcomes associated with the use and volume of echocardiographic exams from a real-world registry database of heart failure (HF) hospitalizations. Methods: This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). A first analysis was performed to assess the trend of echocardiographic examinations between 2012 and 2016. A secondary analysis was performed to assess whether echocardiographic use was associated with in-hospital mortality in 2015. Results: During this period, the use of echocardiography grew at an average annual rate of 6%. Patients with echocardiography had declining rates of hospital mortality, and these trends were associated with high hospitalization costs. In the 2015 sample, a total of 52,832 echocardiograms were examined, corresponding to 65.6% of all HF hospital admissions for that year. We found that the use and volume of echocardiography exams were associated with significantly lower odds of all-cause hospital mortality in heart failure (adjusted odds ratio (OR): 0.48 for use of echocardiography and 0.78 for the third tertile; both p < 0.001). Conclusions: The use of echocardiography was associated with decreased odds of hospital mortality in HF. The volumes of echocardiographic examinations were also associated with hospital mortality. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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11 pages, 1500 KiB

Open AccessEditor’s ChoiceArticle

Left Cardiac Remodelling Assessed by Echocardiography Is Associated with Rho-Kinase Activation in Long-Distance Runners

by Felipe Contreras-Briceño, Julián Vega, Jorge Mandiola, María Paz Ocaranza, Sebastián Herrera, Manuel Salinas, Rodrigo Fernández, Jorge E. Jalil, Sergio Lavandero, Mario Chiong, Paz Godoy, Pablo F. Castro, Marta Sitges and Luigi Gabrielli

J. Cardiovasc. Dev. Dis. 2021, 8(10), 118; https://doi.org/10.3390/jcdd8100118 - 24 Sep 2021

Viewed by 3181

Abstract

This single-blind and cross-sectional study evaluated the role of Rho-kinase (ROCK) as a biomarker of the cardiovascular remodelling process assessed by echocardiography in competitive long-distance runners (LDRs) during the training period before a marathon race. Thirty-six healthy male LDRs (37.0 ± 5.3 years; [...] Read more.

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O₂-peak: 56.5 ± 7.3 mL·kg⁻¹·min⁻¹) were separated into two groups according to previous training level: high-training (HT, n = 16) ≥ 100 km·week⁻¹ and low-training (LT, n = 20) ≥ 70 and < 100 km·week⁻¹. Also, twenty-one healthy nonactive subjects were included as a control group (CTR). A transthoracic echocardiography was performed and ROCK activity levels in circulating leukocytes were measured at rest (48 h without exercising) the week before the race. The HT group showed a higher left ventricular mass index (LVMi) and left atrial volume index (LAVi) than other groups (p < 0.05, for both); also, higher levels of ROCK activity were found in LDRs (HT = 6.17 ± 1.41 vs. CTR = 1.64 ± 0.66 (p < 0.01); vs. LT = 2.74 ± 0.84; (p < 0.05)). In LDRs a direct correlation between ROCK activity levels and LVMi (r = 0.83; p < 0.001), and LAVi (r = 0.70; p < 0.001) were found. In conclusion, in male competitive long-distance runners, the load of exercise implicated in marathon training is associated with ROCK activity levels and the left cardiac remodelling process assessed by echocardiography. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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Review

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15 pages, 2310 KiB

Open AccessEditor’s ChoiceReview

Contemporary Diagnosis and Management of Hypertrophic Cardiomyopathy: The Role of Echocardiography and Multimodality Imaging

by Takeshi Kitai, Andrew Xanthopoulos, Shoko Nakagawa, Natsuko Ishii, Masashi Amano, Filippos Triposkiadis and Chisato Izumi

J. Cardiovasc. Dev. Dis. 2022, 9(6), 169; https://doi.org/10.3390/jcdd9060169 - 25 May 2022

Cited by 9 | Viewed by 8569

Abstract

Hypertrophic cardiomyopathy (HCM) is an underdiagnosed genetic heart disease with an estimated prevalence of 0.2–0.5%. Although the prognosis of HCM is relatively good, with an annual general mortality of ~0.7%, some patients have an increased risk of sudden death, or of developing severe heart failure requiring heart transplantation or left ventricular (LV) assist device therapy. Therefore, earlier diagnosis and proper identification of high-risk patients may reduce disease-related morbidity/mortality by promoting timely treatment. Echocardiography is the primary imaging modality for patients with suspected HCM; it plays central roles in differential diagnosis from other causes of LV hypertrophy and in evaluating morphology, hemodynamic disturbances, LV function, and associated valvular disease. Echocardiography is also an essential tool for the continuous clinical management of patients with confirmed HCM. Other imaging modalities, such as cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI), can supplement echocardiography in identifying high-risk as well as milder HCM phenotypes. The role of such multimodality imaging has been steadily expanding along with recent advancements in surgical techniques and minimally invasive procedures, and the emergence of novel pharmacotherapies directly targeting pathogenic molecules such as myosin inhibitors. Here we review essential knowledge surrounding HCM with a specific focus on structural and functional abnormalities assessed by imaging modalities, leading to treatment strategies. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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14 pages, 3356 KiB

Open AccessEditor’s ChoiceReview

Exercise Stress Echocardiography in the Diagnostic Evaluation of Heart Failure with Preserved Ejection Fraction

by Tomonari Harada, Kazuki Kagami, Toshimitsu Kato, Hideki Ishii and Masaru Obokata

J. Cardiovasc. Dev. Dis. 2022, 9(3), 87; https://doi.org/10.3390/jcdd9030087 - 17 Mar 2022

Cited by 19 | Viewed by 5605

Abstract

More than half of patients with heart failure have a preserved ejection fraction (HFpEF). The prevalence of HFpEF has been increasing worldwide and is expected to increase further, making it an important health-care problem. The diagnosis of HFpEF is straightforward in the presence of obvious objective signs of congestion; however, it is challenging in patients presenting with a low degree of congestion because abnormal elevation in intracardiac pressures may occur only during physiological stress conditions, such as during exercise. On the basis of this hemodynamic background, current consensus guidelines have emphasized the importance of exercise stress testing to reveal abnormalities during exercise, and exercise stress echocardiography (i.e., diastolic stress echocardiography) may be used as an initial diagnostic approach to HFpEF owing to its noninvasive nature and wide availability. However, evidence supporting the use of this method remains limited and many knowledge gaps exist with respect to diastolic stress echocardiography. This review summarizes the current understanding of the use of diastolic stress echocardiography in the diagnostic evaluation of HFpEF and discusses its strengths and limitations to encourage future studies on this subject. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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15 pages, 4617 KiB

Open AccessEditor’s ChoiceReview

Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases

by Katsuji Inoue, Hiroshi Kawakami, Yusuke Akazawa, Haruhiko Higashi, Takashi Higaki and Osamu Yamaguchi

J. Cardiovasc. Dev. Dis. 2022, 9(3), 68; https://doi.org/10.3390/jcdd9030068 - 27 Feb 2022

Cited by 9 | Viewed by 5161

Abstract

The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease. Full article

(This article belongs to the Special Issue Echocardiography in Cardiovascular Disease)

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