Search Results (364)

Background and Objectives: Type 2 diabetes (T2DM) substantially increases cardiovascular risk; beyond the well-recognized left-ventricular involvement in diabetic cardiomyopathy, emerging data indicate subclinical right-ventricular (RV) dysfunction may also be present. This study aimed to evaluate whether speckle-tracking echocardiography identifies subclinical right-ventricular systolic dysfunction in type 2 diabetes, despite normal conventional indices and preserved global systolic function. Materials and Methods: We conducted a cross-sectional, single-center study in accordance with STROBE recommendations, enrolling 77 participants, 36 adults with T2DM, and 41 non-diabetic controls, between December 2024 and July 2025. All participants underwent comprehensive transthoracic echocardiography, including conventional parameters (tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TV S’), right ventricular fractional area change (RVFAC)) and deformation imaging (right ventricular global longitudinal strain (RV GLS), right ventricular free wall longitudinal strain (RVFWS)) using speckle-tracking echocardiography. Biochemical and clinical data, including glycosylated hemoglobin (HbA1c), were recorded. Correlation and ROC curve analyses were performed to explore associations and predictive value. Results: The mean age was comparable between the two groups (62.08 ± 9.54 years vs. 60.22 ± 13.39 years; p = 0.480). While conventional RV parameters did not differ significantly between groups, diabetic patients had significantly lower RV GLS (−13.86 ± 6.07% vs. −18.59 ± 2.27%, p < 0.001) and RVFWS (−15.64 ± 4.30% vs. −19.03 ± 3.53%, p < 0.001). HbA1c levels correlated positively with RV strain impairment (RVFWS r = 0.41, p < 0.001). Both RV GLS and RVFWS were independent predictors of RV dysfunction in logistic regression analysis. ROC analysis showed good diagnostic performance for RV GLS, AUC = 0.84 with an optimal cut-off −17.2% (sensitivity 86.1% and specificity 80.5%) and RVFWS, AUC = 0.76 with cut-off −17.6% (sensitivity 77.8; specificity 80.5%) in identifying early myocardial involvement. Conclusions: RV systolic dysfunction may occur early in T2DM, even when traditional echocardiographic indices remain within normal limits. Speckle-tracking echocardiography, particularly RV GLS and RVFWS, offers sensitive detection of subclinical myocardial impairment, reinforcing its value in early cardiovascular risk stratification among diabetic patients. Full article

Background: Right ventricular (RV) strain using two-dimensional speckle tracking is a reliable and clinically significant tool for detecting RV systolic dysfunction, but it varies by age, vendor, and software. Objectives: To establish pediatric age-specific normal values and Z-score equations for biventricular strain using GE Healthcare equipment and software. Methods: Children 0–18 years with structurally and functionally normal hearts, who visited the Wilhelmina Children’s Hospital Utrecht between October 2020 and December 2023, were retrospectively included and divided into age groups: 0 years, 1–4 years, 5–9 years, 10–13 years, and 14–18 years. Left ventricular (LV) and RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWGLS) were analyzed. Results: We included 129 subjects (57% male) (0 years: n = 17; 1–4 years: n = 22; 5–9 years: n = 34; 10–13 years: n = 35; 14–18 years: n = 20). Low R² values were strain-adjusted for age, height, and body surface area (all < 0.3), and the sample size limited Z-score equation reliability. Therefore, data are presented as mean ± SD or median [IQR] stratified by age. LV GLS, RV GLS, and RV FWGLS showed a nonlinear relationship with age, peaking at the 1–4 years age group and decreasing with age. Conclusions: LV GLS, RV GLS, and RV FWGLS showed age-related differences in children using GE equipment and software, which highlights the importance of age-specific normal strain values, including Z-score equations as a function of age. Full article

Background: Takotsubo syndrome (TS) is an acute heart failure characterized by transient systolic dysfunction of the left ventricle (LV). Given the complex cardiohepatic interactions in heart failure, the purpose of this study was to examine the role of hepatic T1 mapping in TS patients as an imaging biomarker of the cardiohepatic axis and to explore its correlation with demographics, laboratory data, and cardiovascular magnetic resonance (CMR) findings. Methods: In this retrospective pilot study, CMR was performed in 62 consecutive patients with TS (54 females, 73.47 ± 9.88 years). Additionally, 24 age- and sex-matched control subjects were included (20 females, 69.67 ± 6.88 years). A dedicated CMR software (CV42 6.0, CVI42, Circle Cardiovascular Imaging Inc., Calgary, AB, Canada) was used to assess atrial and ventricular strain parameters, as well as parametric mapping, including hepatic T1 mapping. Results: TS patients exhibited significantly higher hepatic T1 mapping values compared with the age-, sex-, and cardiovascular risk factor-matched control group (499.80 ± 141.86 vs. 425.26 ± 51.91, p = 0.017). In multivariable analysis, hepatic T1 mapping was independently associated with right ventricular (RV) longitudinal strain (β coefficient = 2.936, p = 0.007) and N-terminal pro-B-type natriuretic peptide (β coefficient = 2.395, p = 0.024). Conclusions: In this pilot study, hepatic T1 mapping was elevated in TS patients, suggesting its potential role as an imaging biomarker of cardiohepatic interaction. Hepatic T1 also showed independent associations with RV longitudinal strain and N-terminal pro-B-type natriuretic peptide, both well-known markers of adverse outcomes in TS. These preliminary findings warrant validation in larger studies. Full article

Heart failure (HF) imposes a significant burden on public health, affecting over 56.19 million people worldwide. Right ventricular (RV) dysfunction may occur in HF patients due to various factors, including adverse interventricular interactions, ischemic heart disease, and HF-correlated pulmonary hypertension. Additionally, the deterioration of RV function plays a critical role in the progression of HF, regardless of left ventricular (LV) systolic function, suggesting an unfavorable outcome. Throughout the progression of HF and increasing afterload, the right ventricle undergoes adaptive remodeling to preserve adequate cardiac output. Right ventricular-pulmonary artery (RV-PA) coupling integrates the dynamic adaptation of RV systolic function to afterload and has been considered a stronger predictor of HF prognosis than other conventional parameters. Thus, accurate evaluations of RV-PA coupling are significant in the clinical diagnosis and management of HF patients, along with prognostic speculation. In this review, we summarize the basic principles and measurements of RV-PA coupling and focus on its clinical significance across each subtype of HF. Full article

Background and Clinical Significance: Congenital malformations of the right atrium are rare. Their clinical presentation varies widely, from the absence of symptoms to sudden death, often being diagnosed incidentally by cardiac imaging. First described in 1955, the right atrial diverticulum is usually characterized as a pouch-like structure originating from the free atrial wall, or right atrial appendage. The prevalence of congenital malformations of the right atrium is unknown because few clinical cases have been reported. Associated complications include arrhythmias, pulmonary thromboembolism, progressive dilatation marked by a high risk of compression and rupture. In these cases, the optimal therapeutic approach is surgical resection. Case Presentation: We present the case of a 58-year-old, hypertensive female with a history of COVID-19 (Coronavirus Disease 2019), who was admitted for persistent dyspnea and chest pain. An electrocardiogram on arrival showed no arrhythmias or ischemic changes, and echocardiography revealed severe systolic dysfunction—a left ventricular ejection fraction (LVEF) of 20%, moderate mitral and tricuspid regurgitations, and a pericardial collection, adjacent to the right atrium, considered to be a localized pericardial effusion. Coronary angiography excluded ischemic etiology and a viral myocarditis was further suspected. Cardiac magnetic resonance imaging (IRM) showed a non-ischemic scar pattern in the interventricular septum, but also detected a well-defined large mass, which communicated with the right atrium through a 20 mm opening, suggestive of a right atrial diverticulum. Contrast echocardiography confirmed the communication between the cavity and the right atrium. A surgical resection of the large diverticulum was performed. Conclusions: The particularity of this case consists in the incidental identification of a rare cardiac malformation in an adult patient. Full article

Aim: Both the arterial and venous systems independently predict mortality in septic shock, yet no bedside tools are able to integrate their assessment. Risk stratification becomes challenging when arterial parameters suggest favourable outcomes while venous parameters indicate poor prognosis, or vice versa. To address this gap, we developed the VTI-VeXUS index and conducted this proof-of-concept study to test its association with mortality. Methods: We conducted a prospective cohort study in two ICUs, enrolling adult patients with septic shock. We calculated the VTI-VeXUS index (VTI/[VeXUS+1]) from ultrasound measurements obtained within 24 h of ICU admission and stratified patients as having a high or low VTI-VeXUS index based on a cutoff of 11. We evaluated the primary outcome of mortality at 30 days using survival analysis. Results: We enrolled 62 patients. Patients with a low VTI-VeXUS index had higher rates of left ventricular dysfunction (32.3% vs. 3.2%, p = 0.006), right ventricular dysfunction (35.5% vs. 0.0%, p < 0.001), lower stroke volume (54.0 mL vs. 62.0 mL, p = 0.005), and increased 30-day mortality (adjusted HR: 3.86, 95% CI 1.23 to 12.14). Conclusions: In this exploratory proof-of-concept study, a low VTI-VeXUS index was associated with ventricular dysfunction and increased mortality. While limited by small sample size and univariate analysis, these findings suggest this novel integrated metric warrants validation in larger prospective studies. Full article

Background: Pulmonary thromboendarterectomy (PTE) remains the preferred treatment for surgical accessible thrombus in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, residual pulmonary hypertension (PH) can persist post-PTE. Methods: A retrospective single-center analysis of patients that underwent PTE between 2013 and 2023. At 3-month follow-up, we performed a qualitative Echo-Doppler (DE) assessment and applied a semi-quantitative DE scoring system (DESS), assigning point values for six DE parameters: right ventricle (RV) size, RV shape (systolic base–apex ratio), RV function, septal position, tricuspid regurgitation (TR) and RV outflow tract notching (RVOTN). Higher scores suggested a more significant residual PH syndrome. Results: A total of 188 subjects (80%) did not require further PH intervention at ≥3 months (Group A); 48 (20%) required ongoing PH treatment (Group B). The pre-PTE median DESS was 10 and the post-PTE median DESS was 3.00 (range 0–16). The maximum DESS was 17. Using ROC analysis, post-PTE DESS strongly discriminated between Group A and B (AUC 0.76; 95% CI 0.65–0.89; p < 0.001). A post-PTE DESS of >6.5 differentiated Group A and B. Evidence of TR (OR 0.191, CI 0.103–0.279; p < 0.0001) and RV enlargement (OR 0.242; CI 0.153–0.330; p < 0.0001) at follow-up was associated with a need for additional PH interventions. Conclusions: Serial DE examination is a viable, noninvasive method to assess significant residual PH post-PTE. Full article

Background: The coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has had a profound impact on global health, extending beyond pulmonary complications. Cardiovascular involvement in COVID-19 is multifactorial and may be influenced by viral load, inflammatory response, and pre-existing comorbidities. Discussion: Acute complications include myocardial injury, arrhythmias, acute coronary syndromes (ACS), heart failure, Takotsubo cardiomyopathy, myopericarditis, and cardiac arrest. Notably, atrial fibrillation (AF) emerges as a frequent arrhythmic complication, particularly among critically ill patients, and is associated with increased mortality. COVID-19-patients with concomitant ACS present more severe clinical profiles and higher rates of thrombotic events, including stent thrombosis. Cardiac arrest predominantly presents with non-shockable rhythms and is associated with dismal outcomes. COVID-19 also exacerbates heart failure, both by aggravating existing cardiac dysfunction or by precipitating de novo heart failure. Takotsubo cardiomyopathy and myocarditis, although less frequent, have been reported and are often underdiagnosed due to subtle clinical presentations. Right ventricular dysfunction, linked to pulmonary involvement, has emerged as a key prognostic marker. Post-COVID-19 syndrome include persistent cardiac abnormalities such as reduced ventricular function and myocardial inflammation. Cardiac magnetic resonance imaging and strain echocardiography have proven useful in identifying subclinical cardiac involvement. Conclusions: Early recognition and monitoring of cardiovascular complications are crucial for improving outcomes in patients affected by COVID-19. This review summarizes current evidence regarding cardiovascular manifestations associated with COVID-19. Full article

Pulmonary hypertension (PH) is a serious pulmonary vascular disease. Vascular remodeling, metabolic reprogramming, inflammation, and fibrosis are all major pathogenic mechanisms in PH. MicroRNAs (miRNAs) are small RNAs, about 20–24 nucleotides long, that play important regulatory roles in biological processes, and in recent years, miRNAs have been found to potentially play a regulatory role in the pathogenesis of PH, and also serve as biomarkers and therapeutic agents for PH. However, there is still a long way to go from these experimental findings to their implementation in clinical practice. This study reviews the potential role of miRNAs in the pathogenesis of PH and suggests future applications of miRNAs in PH. Full article

Background/Objectives: Historically, echocardiographic imaging of the right heart has been challenging because its abnormal geometry is not conducive to reproducible anatomical and functional assessment. With the development of advanced echocardiographic techniques, it is now possible to complete an integrated assessment of the right heart that has fewer assumptions, resulting in increased accuracy and precision. Echocardiography continues to be the first-line imaging modality for diagnostic analysis and the management of acute and chronic right heart failure because of its portability, versatility, and affordability compared to cardiac computed tomography, magnetic resonance imaging, nuclear scintigraphy, and positron emission tomography. Virtually all echocardiographic parameters have been well-validated and have demonstrated prognostic significance. The goal of this narrative review of the echocardiographic parameters of the right heart chambers and hemodynamic alterations associated with right ventricular dysfunction is to present information that must be acquired during each examination to deliver a comprehensive assessment of the right heart and to discuss their clinical significance in right heart failure. Methods: Using a literature search in the PubMed database from 1985 to 2025 and the Cochrane database, which included but was not limited to terminology that are descriptive of right heart anatomy and function, disease states involving acute and chronic right heart failure and pulmonary hypertension, and the application of conventional and advanced echocardiographic modalities that strive to elucidate the pathophysiology of right heart failure, we reviewed randomized control trials, observational retrospective and prospective cohort studies, societal guidelines, and systematic review articles. Conclusions: In addition to the conventional 2-dimensional echocardiography and color, spectral, and tissue Doppler measurements, a contemporary echocardiographic assessment of a patient with suspected or proven right heart failure must include 3-dimensional echocardiographic-derived measurements, speckle-tracking echocardiography strain analysis, and hemodynamics parameters to not only characterize the right heart anatomy but to also determine the underlying pathophysiology of right heart failure. Complete and point-of-care echocardiography is available in virtually all clinical settings for routine care, but this imaging tool is particularly indispensable in the emergency department, intensive care units, and operating room, where it can provide an immediate assessment of right ventricular function and associated hemodynamic changes to assist with real-time management decisions. Full article

Background and Objectives: Risk stratification in acute heart failure (AHF) remains challenging, particularly in settings where biomarker availability is limited. Echocardiography offers valuable hemodynamic insights, but no single parameter fully captures the complexity of biventricular dysfunction and pressure overload. This study aimed to evaluate a novel echocardiographic index (ViRTUE Index–VTI-RVRA-TAPSE Unified Evaluation) integrating a peak systolic gradient between the right ventricle and right atrium (RV-RA gradient), tricuspid annular plane systolic excursion (TAPSE), the velocity–time integral in the left ventricular outflow tract (VTI LVOT), NT-proBNP (N-terminal pro–B-type Natriuretic Peptide) levels, and in-hospital mortality among patients with AHF. Materials and Methods: We retrospectively analyzed 123 patients admitted with AHF. Echocardiographic evaluation at admission included TAPSE, VTI LVOT, and the RV-RA gradient. An index was calculated as ${\displaystyle \frac{RV-RA gradient }{TAPSE x VTI LVOT}}$. NT-proBNP levels and in-hospital outcomes were recorded. Statistical analysis included correlation, logistic regression, and ROC curve evaluation. Results: The proposed index showed a significant positive correlation with NT-proBNP values (r = 0.543, p < 0.0001) and good discriminative ability for elevated NT-proBNP (AUC = 0.79). It also correlated with in-hospital mortality (r = 0.193, p = 0.032) and showed moderate prognostic performance (AUC = 0.68). Higher index values were associated with greater mortality risk. Conclusions: This novel index, based on standard echocardiographic measurements, reflects both systolic dysfunction and pressure overload in AHF. Its correlation with NT-proBNP and in-hospital mortality highlights its potential as a practical, accessible bedside tool for early risk stratification, particularly when biomarker testing is unavailable or delayed. Full article

Background/Objectives: Iron deficiency (ID) is a common and prognostically relevant comorbidity in heart failure with reduced ejection fraction (HFrEF). It contributes to reduced functional status, exercise capacity, and survival. Intravenous ferric carboxymaltose (FCM) improves symptoms, but its effect on cardiac structure and function remains incompletely understood. The aim of this study was to assess the impact of intravenous FCM on echocardiographic indices of left ventricular (LV), left atrial (LA), and right ventricular (RV) morphology and function in HFrEF patients with ID and determine whether these changes correlate with improvements in exercise capacity. Methods: This sub-analysis of the RESAFE-HF registry (NCT04974021) included 86 HFrEF patients with ID (median age 71.8 years, 83% male). Transthoracic echocardiography was performed at baseline and 12 months post-FCM. Parameters assessed included LV ejection fraction (LVEF), LV global longitudinal strain (GLS), LV diastolic function grade, LAVi, LA strain, TAPSE, and RV free wall strain (FWS). Peak VO₂ was measured to assess exercise capacity. Results: LVEF improved from 29.3 ± 7.8% to 32.5 ± 10.6% (p < 0.001), LV GLS from −7.89% to −8.62%, and the LV diastolic dysfunction grade improved (p < 0.001). LAVi, peak LA strain, TAPSE, and RV FWS also showed significant improvement. Peak VO₂ increased from 11.3 ± 3.2 to 12.1 ± 4.1 mL/min/kg (p < 0.001). Improvements in LVEF, RV FWS, and LV GLS were independent predictors of VO₂ increase (p < 0.001, p < 0.001, and p = 0.01, respectively), explaining 42% of the variance. Conclusions: FCM therapy improves biventricular and atrial function, with echocardiographic gains correlating with an enhanced exercise capacity in HFrEF patients with ID. Full article

Arrhythmogenic cardiomyopathies (ACMs) are a phenotypically and etiologically heterogeneous group of myocardial disorders characterized by fibrotic or fibro-fatty replacement of ventricular myocardium, electrical instability, and an elevated risk of sudden cardiac death. Initially identified as a right ventricular disease, ACMs are now recognized to include biventricular and left-dominant forms. Genetic causes account for a substantial proportion of cases and include desmosomal variants, non-desmosomal variants, and familial gene-elusive forms with no identifiable pathogenic mutation. Nongenetic etiologies, including post-inflammatory, autoimmune, and infiltrative mechanisms, may mimic the phenotype. In many patients, the disease remains idiopathic despite comprehensive evaluation. Cardiac magnetic resonance imaging has emerged as a key tool for identifying non-ischemic scar patterns and for distinguishing arrhythmogenic phenotypes from other cardiomyopathies. Emerging classifications propose the unifying concept of scarring cardiomyopathies based on shared structural substrates, although global consensus is evolving. Risk stratification remains challenging, particularly in patients without overt systolic dysfunction or identifiable genetic markers. Advances in tissue phenotyping, multi-omics, and artificial intelligence hold promise for improved prognostic assessment and individualized therapy. Full article

Background: Right ventricular (RV) dysfunction is associated with poor clinical outcomes in critically ill sepsis patients, but its pathophysiology and predictors are incompletely characterized. We aimed to investigate the predictors of RV dysfunction and its outcomes in sepsis patients admitted to the intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of adult patients admitted to the ICU for sepsis who had echocardiography within 72 h of diagnosis. Patients with acute coronary syndrome, acute decompensated heart failure, or significant valvular dysfunction were excluded. RV dysfunction was defined as the presence of RV dilation, hypokinesis, or both. Demographics and clinical outcomes were obtained from electronic medical records. Results: A total of 361 patients were included in our study—47 with and 314 without RV dysfunction. The mean age of the population was 66.8 years and 54.6% were females. Compared to those without RV dysfunction, patients with RV dysfunction were more likely to require mechanical ventilation (63.8% vs. 43.9%, p = 0.01) and vasopressor support (61.7% vs. 36.6%, p < 0.01). On multivariate logistic regression analysis, increasing age (OR 1.03, 95% C.I. 1.00–1.06), a history of HIV infection (OR 5.88, 95% C.I. 1.57–22.11) and atrial fibrillation (OR 4.34, 95% C.I. 1.83–10.29), and presence of LV systolic dysfunction (OR 14.40, 95% C.I. 5.63–36.84) were independently associated with RV dysfunction. Patients with RV dysfunction had significantly worse 30-day survival (Log-Rank p = 0.023). On multivariate Cox regression analysis, older age (HR 1.02, 95% C.I. 1.00–1.04) and peak lactate (HR 1.16, 95% C.I. 1.11–1.21) were independent predictors of 30-day mortality. Conclusions: Among other findings, our data suggests a possible association between a history of HIV infection and RV dysfunction in critically ill sepsis patients, and this should be investigated further in future studies. Patients with evidence of RV dysfunction had poorer survival in this population; however this was not an independent predictor of mortality in the multivariate analysis. A larger cohort with a longer follow-up period may provide further insights. Full article

Insulin resistance (IR), a core component in the development of type 2 diabetes mellitus (T2DM), is increasingly recognized for its role in cardiovascular and pulmonary complications. This review explores the relationship between IR, right ventricular dysfunction (RVD), and decreased lung volume in patients with T2DM. Emerging evidence suggests that IR contributes to early structural and functional alterations in the right ventricle, independent of overt cardiovascular disease. The mechanisms involved include oxidative stress, inflammation, dyslipidemia, and obesity—factors commonly found in metabolic syndrome and T2DM. These pathophysiological changes compromise right ventricular contractility, leading to reduced pulmonary perfusion and respiratory capacity. RVD has been associated with chronic lung disease, pulmonary hypertension, and obstructive sleep apnea, all of which are prevalent in the diabetic population. As RVD progresses, it can result in impaired gas exchange, interstitial pulmonary edema, and exercise intolerance—highlighting the importance of early recognition and management. Therapeutic strategies should aim to improve insulin sensitivity and cardiac function through lifestyle interventions, pharmacological agents such as SGLT2 inhibitors and GLP-1/GIP analogs, and routine cardiac monitoring. These approaches may help slow the progression of RVD and its respiratory consequences. Considering the global burden of diabetes and obesity, and the growing incidence of related complications, further research is warranted to clarify the mechanisms linking IR, RVD, and respiratory dysfunction. Understanding this triad will be crucial for developing targeted interventions that improve outcomes and quality of life in affected patients. Full article