Search Results (434)

HCM is the most prevalent cardiac disease in cats and is associated with substantial morbidity and mortality. Among its complications, FATE represents a major adverse clinical outcome. Conventional echocardiographic indices typically assess atrial or ventricular parameters separately and may not fully capture the structural relationship between the LA and LV. The left atrioventricular coupling index (LACI) is a volumetric ratio that combines LA remodeling and LV chamber size at end-diastole into a single structural index. This retrospective, cross-sectional observational study included 91 cats, classified according to ACVIM guidelines into healthy controls (n = 33), asymptomatic HCM (stage B1, n = 14; stage B2, n = 16), symptomatic HCM (stage C, n = 15), and cats with FATE (n = 13). Conventional and two-dimensional speckle-tracking echocardiography were performed, and LACI-ED was calculated as the ratio of LA end-diastolic volume to LV end-diastolic volume. LACI-ED increased progressively with disease severity (p < 0.001), showing the highest values in symptomatic HCM and FATE cases. It correlated positively with LA size and volume (p < 0.01) and inversely with LV GLS (p < 0.01). Exploratory ROC analysis for FATE status yielded limited discriminatory performance for LACI-ED > 150% (AUC = 0.575; 95% CI: 0.402–0.736; sensitivity 46.2%; specificity 84.4%). Although LACI-ED > 150% was associated with higher odds of prevalent FATE (OR = 4.65; 95% CI: 1.405–29.215; p = 0.020), this finding should be interpreted with caution. Pairwise comparisons of ROC curve areas between LACI-ED and conventional echocardiographic parameters (LA/Ao ratio, LA diameter, and LV GLS) revealed no statistically significant differences (all p > 0.05). Although LACI-ED > 150% was associated with higher odds of prevalent FATE (OR = 6.8; p < 0.05), this finding should be interpreted with caution. This cross-sectional study evaluates associations with disease stage and thromboembolic status at the time of examination. The findings suggest that LACI-ED reflects disease severity in feline HCM, whereas its utility for thromboembolic risk assessment appears limited. Full article

Introduction: Health problems related to cardiovascular morbidity and mortality are overrepresented in patients with schizophrenia (SCH) and their rates have not declined in parallel with those of the general population. Cardiovascular diseases in patients with SCH are less likely to be diagnosed and treated, and data regarding structural and functional cardiac abnormalities—particularly those involving the left atrium (LA)—remain limited in this population. The present study is the first to provide a detailed three-dimensional speckle-tracking echocardiography (3DSTE)-derived volumetric and functional evaluation of LA properties in patients with chronic SCH compared with age-, gender- and body mass index (BMI)-matched healthy controls (HCs). Methods: A total of 36 patients with SCH were initially enrolled, from which 19 subjects (53%) were excluded due to inferior image quality. Ultimately, 17 SCH patients (mean age: 45.2 ± 7.7 years; 9 males, 53%) were compared with 40 age- and gender-matched HCs (mean age: 42.5 ± 5.7 years; 23 males, 58%). All participants underwent comprehensive two-dimensional Doppler echocardiography and 3DSTE. Results: LA volumes respecting the cardiac cycle were lower in SCH patients compared with controls. Among LA volume-derived functional properties, total and active LA stroke volumes were reduced in patients with chronic SCH, whereas passive LA emptying fraction was increased. All global and mean segmental peak LA strain parameters tended to be increased in SCH patients, with global and mean segmental LA area strain (AS) and mean segmental LA radial strain (RS) reaching statistical significance. Regarding regional peak LA strains, basal LA circumferential strain (CS) and LA-AS, as well as superior LA longitudinal strain (LS), LA-CS, and LA-AS, differed significantly between the groups. All global and mean segmental LA strain parameters measured at atrial contraction tended to be increased in chronic SCH patients, with global and mean segmental LA-AS and mean segmental LA-RS and LA-LS reaching statistical significance. Regional LA strains during atrial contraction demonstrated increased superior LA-RS, LA-CS, LA-LS and LA-AS, along with elevated mid-atrial LA-RS, LA-AS and LA-3D strain. All these abnormalities suggest reduced LA volumes in all phases of LA function, accompanied by overcompensating functional alterations. Conclusions: Chronic schizophrenia is associated with marked volumetric and functional abnormalities of the left atrium. These findings highlight the need for comprehensive cardiac functional evaluation extending beyond left ventricular-centered analysis in patients with this severe mental illness. Full article

Introduction. Left ventricular (LV) function can be characterized by numerous parameters, the most well-known being the ejection fraction (EF), derived from LV end-systolic and end-diastolic volumes (ESV and EDV, respectively) throughout the cardiac cycle. M-mode echocardiography (MME-)-based determination of the longitudinal displacement of the mitral annulus (MA plane systolic excursion, MAPSE) remains a simpler and more practical parameter for assessing LV function in daily clinical routine. Although the relationships between MAPSE, LV deformation and LV rotational mechanics are well-established in healthy individuals, it remains unclear whether MAPSE also correlates with LV volumes themselves. To address this, the associations between LV-ESV and LV-EDV and MAPSE in a healthy cohort were investigated, exploring how these variables relate across average, sub-average, and above-average ranges. Methods. The present cohort study enrolled 115 healthy adult volunteers (mean age: 35.3 ± 12.1 years; 68 men). Complete two-dimensional (2D) Doppler echocardiography with MAPSE assessment and 3DSTE-derived measurement of LV volumes was performed in all cases. Results. Both end-diastolic and end-systolic LV diameters and volumes tended to be higher in individuals with lower- or higher-than-average MAPSE compared to those with average MAPSE. These differences reached statistical significance for 2D echocardiography-derived LV end-systolic diameter and volume, as well as for 3DSTE-derived LV-EDV and LV-ESV. MAPSE remained consistent regardless of the degree of LV-EDV and LV-ESV. No significant correlations were observed between MAPSE and LV-EDV or LV-ESV. Conclusions. LV longitudinal shortening, as represented by MAPSE, is not associated with 3DSTE-derived LV volumes in healthy adults. However, the observed lack of association may not necessarily reflect true physiological independence, but could instead result from limited statistical power, measurement variability, or model misspecification. Full article

Background/Objectives: Hematopoietic stem cell transplantation (HSCT) exposes patients to cardiovascular stress through inflammation, metabolic disturbances, and prior cardiotoxic therapies. Although overt dysfunction is uncommon early after transplantation, subclinical cardiac adaptation remains poorly defined. Methods: We evaluated early electrical and mechanical cardiac responses after HSCT using integrated electrocardiographic (ECG) and echocardiographic assessment. In this prospective cohort study, patients underwent paired pre-transplant and early post-transplant (3–6 months) ECG and comprehensive echocardiography, including tissue Doppler and speckle-tracking analyses of atrial, ventricular, and right heart function. Results: Patients were stratified into multiple myeloma (MM) and non-MM subgroups. ECG voltage increased after HSCT, particularly in MM patients, without changes in left ventricular (LV) mass, geometry, or global systolic indices, suggesting electrical–structural dissociation. Left atrial (LA) reservoir strain decreased despite stable atrial volumes. Diastolic indices showed selective modulation, including a group-time interaction in the lateral e′/a′ ratio without elevated filling pressures. Subgroup analyses suggested divergent myocardial responses, with numerical global longitudinal strain (GLS) improvement in MM patients and reduced LV deformation and right ventricular (RV) fractional area change in non-MM patients. Conclusions: Early cardiac responses after HSCT were heterogeneous and compartment-specific, supporting multiparametric imaging for detection of subclinical cardiac adaptation. Full article

Background. Physiological remodeling resulting from chronic exercise-induced volume and pressure overload is a well-recognized characteristic of the athlete’s heart. This study aimed to explore potential changes in three-dimensional speckle-tracking echocardiography-derived aortic valve annular (AVA) dimensions and dynamics in elite athletes engaged in high-dynamic sports with varying degrees of static components. Furthermore, we sought to determine whether these parameters differ depending on the magnitude of the sport’s dynamic component. Methods. The athlete cohort included 56 individuals and was divided into three groups based on the static component of their sport: C. I. (high dynamic/low static) consisted of 13 elite athletes (mean age: 22.7 ± 3.8 years, 5 males), C. II. (high dynamic/moderate static) consisted of 18 elite athletes (mean age: 23.0 ± 4.6 years, 6 males) and C. III. (high dynamic/high static) consisted of 25 elite athletes (mean age: 21.7 ± 4.5 years, 9 males). Data of athletes were compared with those of 38 age- and sex-matched healthy non-athletic individuals (mean age: 23.8 ± 2.5 years, 14 males). Results. AVA dimensions did not differ significantly between athletes and controls nor among the athlete subgroups. AVA plane systolic excursion (AAPSE) was increased in all athletes compared with controls (1.31 ± 0.30 cm vs. 1.18 ± 0.36 cm, p < 0.05). All athletes showed a significantly larger proportion of individuals showing larger end-diastolic AVA than end-systolic AVA (55% vs. 24%, p < 0.05). All athletes demonstrated reduced basal LV-RS (26.5 ± 13.9% vs. 31.5 ± 13.2%, p < 0.05) and increased basal LV-LS (−21.4 ± 4.4 vs. 19.9 ± 4.2%, p < 0.05) compared with controls. This pattern of findings was consistent across all athlete subgroups. Conclusions. Although AVA is not dilated in elite athletes practicing dynamic sports, its spatial displacement, as represented by AAPSE, together with increased basal LV-LS and a higher proportion of larger end-diastolic AVA, is augmented, while basal LV-RS is reduced. These findings suggest a functional shift from radial contraction toward enhanced longitudinal dynamics. All these findings appear to be independent of the static component of dynamic sports. Full article

Although breast cancer has been associated with subclinical left ventricular dysfunction in humans, the cardiac effects of CMTs remain poorly defined. This pilot, exploratory (communication) study compared clinical and echocardiographic parameters between dogs with CMTs and healthy controls and assessed the feasibility of combining myocardial deformation imaging with exploratory data-driven analysis for preoperative cardiac assessment. All dogs underwent a standardized clinical and echocardiographic assessment, including two-dimensional speckle-tracking echocardiography (2D-STE). Given the limited sample size, analyses were designed to generate hypotheses rather than to provide definitive predictive conclusions. Exploratory machine learning modeling (XGBoost), receiver operating characteristic (ROC) analysis, calibration, and decision curve analysis were performed as proof-of-concept approaches without external validation. Despite normal conventional systolic indices, dogs with CMTs exhibited reduced global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) (p < 0.01), suggesting subclinical systolic dysfunction. Deformation-derived parameters appeared more sensitive for detecting subtle myocardial alterations within this cohort. The exploratory machine learning model demonstrated moderate discrimination (AUC-ROC = 0.75); however, these findings are preliminary and should not be interpreted as evidence of clinical predictive performance. Overall, these results suggest that conventional systolic indices may underestimate early myocardial changes in dogs with CMTs. This communication highlights the feasibility of integrating deformation imaging with exploratory analytical approaches and provides a basis for future large-scale, validated studies in veterinary cardio-oncology. Full article

Background: Iron overload cardiomyopathy (IOC) is a major determinant of outcomes in hemochromatosis, and conventional echocardiography may miss early myocardial toxicity. Comparative data on primary (PH) versus secondary hemochromatosis (SH) using myocardial work (MW) indices are limited. Methods: We performed a retrospective cross-sectional study of 34 adults (16 PH and 18 SH patients) at a tertiary center. They all underwent echocardiography with speckle-tracking to obtain LV global longitudinal strain (GLS) and non-invasive MW indices from pressure-strain loops: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Echocardiographic phenotypes were classified as a Normal, Dilated, Restrictive, or right ventricular/pulmonary hypertension (RVPH) phenotype. Results: SH patients showed higher iron burden and neurohormonal activation than PH patients (maximum ferritin 2954 vs. 444 ng/mL; BNP 93 vs. 13.5 pg/mL; both p < 0.001) and accounted for all deaths (33% vs. 0%) despite similar 3D LVEFs and GLSs. PH patients predominantly exhibited Normal phenotypes (81%), whereas SH patients more often showed advanced phenotypes, mainly RVPH and Dilated. GWI correlated inversely with ferritin (ρ ≈ −0.40), particularly ferritin at echocardiography in SH patients, while PH patients showed no significant correlations. GWW was higher in Dilated/RVPH compared to Normal phenotypes, and in SH patients, higher maximum ferritin was associated with impaired right ventricular free-wall strain. Conclusions: PH and SH patients exhibit distinct IOC phenotypes, with SH patients showing more advanced remodeling and worse outcomes. In this exploratory analysis, MW indices showed modest associations with iron burden markers, suggesting they may provide complementary information beyond LVEF and GLS. These preliminary findings require validation in larger, prospective studies. Full article

Background: Right ventricular (RV) dysfunction is a key contributor to morbidity and mortality in systemic sclerosis (SSc), emerging from the combined effects of microvascular disease, myocardial fibrosis, interstitial lung involvement, and increasing pulmonary vascular load. Conventional echocardiography frequently fails to detect early RV impairment, prompting growing interest in deformation-based parameters such as RV free-wall longitudinal strain (RV-FWS), global longitudinal strain (RV-GLS), and RV–pulmonary artery (PA) coupling indices. Although natriuretic peptides reflect myocardial stress and are widely used in cardiopulmonary diseases, their integration with advanced RV imaging has been inconsistently reported in SSc. This systematic review synthesizes available evidence on RV strain, RV–PA coupling, and their relationship with clinical outcomes and biomarkers in SSc. Methods: A systematic search was conducted to identify clinical studies evaluating RV strain (RV-FWS, RV-GLS), right atrial strain, or RV–PA coupling indices in adult patients with SSc or SSc-associated pulmonary arterial hypertension (SSc-PAH). Eligible studies included those using speckle-tracking echocardiography or cardiac magnetic resonance feature-tracking. Study selection and data extraction were performed in accordance with PRISMA guidelines. Results: Seven studies met the eligibility criteria. Across unselected SSc cohorts, early disease without pulmonary hypertension (PH), and right-heart-catheterization-confirmed SSc-PAH, RV strain consistently detected myocardial impairment even when conventional echocardiographic indices remained normal. RV-FWS and RV-GLS were commonly reduced, and longitudinal data demonstrated progressive deterioration independent of standard measures. Strain-derived RV–PA coupling, particularly RV-FWS/PASP, significantly improved prognostic stratification when added to established PAH risk models. Two studies identified impaired RV deformation as a predictor of mortality, and CMR-derived right atrial strain provided additional prognostic value. Biomarker integration was limited, with only one study reporting an association between natriuretic peptide elevation (NT-proBNP) and impaired RV–PA coupling suggesting that biomarkers may reflect the hemodynamic load, although evidence remains limited captured by strain abnormalities. Conclusions: RV strain and RV–PA coupling indices are more sensitive than conventional echocardiography for detecting early RV dysfunction, monitoring disease progression, and predicting adverse outcomes in SSc. Although biomarker evidence remains limited, available data suggest that natriuretic peptides may provide complementary information to deformation-based assessment, although current evidence remains limited by reflecting combined myocardial and pulmonary vascular load. Standardized prospective studies including both strain imaging and biomarkers are needed to clarify the integrated diagnostic and prognostic value of advanced RV assessment in SSc. Full article

Congenital Long QT Syndrome (LQTS) is a hereditary cardiac channelopathy defined by delayed ventricular repolarization and an elevated risk of life-threatening ventricular arrhythmias. Recent echocardiographic studies using speckle-tracking and strain imaging have identified subtle abnormalities in ventricular and atrial mechanics among LQTS patients, including reduced global longitudinal strain, impaired diastolic function, enlarged left atrial volumes and a consistently negative electromechanical window. These findings challenge the traditional concept of LQTS as solely an electrical disease and support evolving evidence of a subclinical cardiomyopathic phenotype. Left atrial remodeling, although less studied, may represent an underrecognized component of LQTS with potential implications for arrhythmia vulnerability and diastolic dysfunction. This review summarizes current evidence on electromechanical and structural cardiac involvement in congenital LQTS, highlights its diagnostic and clinical implications, and outlines future directions for research in this evolving field. Full article

Background: The clinical benefit of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains controversial, particularly regarding left ventricular (LV) functional recovery. Global longitudinal strain (GLS) has emerged as a more sensitive marker of myocardial function than left ventricular ejection fraction (LVEF). This study aimed to evaluate the effect of CTO revascularization on LV function using GLS. Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. A comprehensive literature search was performed in the PubMed/MEDLINE database from inception through March 2026 using predefined search terms and Boolean operators. Reference lists of relevant articles were also screened to ensure completeness. Studies evaluating GLS before and after PCI for CTO and reporting quantitative strain data were included. Pooled effect estimates were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity and assess the robustness of the findings. Results: Six studies involving 376 patients were included. Successful CTO-PCI may be associated with an improvement in GLS (MD = 1.69; 95% CI: 1.09–2.29; p < 0.001), with substantial heterogeneity (I² = 81%). Subgroup analysis demonstrated greater GLS improvement in studies with longer follow-up durations. Sensitivity analyses confirmed the robustness of the results. Conclusions: CTO revascularization may be associated with an improvement in LV myocardial function as assessed by GLS, even in the absence of marked changes in conventional parameters such as LVEF. These findings support the clinical utility of GLS as a sensitive imaging biomarker for detecting early myocardial recovery and for guiding risk stratification in patients undergoing CTO-PCI. Full article

Background: Left bundle branch block (LBBB) and QRS prolongation are markers of electrical dyssynchrony in heart failure, but they do not fully reflect its mechanical consequences. Myocardial work (MW)-derived indices may provide a more comprehensive assessment of left ventricular (LV) mechanical dyssynchrony. We evaluated associations between LV MW parameters, QRS duration, and LBBB in patients with heart failure with reduced ejection fraction (HFrEF) referred for ICD/CRT implantation. Methods: In this single-centre observational cross-sectional study, 96 consecutive patients referred for ICD or CRT implantation were screened. All patients underwent standardized baseline comprehensive echocardiography followed by advanced MW analysis. Myocardial work index (MWI) dispersion was assessed using two complementary methods. MWI dispersion (SD) was calculated as the standard deviation of segmental MWI values across all LV segments, and MWI dispersion (IQR) was defined as the interquartile range (IQR) of segmental MWI values. We evaluated the associations between QRS duration and MW-derived dyssynchrony parameters (individual and composite), as well as their discriminative performance for LBBB. Seven patients were excluded from further analysis due to inadequate echocardiography image quality. Results: The final study group comprised 89 patients with HFrEF (median age 65.5 years), of whom 67.4% were assigned to CRT. LBBB was present in 41.6%, and the median QRS duration was 142 ms (112–162). All analyzed LV MW indices were significantly associated with QRS duration (all q < 0.01). The strongest correlations were observed for MWI dispersion (IQR) (r = 0.58), peak strain dispersion (PSD) (r = 0.54), lateral–septal work asymmetry (r = 0.53), and MWI dispersion (SD) (r = 0.52) (all q < 0.0001). All MW indices differed significantly between patients with and without LBBB (all q ≤ 0.0001). MWI dispersion (IQR) showed the best single-marker discrimination of LBBB (AUC = 0.852). Composite indices achieved AUC = 0.84 but did not significantly improve discrimination versus MWI dispersion (IQR) alone. Conclusions: Myocardial work-derived indices of left ventricular dyssynchrony are strongly associated with QRS duration and the presence of LBBB in patients with HFrEF. Among them, MWI dispersion (IQR) was shown to be the best-performing MW marker for identifying LBBB. These findings suggest that MW dispersion may serve as a robust echocardiographic marker of mechanical dyssynchrony and warrants further investigation as a potential tool for predicting CRT response. Full article

Background: Neonatal Ebstein’s anomaly (EA) is a severe condition with significant hemodynamic instability and early myocardial dysfunction, where abnormal right-heart geometry limits conventional echocardiography and highlights the value of myocardial deformation imaging. Methods: We conducted a single-center retrospective observational study including 16 neonates with EA and 26 healthy neonates. All subjects underwent comprehensive transthoracic echocardiography during the neonatal period. Conventional two-dimensional imaging and speckle-tracking echocardiography (STE) were used to assess biventricular and biatrial myocardial deformation. Deformation parameters were compared between groups, and receiver operating characteristic (ROC) curve analysis evaluated diagnostic performance. Results: Neonates with EA demonstrated significant structural remodeling and severe biventricular and biatrial dysfunction compared with controls. Speckle-tracking showed markedly reduced right ventricular longitudinal strain (LS) in all segments (all, p < 0.001), particularly in free-wall and four-chamber views. Left ventricular (LV) global LS (GLS) was significantly reduced in neonates with EA compared with controls (−14.53% vs. −22.32%, p < 0.001), indicating early involvement of LV myocardial function in the neonatal period. Atrial reservoir, conduit, and contractile strain were severely impaired in both atria (all, p < 0.001). ROC analysis revealed excellent diagnostic accuracy, especially for LVGLS (AUC 0.919) and right atrial contractile strain (AUC 0.958). Conclusions: STE enables the early detection of extensive biventricular and biatrial myocardial dysfunction in neonatal EA, including abnormalities not fully captured by conventional echocardiographic parameters, thereby providing significant incremental diagnostic value. Full article

Background: Left ventricular global longitudinal strain (GLS) measured by speckle-tracking echocardiography (STE) has become a key marker of myocardial systolic function, yet normal reference values remain heterogeneous, and the magnitude of physiological sex differences is not fully defined. We performed a systematic review and meta-analysis to establish pooled GLS reference estimates in healthy individuals, quantify sex-related differences, and contextualize deformation findings relative to conventional systolic function. Methods: A systematic search of PubMed, Scopus, and EMBASE identified observational studies reporting GLS in healthy adults assessed by two-dimensional or three-dimensional STE. Random-effects meta-analysis using standardized mean differences (SMD) compared GLS between women and men. Descriptive pooled reference values were derived using weighted median and interquartile range (IQR) reconstruction from study-level distributions. Meta-regression analyses explored demographic, clinical, and methodological sources of heterogeneity. A complementary analysis evaluated sex-related differences in left ventricular ejection fraction (LVEF) within the same populations. Results: Thirty-two studies, including 19,157 healthy individuals, were analyzed. The pooled population had a weighted median age of 47.5 years and 53% female participants. Overall, GLS demonstrated a weighted median of 20.3% (IQR 17.8–22.5). Women showed higher GLS values than men (20.8% [18.4–23.1] vs. 19.4% [17.0–21.6]). Meta-analysis of 28 studies confirmed significantly greater GLS in females (SMD 0.487, 95% CI 0.409–0.565; p < 0.001), with consistent findings across imaging modalities and no subgroup interaction. Between-study heterogeneity was substantial (I² = 82.7%), although effect direction was uniform. Meta-regression analyses identified no significant moderators, and sensitivity analyses confirmed stable estimates without publication bias. Segmental analysis demonstrated a physiological base-to-apex strain gradient. In contrast, LVEF was largely comparable between sexes, with no clinically meaningful difference (SMD 0.257, 95% CI 0.186–0.327; p < 0.001), indicating preserved global systolic performance despite differences in myocardial deformation. Conclusions: GLS demonstrates a consistent physiological range in healthy populations, with women exhibiting higher longitudinal deformation than men, independent of the imaging modality. These findings support the adoption of sex-specific GLS reference values and highlight the complementary roles of deformation and volumetric indices in improving the interpretation of myocardial function and reducing misclassification in clinical practice. Full article

Background: In end-stage liver disease (ESLD), cardiovascular changes are frequent and relate to the presence of hyperdynamic circulation. In 2019, diagnostic criteria for cirrhotic cardiomyopathy (CCM) were updated to include tissue Doppler and speckle tracking imaging in defining left ventricle (LV) systolic and diastolic dysfunction. Evaluation of diastolic function remains challenging, with frequent indeterminate cases and emerging evidence of worse prognosis. The aim of the present study was to evaluate the prevalence of LV systolic and diastolic dysfunction in cirrhosis, in correlation with liver disease severity and potential prognostic implications. Methods: We performed an observational, retrospective, non-randomized, single-center study that included 99 cirrhotic patients evaluated for liver transplant (LT) in a tertiary center. Liver disease severity and complications were analyzed with survival and echocardiography data to determine potential correlations with prognosis. For statistical analysis, IBM^® SPSS^® Statistics version 20 (Chicago, IL, USA) was utilized. A two-sided p-value < 0.05 was considered statistically significant. Results: Left atrial (LA) volume index (r = 0.230, p = 0.022), LA reservoir strain (r = 0.291, p = 0.003), and LA contraction strain absolute value (r = 0.223, p = 0.027) positively correlated with the severity of liver disease expressed by MELD Na score. LA dilation (≥34 mL/m²) was the most common echocardiographic finding. It was present in 69.7% of patients, with one third having severe LA dilation (>45 mL/m²), which was associated with worse survival (log rank p = 0.019). LA contraction strain with an absolute value higher than 16% was also associated with worse survival (log rank p = 0.024). In multivariable Cox analysis, only MELD-Na and LA volume index remained independently associated with mortality. Diastolic dysfunction appeared more prevalent among the non-surviving patients irrespective of the diagnostic criteria used (p = 0.023 for American Society of Echocardiography 2016 criteria; p = 0.032 for CCM 2019 criteria). On binomial logistic regression, the presence of significant diastolic dysfunction (>grade 1) was associated with an increased probability of composite end-point of death or LT in the presence of liver disease severity confounders. The use of the LA stiffness index in discerning diastolic function in patients with standard inconclusive evaluation may warrant further investigation. Conclusions: Echocardiographic alterations, particularly LA enlargement, are associated with liver disease severity and clinical outcomes in ESLD. These findings are hypothesis-generating and suggest a potential role for echocardiography in risk stratification, warranting validation in larger prospective studies. Full article

Background: Sudden cardiac death (SCD) is a major challenge in dilated (DCM) and non-dilated left ventricular cardiomyopathy (NDLVC). Current management strategies, based on left ventricular ejection fraction (LVEF), the presence or extent of myocardial scar, and selected high-risk genetic variants, are insufficient to accurately identify patients at risk. Mechanical dispersion (MD), derived from speckle-tracking echocardiography, is a potential marker of arrhythmic risk that reflects variability in regional myocardial contraction timing. Aim: The purpose of this narrative review is to synthesize current evidence on the predictive role of MD for ventricular arrhythmias (VA) and SCD in DCM and NDLVC, with particular emphasis on its relationship to myocardial fibrosis (MF) and established echocardiographic markers. Results: Across prospective and retrospective cohorts of DCM patients, increased MD has consistently identified individuals at higher arrhythmic risk, often independently of LVEF and global longitudinal strain (GLS). Reported threshold values for risk prediction range from 50 ms to 90 ms, with hazard ratios confirming incremental prognostic accuracy. The relationship between MD and MF assessed by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) remains uncertain: some patients experience VA in the absence of LGE, while others display elevated MD despite no detectable focal MF, suggesting that additional mechanisms contribute to the arrhythmogenic substrate in DCM and NDLVC. Conclusions: MD may enhance SCD risk stratification in DCM and NDLVC by reflecting components of the arrhythmic substrate that are not detected by conventional markers. Full article