Purpose: To investigate fetal cardiac functions and remodeling in pregnancies conceived via in vitro fertilization (IVF). Methods: This prospective case-control study included 40 singleton IVF pregnancies and 46 uncomplicated control pregnancies at 28–36 weeks of gestation. The IVF group consisted of pregnancies admitted to the hospital, excluding those with anatomical or chromosomal abnormalities. Fetal cardiac morphological measurements, left myocardial performance index, cardiac output, spectral, tissue Doppler, and M-mode measurements were recorded. Ventricular and great vessel size were assessed for fetal cardiac morphology, while myocardial performance index, spectral Doppler and tissue Doppler parameters were assessed for cardiac function. Results: Cardiothoracic circumference ratio and both ventricular areas were found to be significantly smaller in the IVF group than in the control group. The right ventricular basal sphericity index was also smaller in the IVF group. The mitral and aortic valves were smaller in the IVF group, while tricuspid and pulmonary valve measurements were similar. Left ventricular ejection time was statistically lower in the IVF group, although the myocardial performance index was similar. The IVF group had higher right fetal myocardial performance index on tissue Doppler imaging and lower cardiac output than the control group, but the difference was not statistically significant. Conclusion: This study demonstrated the presence of cardiac morphological remodeling and mild systolic dysfunction in IVF pregnancies.

Objectives: To investigate the clinical value of fetal heart quantification (fetal HQ) in the evaluation of normal foetal heart size, morphology and cardiac function at different gestational weeks. Materials and methods: A total of 101 pregnant women diagnosed with a healthy foetus by foetal echocardiography from September 2021 to December 2023 were selected and classified into four different periods of gestational weeks: 20-28 weeks (25 cases), 29-32 weeks (26 cases), 33-36 weeks (26 cases), 37-40 weeks (24 cases). Quantitative analyses were performed by automatically tracking the endocardium using fetal HQ software that comes with the Voluson E10 from GE. To investigate the correlation between four-chambered vesicle length end-diastolic (4CV LED), four-chambered vesicle transverse width end-diastolic (4CV TWED), global sphericity index (GSI), ejection fraction (EF), stroke volume (SV), cardiac output (CO) and gestation age (GA), and the variability of normal foetal cardiac morphology and cardiac function at different gestational weeks. Results: A statistically significant difference was observed between 4CV LED and 4CV TWED in normal foetuses at different gestational weeks ( P < 0.05), which exhibited a positive correlation with gestational week. Conversely, no significant correlation was identified between GSI and gestational week ( P > 0.05). The mean GSI of 101 normal foetuses found to be 1.25 ± 0.09. A comparative analysis of EF, SV, and CO in normal foetuses at different gestational weeks revealed statistically significant differences in SV and CO ( P < 0.05), which gradually increased with gestational weeks, whereas there was no statistically significant difference in EF ( P ＞ 0.05). Conclusions: Fetal HQ represents a straightforward and dependable method for evaluating GSI and 24-segment SI of the left and right ventricles, which can provide a certain theoretical basis for the clinical quantitative evaluation of fetal cardiac geometry and cardiac function.

not-yet-known not-yet-known not-yet-known unknown Objective: This study evaluated the safety and efficacy of isoproterenol administration as an adjunct for achievement of target heart rate during dobutamine stress echocardiography (DSE). Background: In DSE, optimal accuracy is achieved when a target heart rate of 85% of maximal predicted heart rate (MPHR) is attained. Although rarely studied, intravenous isoproterenol has been used as adjunct therapy to dobutamine and atropine to increase chronotropic response during pharmacologic stress testing. Methods: We identified 5569 DSE studies during which 264 received isoproterenol at MedStar Georgetown University Hospital from August 2011- March 2023. Of the studies receiving isoproterenol, we collected clinical and echocardiographic parameters from each study to assess the effects of isoproterenol administration, including downstream events. Results: In 264 examinations with isoproterenol, 169 (64%) achieved 85% MPHR, 103 (39%) developed premature ventricular contractions, 79 (30%) developed symptoms including nausea/vomiting in 44 (17%), and chest pain in 15 (6%). There was hypertensive response to stress in 53 studies (20%) and hypotensive response in 37 studies (14%). There was no significant increase in 30 day and 1 year death when compared to studies that did not receive isoproterenol. Conclusions: Isoproterenol can effectively be used as an adjunctive agent in DSE to achieve the requisite hemodynamic stress for evaluation of ischemia, with a similar rate of side effects and complications when compared to dobutamine and atropine stress testing.

A 43-year-old woman presented with dyspnea and cough, initially misdiagnosed as RSV. Persistent symptoms led to pulmonary thromboembolism treatment, but worsening issues revealed recurrent pericardial effusion. Imaging and biopsy confirmed pulmonary artery intimal sarcoma, mimicking thromboembolism and autoimmune disease, underscoring diagnostic challenges.

The first description of sudden cardiac death was made by Hippocrates in the 4‘th century BC1. Such cases of sudden collapse and death has intrigued both the public and medical science for centuries and a practical definition is that sudden cardiac death is the unexpected and natural death from a cardiac cause within a short period of time, usually less than 1 hour from the onset of symptoms, in a person without any known prior condition1,2. Sudden cardiac death (SCD) is clearly the end-result of a wide variety of cardiac conditions—both congenital and acquired. However, the most common mechanism for the event of SCD is ventricular fibrillation1. However this is an evolving field of study and the recent study published by Stojanovic et al3 is of great importance as it links two well known risk factors for SCD—left ventricular hypertrophy (LVH) and QT-dispersion4. The finding by Stojanovic et al3 that septal thickness in both athletes and sedentary men are associated with increased QTd is concerning and future studies need to clarify if we need to keep the septum thin at all costs with more exercise for some and less for others.

In the last decade, artificial intelligence (AI) has influenced the field of cardiac computed tomography (CT), with its scope further enhanced by advanced methodologies such as machine learning (ML) and deep learning (DL). The AI-driven techniques leverage large datasets to develop and train algorithms capable of making precise evaluation and predictions. The realm of cardiac CT is expanding day by day and multiple tools are offered to answer different questions. Coronary artery calcium score (CACS) and CT angiography (CTA) provide high-resolution images that facilitates detailed anatomical evaluation of coronary plaque burden. New tools such myocardial CT perfusion (CTP) and fractional flow reserve (FFR CT) have been developed to add a functional evaluation of the stenosis. Seen the great added value of the aforementioned tools, the demand for new exams has increased such as the burden on imagers. Due to its ability to fast compute multiple data, AI can be helpful in both the acquisition and post-processing phases. AI can possibly reduce radiation dose, increase image quality and shorten image analysis time. Moreover, different types of data can be used for risk assessment and patient risk stratification. Recently, the focus of the scientific community on AI has led to numerous studies, especially on CACS and CTA. This narrative review concentrates on AI’s role in the post-processing of CACS, CTA, FFR CT and CTP, discussing both current capabilities and future directions in the field of cardiac imaging.

Introduction: Left atrium (LA) dilates and its function decreases as a chronic secondary change in hypertrophic cardiomyopathy (HCM). LA strain is a more sensitive measure of LV filling pressure than LA volume and can be used to predict the functional capacity in HCM. Objective: To analyse LA strain in patients with HCM and its correlation with exercise tolerance. Methods: A total of 113 patients with HCM were enrolled. All patients underwent detailed clinical evaluation, 24-hour Holter monitoring, exercise stress testing, two dimensional echocardiography with LA strain analysis using speckle tracking imaging. Assessment of functional capacity was done in terms of metabolic equivalents (METS). HCM patients with METS > 6.0 were included in group A while those with METS ≤ 6.0 were included group B. Correlation of various parameters of LA strain (LASr, LAScd and LASct) was done with functional capacity. Results: Mean age of the study population was 47±10.77 years with majority of them being males (71.9%). Group B patients had significantly lower LASr (12.95 ±8.61% vs 22.16±16%; P<0.001), LAScd (-7.28 ±6.29% vs -12.74±8.40%; P<0.001) and LASct (-7.44 ±4.46 vs -11.19±6.53; P<0.001). Multivariable linear regression analysis reported LASr to be an independent predictor of METs (P = 0.04). LASr was strongest echocardiographic predictor of reduced METS with an AUC of 0.78 (95% CI: 0.68 to 0.88), sensitivity of 71.8% and specificity of 82.9%. Conclusion: LA strain parameters are associated with functional capacity in patients with HCM with lower LA strain values being associated with poor functional capacity.

Hao et al analyzed echocardiographic data from 80 patients with atrial fibrillation (AF) who underwent radiofrequency ablation. Comparing the 21% of the patients who developed recurrent AF to those who did not, they found that left atrial appendage (LAA) emptying velocities (eV) of <34.5 cm/s and LAA strain (LAAS) < 11.6% were independent predictors of recurrent AF; indeed, combining these 2 values predicted AF recurrence with an area under the curve (AUC) of 0.978, sensitivity of 94.1% and specificity of 93.7%. Left atrial measurements differed significantly between those with and without recurrent AF but did not independently affect the recurrence of AF. Is there something unique about the LAA that provides an insight into the cause and recurrence of AF beyond the left atrium (LA) per se?

Cardiovascular imaging, a fundamental component in the diagnosis and management of cardiovascular diseases, has a great potential for evolution with the advent of technologies such as artificial intelligence (AI), virtual reality (VR), and the metaverse. 1,2 These innovations promise to enhance diagnostic accuracy, streamline workflows, and transform patient-clinician interactions. However, their true impact on clinical practice remains a topic of debate. 3 While AI’s potential to automate image analysis is actively being explored, the roles of VR and the metaverse are less clear, often appearing more aspirational than immediately practical. 4 This article presents an opinion challenging established thinking about these technologies, focusing on whether they will truly revolutionize cardiovascular imaging or simply augment current approaches without fundamentally changing the landscape.

This is a commentary on the manuscript authored by Stadter P, Keller K. Atrial Adaptations in Athletes Heart. Echocardiography. Sep 2024;41(9):e15931. doi:10.1111/echo.15931

High risk PFO-associated stroke: Proposed algorithm for better risk stratificationPetronela Cristina Chiriac1†, PhD, Anca Dumitrescu Bordianu2†, MD, Mariana Floria 1,3, MD, PhD1 Internal Medicine Clinic, ”Sf. Spiridon” Emergency Clinical Hospital Iasi, 700111, Romania.2 Vascular Surgery Clinic, ”Sf. Spiridon” Emergency Clinical Hospital Iași, 700111, Iasi, Romania.3 Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy ”Grigore T. Popa”, 700111 Iasi, Romania.† Both authors contributed equally.Running title: PFO-associated strokePetronela Cristina Chiriac: chiriac.cristina@spitalspiridon.ro;Anca Dumitrescu Bordianu: bordianu.anca@d.umfiasi.ro;Mariana Floria: floria.mariana@umfiasi.ro; https://orcid.org/0000-0002-9465-1503Correspondence : Floria Mariana, Internal Medicine Department, Grigore T. Popa” University of Medicine and Pharmacy, 16th University Iași, 700115, Romania. E-mail: floria.mariana@umfiasi.ro; floria_mariana@yahoo.com

Mihos and coworkers present an interesting report on the impact of apical aneurysm in patients with apical hypertrophic cardiomyopathy (ApHCM). They reference the literature that shows it occurs in 10-15% of patients with ApHCM and that its presence confers a 3-fold increase in HCM-related death or life-saving aborted HCM-related events, and that it is considered a marker of increased risk of sudden death1-2. Their study shows differences in myocardial work efficiency and global wasted work between patients with and without aneurysms. The question is whether the aneurysm caused the differences or are the aneurysms caused by the differences?

Thanks to impressive advances in the field of oncology over the last thirty years, there has been a dramatic rise in cancer survivors. Nowadays, the risk of dying from cardiovascular disease exceeds cancer-related mortality in this population. Coronary artery disease (CAD) is a major problem due to shared risk factors, an ageing population and in many cases induced and/or accelerated by antitumoral treatment during and even decades after the end of cancer therapy. On the other hand, the presence of CAD at the timepoint of cancer diagnosis largely increases the risk of any cancer therapy related cardiovascular toxicity (CTR-CVT). It is therefore of outermost importance to detect CAD before, during, and after certain types of chemo-, molecular-, and radiotherapy. Multimodality cardiovascular imaging plays a central role in this fragile population where individual risk stratification and multidisciplinary decision making is critical.

Cardiovascular magnetic resonance imaging (MRI) in patients with cardiac implants, such as pacemakers and defibrillators, has gained importance in recent years with the development of modern cardiac implantable electronic devices. The increasing clinical need to perform MRI examinations in patients with cardiac implants has driven the development of new advanced MRI sequences to mitigate image artifacts associated with cardiac implants. More specifically, advances in imaging techniques, such as wideband late gadolinium enhancement imaging, wideband T1 mapping, and wideband perfusion, have been designed to improve image quality and examinations in patients with cardiac implants, enabling a comprehensive and more reliable diagnosis, which was previously unattainable in these patients. This review article explores recent developments and applications of wideband techniques in the field of cardiovascular MRI, offering insights into their transformative potential. Clinical applications of wideband cardiovascular MRI are highlighted, particularly in assessing myocardial viability, guiding ventricular tachycardia ablation, and characterizing myocardial tissue.

Cardiovascular diseases caused 20.5 million deaths in 2021, accounting for nearly one-third of global mortality 1. This underscores the importance of identifying practical prognostic markers for effective patient stratification and treatment, particularly in ischemic heart disease (IHD). Transthoracic echocardiography (TTE) is a fundamental and accessible, non-invasive imaging tool widely used in clinical cardiology for diagnosis and management concerning patients with a broad spectrum of cardiovascular diseases. It is the first level non-invasive imaging method and the most widely used in clinical practice for the diagnosis and follow-up of patients with acute coronary syndrome (ACS). Alongside established echocardiographic prognostic parameters, new measurements have shown their predictive relevance for adverse events in IHD patients, including three-dimensional (3D) imaging, tissue Doppler (TDI) and speckle tracking technology. The aim of this review is to identify the current diagnostics echocardiographic tools in the literature that may provide new prognostic parameters applicable in the acute phase and at follow-up in patients following an acute myocardial infarction. We focused on the latest imaging methods such as TDI, Myocardial Work Index, Speckle-Tracking Strain and 3D technologies evaluated using TTE, given its ease of use, and widespread accessibility at all stages of coronary artery disease.

Objective This study aimed to assess alterations in right ventricular (RV) function following percutaneous coronary intervention (PCI) in patients with non–acute coronary syndrome angina utilizing three-dimensional speckle tracking echocardiography (3D-STE). Methods A prospective study was conducted involving 136 patients diagnosed with non–acute coronary syndrome angina undergoing PCI, constituting the study group, alongside 110 age and gender-matched healthy volunteers serving as the control group. Echocardiographic evaluations, including both conventional and three-dimensional assessments, were performed on all study participants at 1 week, 6 months, and 12 months post-PCI. Parameters such as tricuspid annular plane systolic excursion (TAPSE) were derived from conventional echocardiography, while tricuspid lateral annular systolic velocity (S’) was measured via tissue Doppler imaging. Three-dimensional speckle tracking echocardiography (3D-STE) was utilized to quantify metrics including right ventricular fractional area change (RVFAC), right ventricular free wall longitudinal strain (RVFWLS), right ventricular global longitudinal strain (RVGLS), right ventricular stroke volume (RVSV), and right ventricular ejection fraction (RVEF). Results TAPSE, S’, RVFAC, RVFWLS, RVGLS, RVSV and RVEF exhibited significant increases from 1 week to 6 months post-PCI ( P < 0.05). However, from 6 to 12 months post-PCI, RVFAC, RVGLS, RVSV and RVEF demonstrated no notable changes ( P > 0.05). Meanwhile, TAPSE, S’, and RVFWLS sustained significant elevations: TAPSE (19.63±3.253% to 22.603±2.885%, P < 0.001); S’ (10.57±2.643 cm/s to 12.61±2.189 cm/s, P < 0.001); RVFWLS (18.64±2.745% to 19.926±3.291%, P = 0.002).By the 12-month mark post-PCI, S’, RVFAC, RVFWLS, RVGLS and RVEF were notably lower compared to those in the healthy control group: S’ (12.61±2.189 cm/s vs. 13.20±1.946 cm/s, P < 0.001), RVFAC (48.469±2.402% vs. 49.20±3.222%, P < 0.001), RVFWLS (19.926±3.291% vs. 22.10±1.994%, P < 0.001), RVEF (49.191±5.801% vs. 50.15±4.844%, P < 0.001). Conclusion Following PCI, right ventricular systolic function in patients with non–acute coronary syndrome angina improves significantly over time. However, even at the 12-month post-PCI mark, the right ventricular systolic function remains inferior to that of the control group. Notably, 3D-STE emerges as a non-invasive method for quantifying right ventricular systolic function post-PCI in non–acute coronary syndrome angina patients.

Abstract: Background: The transesophageal echocardiogram (TEE) is the standard imaging modality for confirming the presence or absence of patent foramen ovale. There is a causal association between PFO and unexplained stroke. It seems that 3D-TEE can present a high-risk PFO morphological feature, which seems to show more than just being easier to open. Methods: In total 134 consecutive patients with cryptogenic stroke or migraine who had suspected PFO and underwent c-TCD, TTE, and c-TEE were included in this study. TEE confirmed the PFO. The right-to-left shunt (RLS) grade of PFO at rest and abdominal compression Valsalva maneuver was detected by c-TEE. Results: The long diameter of FO (1.74±0.3 vs. 1.60±0.4, P=0.039), the short diameter of FO (1.12±0.3 vs. 1.00±0.3, P=0.036), perimeter of FO (4.62±0.7 vs. 4.22±1.0, P=0.026) and area (1.80±0.8 vs. 1.35±0.8, P=0.05) of the FO were significantly larger in the larger RLS group. The cut-off value calculated by ROC for the diagnosis of high-risk PFO was that the length of the PFO tunnel was 12 mm and Left funnelform combined with multiple exits of left atrial (sensitivity was 92%, specificity was 90%). Conclusions: A larger oval fossa can be more easily activated and cause a large right-to-left shunt. The left funnelform, a longer length of the PFO tunnel, and multiple exits of the tunnel of LA increase the risk of CS in anatomical of PFO respect. TEE can precisely visualize the specific morphological characteristics of PFO. These features on TEE have a strong correlation with CS.

Infective endocarditis (IE) continues to have high rates of adverse outcomes, despite recent advances in diagnosis and management. Although the use of computer tomography and nuclear imaging appears to be increasing, echocardiography, widely available in most centers, is the recommended initial modality of choice to diagnose and consequently guide the management of IE in a timely-dependent fashion. Echocardiographic imaging should be performed as soon as the IE diagnosis is suspected. Several factors may delay diagnosis, for example echocardiography findings may be negative early in the disease course. Thus, repeated echocardiography is recommended in patients with negative initial echocardiography if high suspicion for IE persists, in patients at high risk. However systematic echocardiographic screening should not be utilized as a common tool for fever, but only in the presence of a reasonable clinical suspicion of IE. It may increase the risk of false positive rates of patients requiring IE therapy or may exacerbate diagnostic uncertainty about subtle findings. Considering the complexity of the disease, the echocardiographic proper use should be increasingly time-efficient and focused on the correct identification of IE lesions and associated complications. The path to identify patients who need surgery passes through an echocardiographic skill ensuring the identification of the cardiac anatomical structures and their involvement on the destructive infective extension. We pointed out the role of echocardiography focused on the correct identification of IE distinctive lesions and the associated complications, as part of a diagnostic strategy, within an integrated multimodality imaging, managed by an “endocarditis team”.