Roberto M. Lang

BackgroundThromboembolic events (TE) often occur in Cardiac Amyloidosis (CA). However, apart from atrial arrhythmia or prior TE, there are no established risk factors, including the CHA2DS2-VASc score, for identifying those at higher risk of TE. Our aim was to identify clinical and echocardiographic predictors of TE in CA.MethodsWe analyzed 157 patients with CA (69±11 years, 55% AL-CA), in sinus rhythm, with no history of atrial arrhythmia or anticoagulation use, who underwent at least one echocardiogram. Primary endpoint was venous or arterial TE. We used LASSO Cox proportional hazards (CoxPH) analysis to identify TE-associated clinical and echocardiographic variables and traditional CoxPH to assess their association with TE occurrence over time.ResultsThirty-seven patients (24%) developed a TE. Three variables were independently predictive of TE, based on the regularization parameter (λ= 0.11 …

Right ventricular thrombi (RVTs) have been almost exclusively studied in patients with pulmonary embolism (PE). The implications of an isolated RVT, a finding typically encountered on transthoracic echocardiography (TTE), are lacking. In this study, we sought to identify the echocardiographic and clinical features associated with the presence of RVTs. Between 1998 and 2023, 138 patients with RVT documented on TTE were retrospectively identified. Demographic data, presence of intracardiac devices, hypercoagulable conditions, history of deep vein thrombosis (DVT), PE, and/or left ventricular thrombus were abstracted from electronic chart review. Measurements of right and left ventricular size, and function were performed on TTE. Of the total population of patients with RVT, <1/2 had intracardiac devices, 29% had a documented hypercoagulable state (e.g., cancer or a clotting disorder). Most patients had …

We thank Drs Lancellotti and Go for their observations and comments 1 on our recently published study, 2 in which we characterized the longitudinal and non-longitudinal components of right ventricular (RV) contraction in a large group of healthy subjects from the World Alliance of Societies of Echocardiography (WASE) study.Three-dimensional (3D) imaging has revolutionized echocardiography, but its impact is rarely as apparent as its implementation for the assessment of the right heart. 3D-derived echocardiographic parameters of RV dysfunction provide greater diagnostic and prognostic value while overcoming conventional metrics’ weaknesses. 3 Using the WASE cohort, we uncovered age-, sex-, and race-related differences in healthy hearts’ RV contraction patterns. 2 However, as perfectly pointed out by the authors, the wider adoption of 3D echocardiography faces two important barriers worth further …

BackgroundAlthough regional wall motion abnormality (RWMA) detection is foundational to transthoracic echocardiography (TTE), current methods are prone to inter-observer variability. We aimed to develop a deep learning (DL) model for RWMA assessment and compare it to expert and novice readers.MethodsWe used 15,746 TTE studies—including 25,529 apical videos—which were split into training, validation, and test datasets. A convolutional neural network was trained and validated using apical 2-, 3-, and 4-chamber videos to predict the presence of RWMA in 7 regions defined by coronary perfusion territories, using the ground truth derived from clinical TTE reports. Within the test cohort, DL model accuracy was compared to 6 expert and 3 novice readers using F1 score evaluation, with the ground truth of RWMA defined by expert readers. Significance between the DL model and novices was assessed …

Three-dimensional transoesophageal echocardiography (3D TOE) has been rapidly developed in the last 15 years. Currently, 3D TOE is particularly useful as an additional imaging modality for the cardiac echocardiographers in the echo-lab, for cardiac interventionalists as a tool to guide complex catheter-based procedures cardiac, for surgeons to plan surgical strategies, and for cardiac anaesthesiologists and/or cardiologists, to assess intra-operative results. The authors of this document believe that acquiring 3D data set should become a ‘standard part’ of the TOE examination. This document provides (i) a basic understanding of the physic of 3D TOE technology which enables the echocardiographer to obtain new skills necessary to acquire, manipulate, and interpret 3D data sets, (ii) a description of valvular pathologies, and (iii) a description of non-valvular pathologies in which 3D TOE has shown to be a …

BACKGROUND Left atrial (LA) volume is an echocardiographic marker of remodeling, thromboembolic risk, and prognosis in atrial fibrillation (AF); limited data are available on LA appendage (LAA) characterization beyond morphology. We sought to evaluate LAA characteristics in 2-dimensional (2D) and 3-dimensional (3D) transesophageal echocardiography (TEE) and the correlation with LA/LAA prothrombotic state and prognosis. METHODS We prospectively studied 206 hospitalized patients with AF using 2D transthoracic echocardiography (TTE) and 2D/3D TEE of the LAA ≤24 hours from admission. Patients were divided according to the presence or absence of LAA sludge and/or thrombus. Data on clinical events were collected for 2 years. RESULTS Patients with LAA sludge/thrombus (n=35) on admission had higher LA volumes, lower left ventricular ejection fraction, lower LAA emptying and filling flow velocity, larger 2D LAA measurements (2D LAA ostium diameter, 2D LAA area) as well as larger 3D LAA measurements (higher 3D LAA volumes (LAAV), higher 3D end-systolic [ES] LAA ostium area), and more frequently non-chicken wing morphology. On multivariable logistic regression analysis, LAA filling flow velocity and 3D ES LAAV were associated with the presence of LAA sludge/thrombus at admission (P=0.031 and P<0.0001 respectively). Receiver operating characteristic curve analysis revealed the optimal cut-off for 3D ES LAAV to discriminate patients at risk of death within 2 years was 9.3 mL. Kaplan–Meier curves demonstrated a significant difference in survival at 2-year follow-up according to this value: 3 deaths occurred …

Introducción: El número creciente de estudios ecocardiográficos y la necesidad de cumplir rigurosamente con las recomendaciones de guías internacionales de cuantificación, ha llevado a que los cardiólogos deban realizar tareas sumamente extensas y repetitivas, como parte de la interpretación y análisis de cantidades de información cada vez más abrumadoras. Novedosas técnicas de machine learning (ML), diseñadas para reconocer imágenes y realizar mediciones en las vistas adecuadas, están siendo cada vez más utilizadas para responder a esta necesidad evidente de automatización de procesos.Objetivo: Nuestro objetivo fue evaluar un modelo alternativo de interpretación y análisis de estudios ecocardiográficos, basado fundamentalmente en la utilización de software de ML, capaz de identificar y clasificar vistas y realizar mediciones estandarizadas de forma automática.Material y métodos: Se utilizaron imágenes obtenidas en 2000 sujetos normales, libres de enfermedad, de los cuales 1800 fueron utilizados para desarrollar los algoritmos de ML y 200 para su validación posterior. Primero, una red neuronal convolucional fue desarrollada para reconocer 18 vistas ecocardiográficas estándar y clasificarlas de acuerdo con 8 grupos (stacks) temáticos. Los resultados de la identificación automática fueron comparados con la clasificación realizada por expertos. Luego, algoritmos de ML fueron desarrollados para medir automáticamente 16 parámetros de eco Doppler de evaluación clínica habitual, los cuales fueron comparados con las mediciones realizadas por un lector experto. Finalmente, comparamos el tiempo necesario para …

Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%–15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent …