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Advances in Clinical Application of Echocardiography

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 April 2022) | Viewed by 25679

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Special Issue Editors

Dr. Francesca Bursi

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Guest Editor

Division of Cardiology, Cardiorespiratory Department, ASST Santi Paolo e Carlo, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy
Interests: echocardiography; valvular heart disease; mitral regurgitation; heart failure; diastolic dysfunction; risk stratification
Special Issues, Collections and Topics in MDPI journals

Dr. Giovanni Benfari

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Section of Cardiology, Department of Medicine, University of Verona, 37129 Verona, Italy
Interests: echocardiography; left atrium; valvular heart disease; aortic valve stenosis; mitral regurgitation; heart failure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite the armamentarium of the clinician is now provided of several imaging techniques, each with unique advantages and applications, echocardiography remains the cornerstone imaging technique due to its unparalled availability, rapidity, portability, and real time capabilities. And it is the most commonly used technique by cardiologists for diagnosis, management and procedural guidance, and follow-up.

In the last decades, there has been a wide development of novel applications, including Doppler, tissue Doppler, flow dynamics, contrast echocardiography, speckle tracking imaging, and 3D echocardiography. These methods provided important pathophysiological insights in the anatomical and functional quantification of ventricles, atria and valves, demonstrating their incremental prognostic role.

However, we believe that the last advance of echocardiography, in most recent years, is the gradual implementation and expanded application of these sophisticated techniques into busy echocardiography laboratory clinical practices.

The emerging artificial intelligence (AI) and especially machine learning products allowed improvement of image quality, reproducibility and helped to speed workflow by automated quantification of anatomy and function of chambers and valves and may help the spread and facilitate the use of these new complex tools. The COVID pandemia contributed to understanding the importance to extend the use of echocardiography especially with miniaturization to other specialty and clinical settings such as in the emergency department with POCUS.

Topics which will be welcomed in this Special Issue of Journal of Clinical Medicine include, but are not limited to, the following:

Speckle tracking imaging;
Left ventricular and atrial function;
3D echocardiography;
Valve disease quantification (low gradient aortic stenosis, secondary mitral regurgitation, tricuspid regurgitation);
Left ventricular geometry;
Artificial intelligence application;
POCUS;
Stress echocardiography.

especially focusing on their clinical application in medical practice.

Dr. Francesca Bursi
Dr. Giovanni Benfari
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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 Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Advanced echocardiography
Speckle tracking imaging
3D echocardiography
Left ventricular function
Left atrial function
Right ventricular function
Valve disease quantification
Artificial intelligence application
POCUS
Stress echocardiography

Published Papers (10 papers)

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Research

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16 pages, 1281 KiB

Open AccessArticle

The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis

by Cristhian H. Aristizábal-Duque, Juan Fernández Cabeza, Isabel María Blancas Sánchez, Mónica Delgado Ortega, Pilar Aparicio Martinez, Manuel Romero-Saldaña, Francisco Javier Fonseca del Pozo, Manuel Pan, Martin Ruiz Ortiz and María Dolores Mesa-Rubio

J. Clin. Med. 2022, 11(12), 3272; https://doi.org/10.3390/jcm11123272 - 08 Jun 2022

Cited by 2 | Viewed by 1467

Abstract

Background: Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. Methods: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. Results: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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12 pages, 2146 KiB

Open AccessArticle

The Agreement of a Two- and a Three-Dimensional Speckle-Tracking Global Longitudinal Strain

by Jiří Plášek, Tomáš Rychlý, Diana Drieniková, Ondřej Cisovský, Tomáš Grézl, Miroslav Homza and Jan Václavík

J. Clin. Med. 2022, 11(9), 2402; https://doi.org/10.3390/jcm11092402 - 25 Apr 2022

Cited by 4 | Viewed by 1844

Abstract

Background: Two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE) enables assessment of myocardial function. Here, we examined the agreement between 2D and 3D STE measurement of a global longitudinal strain (GLS) in patients with normal left ventricle, reduced ejection fraction, and cardiac pacing. Methods: Our analysis included 90 consecutive patients (59% males; average age: 73.2 ± 11.2 years) examined between May 2019–December 2020, with valid 2D and 3D loops for further speckle-tracking strain analysis. Linear regression, Pearson correlation, and a Bland–Altman plot were used to quantify the association between 2D and 3D GLS and related segments, using the 17-segment American Heart Association (AHA) model. Analyses were performed in the entire study group and subgroups. Intra- and inter-observer variability of 2D and 3D GLS measurement was also performed in all participants. Results: We observed a strong correlation between 2D and 3D GLS measurements (R = 0.76, p < 0.001), which was higher in males (R = 0.78, p < 0.001) than females (R = 0.69, p < 0.001). Associated segment correlation was poor (R = 0.2–0.5, p < 0.01). The correlation between 2D and 3D GLS was weaker in individuals with ventricular pacing of >50% (R = 0.62, p < 0.001) than <50% (R = 0.8, p < 0.001), and in patients with LVEF of <35% (R = 0.69, p = 0.002) than >35% (R = 0.72, p < 0.001). Intra-observer variability for 2D and 3D GLS was 2 and 2.3%, respectively. Inter-observer variability for 2D and 3D GLS was 3.8 and 3.6%, respectively Conclusion: Overall 2D and 3D GLS were closely associated but not when analyzed per segment. It seems that GLS comparison is more representative of global shortening than local displacement. Right ventricular pacing and reduced left ventricular ejection fraction were associated with a reduced correlation between 2D and 3D GLS. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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Graphical abstract

13 pages, 4940 KiB

Open AccessArticle

Non-Invasive Evaluation of Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion

by Tatsuya Nakachi, Shingo Kato, Naka Saito, Kazuki Fukui, Tae Iwasawa, Tsutomu Endo, Masami Kosuge, Daisuke Utsunomiya, Kazuo Kimura and Kouichi Tamura

J. Clin. Med. 2021, 10(20), 4712; https://doi.org/10.3390/jcm10204712 - 14 Oct 2021

Cited by 2 | Viewed by 1813

Abstract

Background: As percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) gains wider acceptance as a therapeutic option for coronary artery disease, the importance of appropriate patient selection has increased. Although cardiovascular magnetic resonance imaging (MRI) allows segmental and quantitative analyses of myocardial ischemia and scar transmurality, it has limitations, including contraindications, cost, and accessibility. This study established a non-invasive method to evaluate patients undergoing CTO-PCI using two-dimensional speckle-tracking echocardiography (2D-STE). Methods: Overall, we studied 55 patients who underwent successful CTO-PCI. Cardiovascular MRI and 2D-STE were performed before and 8 ± 2 months after CTO-PCI. Segmental findings of strain parameters were compared with those obtained with late gadolinium enhancement and stress-perfusion MRI. Results: With a cutoff of −10.7, pre-procedural circumferential strain (CS) showed reasonable sensitivity (71%) and specificity (73%) for detecting segments with transmural scar. The discriminatory ability of longitudinal strain (LS) for segments with transmural scar significantly improved during follow-up after successful CTO-PCI in the territory of the recanalized artery (area under the curve (AUC) 0.70 vs. 0.80, p < 0.001). LS accuracy was lower than that of CS at baseline (AUC 0.70 vs. 0.79, p = 0.048), and was increased at follow-up (AUC 0.80 vs. 0.82, p = 0.81). Changes in myocardial perfusion reserve from baseline to follow-up were significantly associated with those in LS but not in CS. Conclusions: Use of 2D-STE may allow the non-invasive evaluation of patients undergoing CTO-PCI to assess the indication before the procedure and treatment effects at follow-up. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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12 pages, 1001 KiB

Open AccessArticle

Speckle-Tracking Global Longitudinal and Regional Strain Analysis in Neonates with Coarctation of Aorta: A Case-Control Study

by Liliana Gozar, Claudiu Mărginean, Andreea Cerghit Paler, Dorottya Gabor-Miklosi, Daniela Toma, Mihaela Iancu, Rodica Togănel and Amalia Făgărășan

J. Clin. Med. 2021, 10(19), 4579; https://doi.org/10.3390/jcm10194579 - 02 Oct 2021

Cited by 1 | Viewed by 1585

Abstract

Our objectives are to compare speckle-tracking peak global longitudinal (pGLS) and regional strain values in neonates with coarctation of aorta (CoA) and control groups. Echocardiographic parameters measured by speckle-tracking were studied in a retrospective single-center study. A comparison of pGLS and segmental deformation between neonates with CoA and control group was performed using a three-way mixed ANOVA model. There was a significant difference in the means of segmental strain values between CoA and control group at the apical (p = 0.018) and basal segments (p = 0.031) of the interventricular septum and at the apical segment (p = 0.026) of the left ventricle (LV). After correcting for multiple comparisons, the results had a tendency toward statistical significance (adjusted-p < 0.10). There was significant difference in the mean values of pGLS [F(1, 39) = 7.61, p = 0.009, adjusted p = 0.018] between the studied groups. The results of ROC analysis showed that a cut-off value of −16.60% for pGLS provided an estimated sensitivity of 92.31% (95% CI: [63.97, 99.81]) and 71.43% specificity (95% CI: [51.33, 86.78]) for the diagnosis of CoA in neonates (AUC = 0.794, 95% CI: [0.66, 0.93]). pGLS can be regarded as a feasible and reproducible parameter reflecting LV dysfunction in newborns with CoA when compared to newborns with a false-positive diagnosis. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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10 pages, 628 KiB

Open AccessArticle

Impact of Different Approaches to Kidney Transplant with and without Chronic Hemodialysis on Cardiac Function and Morphology: A Case–Control Study

by Marta Obremska, Dorota Kamińska, Magdalena Krawczyk, Magdalena Krajewska and Wojciech Kosmala

J. Clin. Med. 2021, 10(17), 3913; https://doi.org/10.3390/jcm10173913 - 30 Aug 2021

Cited by 2 | Viewed by 1437

Abstract

Patients with end-stage renal disease have higher cardiovascular morbidity and mortality compared with the general population. Preemptive kidney transplant (KTx) has been shown to be associated with improved survival, better quality of life, lower healthcare burden, and reduced cardiovascular risk. In this case–control study, we investigated the cardiovascular benefits of two approaches to KTx: with and without previous chronic hemodialysis. We enrolled 21 patients who underwent preemptive KTx and 21 matched controls who received chronic hemodialysis before KTx. Cardiac morphological and functional parameters were assessed by echocardiography. Overall, patients undergoing preemptive KTx showed less extensive cardiac damage compared with controls, as evidenced by higher global longitudinal strain, peak atrial and contractile strain, and early diastolic mitral annular velocity as well as a lower left ventricular mass, left atrial volume index, and the ratio of mitral inflow early diastolic velocity to the mitral annular early diastolic velocity. In the multivariable analysis, the presence of chronic hemodialysis prior to KTx was an independent determinant of post-transplant cardiac functional and structural remodeling. These findings may have important clinical implications, supporting the use of preemptive KTx as a preferred treatment strategy in patients with end-stage renal disease. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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10 pages, 11044 KiB

Open AccessArticle

by Jeffrey Shi Kai Chan, Dawnie Ho Hei Lau, Yiting Fan and Alex Pui-Wai Lee

J. Clin. Med. 2021, 10(16), 3619; https://doi.org/10.3390/jcm10163619 - 16 Aug 2021

Cited by 10 | Viewed by 2369

Abstract

Analysis of the cardiac vortex has been used for a deeper understanding of the pathophysiology in heart diseases. However, physiological changes of the cardiac vortex with normal aging are incompletely defined. Vector flow mapping (VFM) is a novel echocardiographic technique based on Doppler and speckle tracking for analysis of the cardiac vortex. Transthoracic echocardiography and VFM analysis were performed in 100 healthy adults (33 men; age = 18–67 years). The intracardiac flow was assessed throughout the cardiac cycle. The size (cross-sectional area) and circulation (equivalent to the integral of normal component of vorticity) of the largest vortices in systole (S-vortex), early diastole (E-vortex), and late diastole (A-vortex) were measured. Peak energy loss (EL) was calculated from information of the velocity vector of intracardiac flow in systole and diastole. With normal aging, the circulation (p = 0.049) of the E-vortex decreased, while that of the A-vortex increased (both p < 0.001). E-vortex circulation correlated directly to e’ (p = 0.003), A-vortex circulation correlated directly to A and a’ (both p < 0.001), and S-vortex circulation correlated directly to s’ (p = 0.032). Despite changes in vortex patterns, energy loss was not significantly different in older individuals. Normal aging is associated with altered intracardiac vortex patterns throughout the cardiac cycle, with the late-diastolic A-vortex becoming physiologically more dominant. Maintained energy efficiency accompanies changes in vortex patterns in aging hearts. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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11 pages, 1227 KiB

Open AccessArticle

High Prevalence of Late-Onset Fabry Cardiomyopathy in a Cohort of 499 Non-Selective Patients with Left Ventricular Hypertrophy: The Asian Fabry Cardiomyopathy High-Risk Screening Study (ASIAN-FAME)

by Yiting Fan, Tsz-Ngai Chan, Josie T. Y. Chow, Kevin K. H. Kam, Wai-Kin Chi, Joseph Y. S. Chan, Erik Fung, Mabel M. P. Tong, Jeffery K. T. Wong, Paul C. L. Choi, David K. H. Chan, Bun Sheng and Alex Pui-Wai Lee

J. Clin. Med. 2021, 10(10), 2160; https://doi.org/10.3390/jcm10102160 - 17 May 2021

Cited by 6 | Viewed by 3460

Abstract

Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured plasma alpha-galactosidase A activity using dried blood spot tests in 499 (age = 66 ± 13 years; 336 men) Hong Kong Chinese patients with LVH defined as maximal LV septal/posterior wall thickness ≥13 mm on echocardiography. Patients with low enzyme activity underwent mutation analysis of the GLA gene. Eight (age = 53−74 years; all men) unrelated patients (1.6%) had low plasma alpha-galactosidase A activity (0.57 ± 0.27 μmol/L wb/hr) and all were confirmed to have the GLA IVS4 + 919G > A mutation. FD patients presented with heart failure (n = 5), heart block (n = 2), ventricular tachycardia (n = 1), chest pain (n = 3), and/or murmur (n = 1). Uncontrolled hypertension (n = 4) and/or severe mitral/aortic valve pathology (n = 2) were frequent. Ethnic subgroups included Teochew (n = 5), Canton (n = 2), and Wenzhou (n = 1). Endomyocardial biopsy (n = 6) revealed hypertrophic myocytes with vacuolization and dense lamellar bodies. Late-onset IVS4 + 919G > A FD is prevalent among Chinese LVH patients, and should be considered as a cause of LVH in adult patients even when hypertension and/or valve pathology are present. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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10 pages, 1573 KiB

Open AccessArticle

Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients

by Andrea Barbieri, Francesca Bursi, Giovanni Camaioni, Anna Maisano, Jacopo Francesco Imberti, Alessandro Albini, Gerardo De Mitri, Francesca Mantovani and Giuseppe Boriani

J. Clin. Med. 2021, 10(6), 1279; https://doi.org/10.3390/jcm10061279 - 19 Mar 2021

Cited by 9 | Viewed by 2184

Abstract

A recently developed algorithm for 3D analysis based on machine learning (ML) principles detects left ventricular (LV) mass without any human interaction. We retrospectively studied the correlation between 2D-derived linear dimensions using the ASE/EACVI-recommended formula and 3D automated, ML-based methods (Philips HeartModel) regarding LV mass quantification in unselected patients undergoing echocardiography. We included 130 patients (mean age 60 ± 18 years; 45% women). There was only discrete agreement between 2D and 3D measurements of LV mass (r = 0.662, r² = 0.348, p < 0.001). The automated algorithm yielded an overestimation of LV mass compared to the linear method (Bland–Altman positive bias of 13.1 g with 95% limits of the agreement at 4.5 to 21.6 g, p = 0.003, ICC 0.78 (95%CI 0.68−8.4). There was a significant proportional bias (Beta −0.22, t = −2.9) p = 0.005, the variance of the difference varied across the range of LV mass. When the published cut-offs for LV mass abnormality were used, the observed proportion of overall agreement was 77% (kappa = 0.32, p < 0.001). In consecutive patients undergoing echocardiography for any indications, LV mass assessment by 3D analysis using a novel ML-based algorithm showed systematic differences and wide limits of agreements compared with quantification by ASE/EACVI- recommended formula when the current cut-offs and partition values were applied. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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Review

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29 pages, 929 KiB

Open AccessReview

Echocardiographic Advances in Dilated Cardiomyopathy

by Andrea Faggiano, Carlo Avallone, Domitilla Gentile, Giovanni Provenzale, Filippo Toriello, Marco Merlo, Gianfranco Sinagra and Stefano Carugo

J. Clin. Med. 2021, 10(23), 5518; https://doi.org/10.3390/jcm10235518 - 25 Nov 2021

Cited by 8 | Viewed by 3550

Abstract

Although the overall survival of patients with dilated cardiomyopathy (DCM) has improved significantly in the last decades, a non-negligible proportion of DCM patients still shows an unfavorable prognosis. DCM patients not only need imaging techniques that are effective in diagnosis, but also suitable for long-term follow-up with frequent re-evaluations. The exponential growth of echocardiography’s technology and performance in recent years has resulted in improved diagnostic accuracy, stratification, management and follow-up of patients with DCM. This review summarizes some new developments in echocardiography and their promising applications in DCM. Although nowadays cardiac magnetic resonance (CMR) remains the gold standard technique in DCM, the echocardiographic advances and novelties proposed in the manuscript, if properly integrated into clinical practice, could bring echocardiography closer to CMR in terms of accuracy and may certify ultrasound as the technique of choice in the follow-up of DCM patients. The application in DCM patients of novel echocardiographic techniques represents an interesting emergent research area for scholars in the near future. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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13 pages, 2768 KiB

Open AccessReview

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

by Francesca Mantovani, Andrea Barbieri, Alessandro Albini, Niccolò Bonini, Diego Fanti, Simone Fezzi, Martina Setti, Andrea Rossi, Flavio Ribichini and Giovanni Benfari

J. Clin. Med. 2021, 10(19), 4364; https://doi.org/10.3390/jcm10194364 - 24 Sep 2021

Cited by 7 | Viewed by 4653

Abstract

The combination of aortic stenosis (AS) and mitral regurgitation (MR) is common in patients with degenerative valvular disease. It is characterized by having complex pathophysiology, leading to potential diagnostic pitfalls. Evidence is scarce in the literature to direct the diagnostic framework and treatment of patients with this particular combination of multiple valvular diseases. In this complex scenario, the appropriate use of advanced echocardiography and multimodality imaging methods plays a central role. Transcatheter mitral valve replacement or repair and transcatheter aortic valve replacement widen the surgical options for valve diseases. Therefore, there is an increasing need to reconsider the function, timing, and mode intervention for patients with a combination of AS with MR towards more personalized treatment. Full article

(This article belongs to the Special Issue Advances in Clinical Application of Echocardiography)

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