Search Results (125)

Dynamic myocardial CT perfusion imaging enables functional assessment of coronary artery stenosis and myocardial microvascular disease. However, it is susceptible to residual motion artifacts arising from cardiac and respiratory activity. These artifacts introduce temporal misalignments, distorting Time-Enhancement Curves (TECs) and leading to inaccurate myocardial perfusion measurements. Traditional nonrigid registration methods can address such motion but are often computationally expensive and less effective when applied to low-dose images, which are prone to increased noise and structural degradation. In this work, we present a CNN-based motion-correction framework specifically trained for low-dose cardiac CT perfusion imaging. The model leverages spatiotemporal patterns to estimate and correct residual motion between time frames, aligning anatomical structures while preserving dynamic contrast behaviour. Unlike conventional methods, our approach avoids iterative optimization and manually defined similarity metrics, enabling faster, more robust corrections. Quantitative evaluation demonstrates significant improvements in temporal alignment, with reduced Target Registration Error (TRE) and increased correlation between voxel-wise TECs and reference curves. These enhancements enable more accurate myocardial perfusion measurements. Noise from low-dose scans affects registration performance, but this remains an open challenge. This work emphasizes the potential of learning-based methods to perform effective residual motion correction under challenging acquisition conditions, thereby improving the reliability of myocardial perfusion assessment. Full article

Background: Takotsubo cardiomyopathy (TTC) has been historically considered a contraindication for heart donation due to its transient left ventricular dysfunction. However, emerging evidence supports that hearts from donors with fully recovered Takotsubo Cardiomyopathy can be safely transplanted. Methods: This case series describes seven heart transplantations performed between January 2022 and September 2025 using donors with previously diagnosed Takotsubo cardiomyopathy. Donor characteristics, intraoperative data, echocardiography data and postoperative outcomes were analyzed. Results: The mean donor age was 33.5 years (range 18–58), with a male-to-female ratio of 6:1. All donors exhibited echocardiographic evidence of Takotsubo Cardiomyopathy at the time of brain death, with full or partial recovery before procurement. Coronary angiography excluded obstructive coronary disease. Echocardiographic follow-up demonstrated the mean LVEF increased to 52 ± 6%, reaching 58 ± 4% at 12 months, global longitudinal strain (GLS) improved progressively (from −14.2 ± 2.8% to −18.5 ± 1.9%), confirming normalization of myocardial deformation and the right ventricular function, assessed by TAPSE, rose from 15 ± 3 mm at discharge to 20 ± 2 mm at 12 months. All patients transplanted with donors who had Takotsubo cardiomyopathy are alive at the 12-month follow-up. Conclusions: Hearts from donors with resolved Takotsubo Cardiomyopathy can be safely used for transplantation without compromising early- or mid-term outcomes. Expanding donor eligibility criteria to include selected TTC donors may contribute to mitigating organ shortages in advanced heart failure patients. Full article

Background: Immune checkpoint inhibitors (ICIs) improve cancer outcomes but may cause cardiovascular toxicity, including early subclinical myocardial injury. Conventional echocardiography has limited sensitivity, whereas speckle-tracking echocardiography (STE) allows for early detection of myocardial deformation. Data on short-term ICI-related effects on biventricular mechanics are limited, and atrial function remains poorly characterized. This study evaluated the early impact of ICI therapy on biventricular and biatrial mechanics using STE in patients with advanced cancer. Methods: In this prospective, single-center study, 28 consecutive patients with advanced cancer undergoing ICI therapy were followed for 3 months. Clinical, laboratory, electrocardiographic, and echocardiographic assessments were performed at baseline, 1 month, and 3 months. STE was used to assess left ventricular global longitudinal strain (LV-GLS) and circumferential strain; right ventricular GLS (RV-GLS); and left and right atrial reservoir, conduit, and contractile strain parameters. Subclinical LV dysfunction was defined as a relative LV-GLS reduction >15%. Logistic and Cox regression analyses identified predictors of strain impairment and adverse clinical events. Results: Conventional echocardiographic parameters, including left ventricular ejection fraction, remained stable. In contrast, LV-GLS declined progressively from 20.7 ± 2.1% to 17.6 ± 2.7% at 3 months (p = 0.002), with subclinical LV dysfunction observed in 85.7% of patients. RV-GLS also deteriorated despite preserved TAPSE. Both left and right atrial strain and strain-rate parameters showed an early and marked decline, accompanied by increased left atrial stiffness despite unchanged atrial volumes. Older age and higher neutrophil-to-lymphocyte ratio (NLR) were associated with LV-GLS impairment. Over a mean follow-up of 5.4 ± 3 months, baseline LV-GLS independently predicted adverse clinical events and mortality. Optimal cut-off values were 67 years for age, 4 for NLR, and 19.5% for LV-GLS. Conclusions: Short-term ICI therapy is associated with early, diffuse subclinical myocardial dysfunction involving both ventricles and atria, detectable only by STE. Comprehensive biventricular and biatrial strain assessment may enhance early cardio-oncology surveillance and risk stratification in ICI-treated patients. Full article

Background/Objectives: Ethnicity is associated with differences in cardiac structure and function in non-pregnant populations, but pregnancy-specific data—particularly for myocardial deformation—remain limited. We investigated whether ethnicity influences cardiac geometry, biventricular and biatrial mechanics, hemodynamics, and carotid vascular indices in healthy women during the third trimester of pregnancy. Methods: In this prospective, monocentric study, 80 healthy women with singleton third-trimester pregnancies were enrolled, including 40 Asian and 40 Caucasian women matched for age and body mass index. All participants underwent standardized clinical and laboratory evaluation, comprehensive transthoracic echocardiography with Doppler, speckle-tracking analysis of both ventricles and atria, and bilateral carotid ultrasonography. Logistic regression analyses were performed in Asian women to identify correlates of supranormal left ventricular ejection fraction (LVEF ≥ 70%) and enhanced left ventricular global longitudinal strain (LV-GLS > 20%). Results: Age and gestational age were similar between groups, whereas body surface area was lower in Asian women (1.65 ± 0.12 vs. 1.77 ± 0.15 m², p < 0.001). Asian women exhibited smaller left ventricular dimensions and volumes but higher LVEF (median 71.6% vs. 66.4%, p < 0.001). Heart rate and blood pressure were comparable, whereas stroke volume [45.5 ± 9.6 vs. 68.0 (48.9–110) mL, p < 0.001] and cardiac output (3.9 ± 0.9 vs. 4.9 ± 0.8 L/min, p < 0.001) were lower in Asian women, who also demonstrated higher total peripheral resistance and lower ventricular–arterial coupling (0.31 ± 0.09 vs. 0.37 ± 0.07, p = 0.001). Speckle-tracking echocardiography revealed higher LV-GLS (21.9 ± 1.9% vs. 20.5 ± 2.0%, p = 0.002), higher LV global circumferential strain, enhanced right ventricular longitudinal strain, and higher reservoir strain of both atria in Asian women. Carotid ultrasonography showed smaller common carotid diameter and cross-sectional area in Asian women (10.7 ± 2.5 vs. 13.7 ± 2.3 mm², p < 0.001). In regression analyses, supranormal LVEF was independently associated with smaller LV end-diastolic diameter (OR 0.39, 95% CI 0.16–0.97), while enhanced LV-GLS was independently associated with lower neutrophil-to-lymphocyte ratio (OR 0.04, 95% CI 0.00–0.87). Conclusions: Ethnicity is associated with multidimensional differences in cardiac geometry, myocardial mechanics, vascular load, and carotid structure in healthy third-trimester pregnancy. Ethnicity-aware interpretation and tailored reference ranges may improve the accuracy of echocardiographic assessment during late gestation. Full article

Background: Right ventricular (RV) dysfunction is common in advanced lung disease due to chronic pressure overload and altered pulmonary vascular mechanics. Lung transplantation (LTx) reduces RV afterload, and pulmonary rehabilitation (PR) may further enhance functional recovery. However, the combined effects of LTx and structured PR on RV myocardial deformation—particularly using speckle-tracking echocardiography (STE)—remain insufficiently characterized. Methods: This single-arm pre–post study included 20 bilateral lung transplant recipients who completed an 8-week, twice-weekly supervised outpatient PR program. Echocardiographic evaluation—including 2D measurements, M-mode, tissue Doppler imaging (TDI), and STE-derived strain parameters—was performed immediately post-discharge (baseline) and after PR. RV global longitudinal strain (RVGLS) and RV free-wall longitudinal strain (RVFWS) served as primary functional outcomes. Results: Improvements were observed in RV myocardial deformation after PR. RVGLS improved from a median of 15.52% to 16.64% (p = 0.004), and RVFWS increased from 15.82% to 17.10% (p = 0.001). RV mid-cavity diameter decreased significantly (p = 0.042), reflecting favorably altered RV geometry. Conventional parameters—including TAPSE, S′ velocity, RVEDA, and FAC—showed no statistically significant changes. These findings indicate that STE parameters are more sensitive than traditional indices for detecting early RV remodeling in the post-transplant period. Conclusions: Lung transplantation combined with a structured PR program was associated with early improvements in RV deformation indices measurable by STE, even when traditional echocardiographic indices remained within normal limits. STE may therefore serve as a sensitive tool for monitoring subclinical RV recovery after LTx and for assessing the additive benefits of PR. Full article

Background: Ventricular function assessments in Fontan patients remain challenging. Ejection fraction (EF) lacks sensitivity for early dysfunction, and the roles of strain and advanced imaging in systemic left ventricle (LV) physiology are not fully defined. We aimed to compare (i) LV and atrial strain indices between pediatric Fontan patients with preserved EF (P-LVEF) versus reduced EF (R-LVEF) and (ii) echocardiographic global longitudinal strain, segmental longitudinal strain indices, and conventional 2D and 3D echocardiographic parameters through cardiac morphology. Methods: Pediatric patients with Fontan circulation and systemic LV morphology underwent clinical, hemodynamic, and multimodality echocardiographic evaluation, including 2D/3D parameters, global and segmental LV strain, and left atrial strain. Outcomes were analyzed according to EF status and congenital morphology. Significant results from multiple comparisons were followed by post hoc analysis, where appropriate. Results: Patients with a reduced EF exhibited a worse clinical status, a higher pulmonary vascular resistance index, and greater systemic congestion compared with those with a preserved EF. Conventional 2D indices showed no significant differences between the two studied groups except for LV end-systolic volume (ESV) (p = 0.0315) and LV end-systolic longitudinal diameter (ESL) (p = 0.0024), which showed higher values in the R-LVEF group. Although the relative frequency of impaired deformation was higher in Fontan patients with an unbalanced atrioventricular canal compared with the Fontan patients with a tricuspid atresia + pulmonary stenosis + ventricular septal defect, the difference did not reach statistical significance (p = 0.1365). Most segmental longitudinal strain values were not significantly different across patients with different cardiac morphology, except for the basal anterior segment and apical inferoseptal segment (p < 0.05). Conclusions: In pediatric Fontan patients with systemic LV morphology, a reduced EF was associated with a worse clinical and hemodynamic status. Conventional echocardiographic indices showed a limited ability to differentiate between the compared groups. Although no statistically significant differences were detected between pediatric Fontan patients with preserved EF and reduced EF, LV and atrial strain indices provided complementary information on ventricular–atrial interactions and myocardial deformation. These findings are exploratory and warrant confirmation in larger, prospective studies. Full article

This study used a rat model of coronary artery reperfusion imaged with preclinical 7-tesla magnetic resonance imaging (7T-MRI) to evaluate cardiac function, myocardial deformation, and the impact of infarction-to-reperfusion time. Wistar rats were assigned to control (n = 6), 20 min infarction (n = 10), 30 min infarction (n = 6), and 40 min infarction (n = 6) groups. Myocardial infarction occurred in all infarction groups but not in controls. Imaging included short- and long-axis slices. Cardiac function was assessed using end-diastolic volume, end-systolic volume, and left-ventricular ejection fraction. Myocardial deformation was analyzed by circumferential strain, radial strain (RS), and longitudinal strain (LS, four-chamber and two-chamber) using feature tracking. The 30 and 40 min infarction groups showed significant reductions in cardiac function and strain compared to the controls. RS decreased significantly between the control and 20 min infarction groups (40.6 ± 4.7% and 34.0 ± 4.1%, p < 0.05). No significant LS difference was observed between 30 and 40 min. Consequently, RS detects early myocardial changes (20 min), whereas LS may reflect compensatory contractility in severe infarction. Preclinical 7T-MRI provides valuable insights into the impact of infarction duration on cardiac function and myocardial deformation. Full article

Neonatal pulmonary hypertension (PH) is a major cause of illness and death in newborns. Neonatologist-performed echocardiography (NPE) is increasingly used as a bedside tool to assess heart function, shunt patterns, and pulmonary blood flow in real time, helping clinicians better understand the severity and type of PH. This narrative review summarizes current evidence on the use of NPE in diagnosing, monitoring, and treating neonatal PH, drawing on clinical studies, guidelines, and expert recommendations. NPE provides key diagnostic and therapeutic information, including evaluation of ventricular function, estimation of pulmonary pressures, and assessment of shunt direction. Advanced measures—such as tricuspid annular plane systolic excursion (TAPSE), myocardial performance index, pulmonary artery acceleration time (PAAT), and deformation imaging—improve accuracy and help guide therapies like inhaled nitric oxide, milrinone, and sildenafil. NPE is also useful in chronic conditions such as bronchopulmonary dysplasia (BPD)- and congenital diaphragmatic hernia (CDH)-associated PH. Despite its clear clinical value, NPE use remains limited by variations in training, protocols, and resource availability. Standardized curricula, accreditation, and unified reporting practices are needed to ensure safe, consistent integration of NPE into neonatal care pathways. Full article

In the cardiovascular system, geometric remodeling of the cardiac chambers is the main mechanism enabling increased cardiac performance during exercise in athletes, as well as underlying pathological progression toward heart failure. In this study, we investigated cardiac mechanics in healthy children across five phases of physical exercise, Rest, Mid, Peak, and Recovery, at 5 and 10 min, using three-dimensional echocardiography. Analyses were conducted relative to a reference cohort of healthy children to identify exercise-induced modifications that may contribute to cardiac remodeling. Ventricular performance was assessed through two complementary approaches: myocardial deformation, quantified by the principal values and directions of the strain tensor, and intraventricular flow dynamics, including assessments of ventricular filling patterns as the vorticity, vortex formation time and hemodynamic forces. This preliminary study offers promising insights into early cardiac function changes that may inform our understanding of cardiac remodeling during adaptation, healing or disease progression. Full article

Background: Takotsubo syndrome (TTS) often mimics anterior ST-elevation myocardial infarction (STEMI) caused by left anterior descending (LAD) occlusion, yet the two entities differ fundamentally in pathophysiology and mechanical behavior. Two-dimensional speckle-tracking echocardiography (2D-STE) enables detailed assessment of left ventricular (LV) deformation beyond conventional ejection fraction (LVEF). This meta-analysis compared global and regional LV strain patterns in TTS versus LAD-related anterior STEMI during the acute phase. Methods: A systematic search of PubMed, Embase, and Scopus through October 2025 identified observational case–control studies directly comparing TTS and angiographically confirmed anterior STEMI, with LV mechanics assessed by 2D-STE. Random-effects models were used to pool standardized mean differences (SMDs) for LVEF; global longitudinal strain (GLS); apical, mid-ventricular, and basal longitudinal strain (ALS, MLS, BLS); and global radial strain (GRS). Heterogeneity (I²), publication bias (funnel plots, Egger’s test), meta-regression, and leave-one-out sensitivity analyses were performed. Results: Six studies comprising 221 TTS and 290 anterior STEMI patients met the inclusion criteria. TTS patients were older, predominantly female, and had fewer metabolic risk factors, while LV size was comparable. LVEF was significantly lower in TTS (SMD −1.149; 95% CI −2.20 to −0.10; p = 0.032), with stable findings across sensitivity analyses and no evidence of publication bias. GLS, ALS, MLS, and BLS showed only a non-significant trend toward greater impairment in TTS, and these comparisons were limited by marked inter-study heterogeneity. In contrast, GRS was significantly and consistently more reduced in TTS (SMD −1.284; 95% CI −1.59 to −0.98; p < 0.001), indicating more profound global radial dysfunction. Meta-regression showed no significant influence of demographic factors or vendor-specific software on LVEF or GLS differences. Conclusions: Compared with LAD-related anterior STEMI, TTS is associated with more severely depressed LVEF and markedly impaired radial strain, while longitudinal strain differences remain inconclusive and suggest only a potential trend toward greater dysfunction, reflecting the limited and heterogeneous evidence. These findings are consistent with diffuse, stress-induced myocardial stunning in TTS and suggest that 2D-STE may aid differentiation between stress cardiomyopathy and ischemic infarction in the acute setting, although longitudinal strain parameters should be interpreted cautiously and regarded as hypothesis-generating. Full article

Background: Pregnancy induces substantial cardiovascular remodeling, yet whether maternal cardiac adaptation differs across ethnic groups remains unclear. Body size, ventricular geometry, and thoracoabdominal configuration may modulate key functional indices such as left ventricular ejection fraction (LVEF) and global longitudinal strain (LV-GLS). This systematic review compared echocardiographic characteristics between Asian and Western healthy pregnant women in late gestation and explored physiological mechanisms underlying observed differences. Methods: A comprehensive search of PubMed, Scopus, and EMBASE identified studies reporting transthoracic echocardiography in healthy singleton third-trimester pregnancies across Asian and Western populations. Extracted variables included anthropometry, ventricular dimensions and volumes, LVEF, and LV-GLS. Pooled estimates were calculated using inverse-variance weighting, with heterogeneity quantified using the I² statistic. Study quality was assessed with the NIH Case–Control Quality Assessment Tool. Comparative forest plots visualized population differences. Results: Twenty studies involving 1431 participants (578 Asian and 853 Western women) met inclusion criteria. Asian women consistently exhibited smaller ventricular chambers, higher LVEF, and more favorable LV-GLS. Importantly, these differences persisted after indexing LV-GLS to BSA, indicating that body-size normalization attenuates—but does not eliminate—population differences in myocardial deformation. Western women demonstrated slightly attenuated GLS despite preserved LVEF, plausibly attributable to larger cardiac size, higher wall stress, greater diaphragmatic elevation, and increased extrinsic thoracic compression. Between-study heterogeneity was substantial (I² > 95%) due to variation in imaging platforms, strain software, and population characteristics. Methodological quality was fair, with frequent lack of sample-size justification and incomplete confounder adjustment. Conclusions: Healthy Asian pregnant women display a hyperdynamic systolic phenotype, whereas Western women show a physiologically appropriate, load-related attenuation of LV-GLS with preserved LVEF. These findings highlight the need for ethnicity-associated and anatomy-aware echocardiographic reference values and support incorporating thoracic geometric indices, such as the modified Haller Index, into strain interpretation during pregnancy. Full article

Primary mitral regurgitation (PMR) is the most common mitral valve disorder in clinical practice. Although several prognostic indicators derived from resting transthoracic echocardiography (TTE) and exercise stress echocardiography (ESE) are available, patient outcomes remain highly variable, with substantial differences in complication rates and mortality. Identifying individuals at lower cardiovascular risk is therefore clinically relevant, as they represent a large proportion of cases. Current guidelines recommend an integrative approach—combining qualitative, semi-quantitative, and quantitative indices—to determine the timing of intervention, but they do not specifically address risk stratification in low-risk PMR populations. Recent studies have highlighted the potential prognostic value of chest wall configuration, assessed noninvasively using the Modified Haller Index (MHI). Defined as the ratio of latero-lateral thoracic diameter to the antero-posterior (A-P) sternum–spine distance, MHI appears to influence myocardial deformation indices obtained by speckle-tracking echocardiography (STE). Patients with PMR due to mitral valve prolapse (MVP) often show a reduced A-P thoracic diameter caused by sternal depression. Among these, those with an MHI > 2.5 or A-P diameter ≤ 13.5 cm display greater impairment in global and basal strain, particularly in longitudinal and circumferential directions. These abnormalities likely reflect extrinsic geometric constraints and cardiac displacement leading to apparent dyssynchrony rather than intrinsic myocardial dysfunction. A reduced A-P diameter was also independently associated with mitral annular disjunction (MAD) in MVP and emerged as a determinant of impaired strain in this subgroup. In a retrospective cohort of 424 symptomatic MVP patients with moderate MR undergoing ESE, positive tests and exercise-induced severe MR were uncommon. Importantly, an MHI > 2.5 or an A-P diameter ≤ 13.5 cm was associated with a favorable medium-term prognosis, with few adverse cardiovascular events. This narrative, non-systematic review, based on a structured but non-PRISMA literature search, summarizes current evidence on conventional and novel echocardiographic prognostic markers and their implications for risk stratification in PMR. As such, it carries inherent limitations, including potential selection bias, incomplete retrieval of unpublished or negative studies, and reliance on single-center observational data. The findings should therefore be interpreted cautiously and validated through larger, independent, multicenter investigations. Full article

Background: Left ventricular (LV) mechanics assessed by speckle-tracking echocardiography provides sensitive markers of cardiac adaptation to exercise. Different training modalities—endurance, high-intensity interval training (HIIT), and acute exercise tests—impose distinct hemodynamic loads, yet their comparative effects on LV deformation remain unclear. Importantly, acute and chronic endurance exposures may elicit divergent myocardial responses that must be interpreted separately. Methods: A systematic search of PubMed, Scopus, and EMBASE (through September 2025) identified studies evaluating LV mechanics in response to endurance, HIIT, or acute exercise among healthy or recreationally active individuals. Echocardiographic parameters of strain and torsion were extracted, and methodological quality was appraised using the NIH Quality Assessment Tool. Results: Twenty-three studies (859 participants) met inclusion criteria. Acute prolonged endurance exercise—particularly marathon and ultra-endurance events—was associated with transient, fully reversible reductions in global longitudinal, circumferential, and radial strain and torsion, despite preserved ejection fraction, reflecting short-term myocardial fatigue rather than maladaptive remodeling. In contrast, chronic endurance training maintained or improved LV mechanics without evidence of dysfunction, while HIIT interventions consistently enhanced LV systolic strain and rotational indices across diverse age groups and sexes, reflecting improved contractile efficiency and physiological remodeling. Acute exercise produced heterogeneous, load-dependent strain responses, with isometric stress increasing regional strain and maximal exertion inducing temporary global reductions. Between-study heterogeneity was moderate, methodological quality generally good, and small-study effects varied by modality, being most evident in endurance studies, borderline for HIIT, and limited for acute tests due to sample size. Conclusions: Acute endurance exercise produces transient, reversible LV deformation changes, whereas chronic endurance training preserves mechanical efficiency. HIIT reliably enhances systolic strain and torsional mechanics, and acute exercise elicits variable but physiologically meaningful responses. These findings clarify that transient post-race strain reductions reflect physiological fatigue, not chronic maladaptation, and underscore the modality-specific nature of myocardial adaptation to exercise. Full article

Mutations in genes encoding sarcomeric proteins are a common cause of cardiomyopathy and sudden cardiac death in humans. We evaluated the hypothesis that myofilament dysfunction is coupled to morphological and functional alterations of cardiomyocyte nuclei in a Tnnc1-targeted knock-in (Tnnc1-p.A8V) mouse model of hypertrophic cardiomyopathy (HCM). Tnnc1 is the gene that codes for the isoform of the Ca²⁺-regulatory protein troponin C (cTnC) that is expressed in cardiomyocytes and slow skeletal muscle fibers and resides on thin filaments of sarcomeres in those muscles. This pathogenic mutation in a sarcomere gene alters many aspects of cardiomyocyte function, including sarcomere contractility, cytoplasmic Ca²⁺ buffering, and gene expression. Analysis of myocardial histological sections and isolated cardiomyocytes from adult Tnnc1-p.A8V mouse hearts revealed significantly smaller (cross-sectional area and volume) and rounder nuclei compared to those from age-matched, wild-type control mice. Changes in nuclear morphology could not be explained by differences in cardiomyocyte size or ploidy. Isolated wild-type and mutant cardiomyocyte nuclei, which are embedded centrally within myofibrils, undergo compression during contraction of the cardiomyocyte, indicating that during each heartbeat cardiomyocyte nuclei would be mechanically deformed as well as being exposed to elevated cytoplasmic Ca²⁺. Immunoblotting analysis indicated decreased nuclear localization of cardiac troponin C and decreased histone H4 expression in Tnnc1-p.A8V mouse hearts. Next, we investigated the influence of nucleocytoplasmic transport by immunofluorescence microscopy, and we could not confirm nuclear localization of cardiac troponin C in fixed myocardial tissue from adult mice. However, cardiac troponin C could be detected in healthy human-induced pluripotent stem cell-derived cardiomyocyte nuclei. We conclude that pathological myofilament dysfunction due to a pathogenic, cardiomyopathy-associated mutation can be linked to altered protein composition of cardiomyocyte nuclei and aberrant nuclear morphology. Full article

Catheter ablation (CA) has become a validated technique for treating patients with symptomatic or paroxysmal atrial fibrillation (AF), as recommended by the latest 2024 European society of cardiology (ESC) guidelines, class II level A. The procedure is also recommended for patients with persistent AF without major risk factors for AF recurrence, as an alternative to antiarrhythmic medications class I or III. However, CA carries the risk of AF recurrence in 30–35% of patients, sometimes after the procedure. Multiple factors impact the onset, maintenance, and recurrence of AF after CA, including clinical, biohumoral, echocardiographic, genetic, and lifestyle factors. Beyond traditional predictors, emerging factors such as obstructive sleep apnea syndrome, chronic renal failure, chronic lung disease, physical activity patterns, gut microbiota composition, and epicardial fat thickness significantly influence outcomes. Therefore, optimizing patient’s selection for CA is an important strategy to minimize the risk of AF recurrence. Many echocardiographic parameters emerged as predictors of AF recurrence post-CA, but none stood out as a potential single factor. These factors include traditional markers such as left atrial size by 2D echocardiography, LV ejection fraction, LV diastolic function parameters as well as myocardial deformation addressed by the recently developed speckle tracking analysis. Additionally, the duration and type of AF represent fundamental risk factors, with longstanding persistent AF showing significantly higher recurrence rates compared to paroxysmal forms. Novel biomarkers including MR-proANP, caspase-8, hsa-miR-206, and neurotrophin-3 show promise in enhancing risk prediction capabilities. The aim of this review is to explore the most relevant echocardiographic parameters, including myocardial deformation, that could accurately predict recurrence of AF after CA, while also examining the role of emerging clinical and biochemical predictors in comprehensive patient selection strategies. Full article