Chronotropic incompetence during exercise or pharmacological stress is associated with reduced survival in patients with chronic coronary syndromes.

Aims: Chronotropic incompetence (CI) is a biomarker of cardiac autonomic dysfunction. The aim of the study is to assess the risk stratification value of CI during exercise or pharmacological stress echocardiography in patients with chronic coronary syndromes.

Methods And Results: In a prospective, multicenter, international, observational study, we enrolled 13 445 patients with known or suspected chronic coronary syndromes who underwent stress echocardiography in 19 clinical sites from 10 countries using either exercise (n = 2594), dobutamine (n = 2440), or dipyridamole (n = 8411).

Exercise Doppler Echocardiography of the Right Heart and Pulmonary Circulation in Patients With Cardiovascular Risk Factors: Observations From the RIGHT Heart International NETwork (RIGHT-NET).

Background: The precise impact of cardiovascular risk factors (CVRFs) on the right ventricle-pulmonary circulation unit remains unclear.

Research Question: Are there any differences regarding resting and exercise right ventricular function in patients with CVRFs but without overt cardiovascular disease when compared with healthy control patients?

Study Design And Methods: We extracted from the Right Heart International Network international registry the data of 362 patients with at least 1 CVRF but no overt cardiovascular disease, and 375 healthy control patients. All patients and control patients had undergone resting and exercise echocardiographic evaluations on a semirecumbent cycle ergometer.

Stress Echo 2030 Study: A Flagship Project of the Italian Society of Echocardiography and Cardiovascular Imaging.

Over the past decade, stress echocardiography has evolved from a test for assessing epicardial artery stenosis to a comprehensive functional test, targeting multiple cardiovascular parameters. The new approach includes several structured steps: (a) evaluating regional wall motion abnormalities to detect epicardial artery stenosis or vasospasm; (b) assessing pulmonary congestion and diastolic function via B-lines with lung ultrasound; (c) gauging preload and contractile reserve with volumetric echocardiography; (d) measuring coronary microvascular reserve using Doppler-based coronary flow velocity in the middistal left anterior descending artery; and (e) determining cardiac sympathetic reserve by tracking heart rate reserve on an ECG. This evolution was supported extensively by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), which played a key role in five areas: (1) developing the initial, curiosity-driven project; (2) disseminating protocols and results at national and international conferences, supporting logistic infrastructure and publication expenses; (3) establishing a digital platform (customized Redcap) for data entry and storage; (4) facilitating patient recruitment across 19 Italian centers; and (5) offering formal endorsement through six presidencies, adding credibility and reach beyond any single institution.

Cardiac Telerehabilitation After Acute Coronary Syndrome Ensures Similar Improvement in Exercise Capacity as Inpatient Rehabilitation, Regardless of the Age Profile of the Compared Groups.

During the COVID-19 pandemic, the availability of cardiac rehabilitation (CR) was limited. On the other hand, during that period of epidemic restrictions, patients with acute coronary syndrome (ACS) required careful control and monitoring after coronary events. The aim of this study was to assess whether CR conducted during the epidemic restrictions in a remote mode ensured similar improvement in physical performance as CR conducted in a centre-based mode before the COVID-19 pandemic.

Exercise Echocardiography of Left Ventricular Diastolic Function in Healthy Subjects: Insights From the RIGHT-NET.

Background: Exercise transthoracic Doppler echocardiography (TTE) is considered suggestive of left ventricular (LV) diastolic dysfunction when the ratio of mitral Doppler E to tissue Doppler e' waves is >15 with or without a peak tricuspid regurgitation velocity (TRV) >3.4 m/s. However, these measurements may be affected by exercise intensity.

Bicuspid Aortic Valves (BAV) Registry (RE-BAV): Clinical and echocardiographic characteristics of patients with BAV according to novel classification of bicuspid aortic valves.

Background: Bicuspid aortic valve (BAV) is a common congenital heart defect linked to abnormal valve structure and aortic dilatation.

Aims: To present BAV types and valvulo-aortopathy in the Polish population using the latest 2021 classification.

Methods: RE-BAV is a registry of adult ambulatory and hospitalized patients with BAV evaluated in echocardiographic laboratories at 23 tertiary centers in Poland (2021-2023).

Reliability of spectral Doppler in handheld ultrasonographic device.

To verify and validate the reliability of diastolic function parameters and valvular flow velocities acquired during the handheld ultrasound device (HUD) echocardiographic examination. Study population consisted of the consecutive patients referred for consultation due to dyspnea or impaired exercise tolerance. All patients underwent brief bedside echocardiographic screening with HUD.

Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study.

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes.

Methods: In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024.

Elevated miRNA-499 Levels in Early Phase of Non-ST Elevation Acute Coronary Syndromes Predict Increased Long-Term Risk of Major Adverse Cardiac Events.

: Available data suggest the diagnostic potential of testing microRNAs (miRs) in myocardial infarction, but their prognostic value remains unclear. To evaluate the prognostic value of circulating miRs (miR-1, miR-21, miR-133a, miR-208 and miR-499) for predicting major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction (MI) or cardiovascular rehospitalization, in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS). Our prospective, single-center, observational study included patients (pts) with NSTE-ACS admitted <24 h after symptoms onset and pts with confirmed stable coronary artery disease (SCAD) as controls.

Management and predictors of event-free survival in nonagenarians with myocardial infarction: A nationwide analysis.

Background: Myocardial infarction (MI) remains the leading cause of death, especially in the elderly.

Aims: To characterize management and factors related to event-free survival in patients with acute MI aged at least 90 years.

Methods: We included all patients aged at least 90 years hospitalized for MI in Poland between 2014 and 2020 and followed them for one year.

Left atrial function during exercise stress echocardiography as a sign of paroxysmal/persistent atrial fibrillation.

Objective: Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF).

Methods: A prospective cohort of 1055 patients in SR was enrolled across 12 centers.

Predictors of hypercontractile heart phenotype in patients with chronic coronary syndromes or heart failure.

Hypercontractile phenotype (HP) of the left ventricle (LV) is an actionable therapeutic target in patients with chronic coronary syndromes (CCS) or heart failure (HF), but its clinical recognition remains difficult. To assess the clinical variables associated with the HP. In a prospective, observational, multicenter study, we recruited 5122 patients (age 65 ± 11 years, 2974 males, 58%) with CCS and/or HF with preserved ejection fraction (EF).

Permanent and Persistent Atrial Fibrillations Are Independent Risk Factors of Mortality after Severe COVID-19.

The new coronavirus disease (COVID-19), a pandemic infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), had a deep global influence on morbidity and mortality profiles. Comorbidities, especially cardiovascular diseases, were identified to strongly modify the clinical course of COVID-19. However, the prognostic role of incident or prevalent atrial fibrillation has not been fully explained.

The use of artificial intelligence for predicting postinfarction myocardial viability in echocardiographic images.

Background: Evaluation of standard echocardiographic examination with artificial intelligence may help in the diagnosis of myocardial viability and function recovery after acute coronary syndrome.

Methods: Sixty-one consecutive patients with acute coronary syndrome were enrolled in the present study (43 men, mean age 61 ± 9 years). All patients underwent percutaneous coronary intervention (PCI).