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).

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.

Right ventricular-pulmonary artery coupling in patients with tricuspid valve regurgitation: use of echo-derived pulmonary artery effective elastance.

Aims: Tricuspid valve regurgitation (TR) is common and associated with increased mortality. The interaction between the pulmonary artery (PA) circulation and the right ventricle (RV) and association with outcomes is incompletely understood. The effective PA elastance (PA Ea) is a composite measure of RV afterload that refers to the pulmonary vascular load that the RV must overcome to eject blood.

Use of artificial intelligence to predict outcomes in mild aortic valve stenosis.

Aims: Aortic stenosis (AS) is a common and progressive disease, which, if left untreated, results in increased morbidity and mortality. Monitoring and follow-up care can be challenging due to significant variability in disease progression. This study aimed to develop machine learning models to predict the risks of disease progression and mortality in patients with mild AS.

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.

The Imaging Spectrum of Device-Related Thrombus After Percutaneous Left Atrial Appendage Occlusion.

Surveillance imaging at 45 to 90 days after transcatheter left atrial appendage occlusion device implantation with transesophageal echocardiography (TEE) or cardiac computed tomography (CT) is recommended to assess device position and the presence of device-related complications such as device-related thrombus (DRT) or peridevice leak. Detection of DRT is associated with a significantly increased risk of a stroke or systemic embolization event within 6 months of detection. Nonetheless, there is significant variability in detection of DRT as a result of timing, frequency, and imaging modality used for surveillance.

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.

A Novel Presentation of Eclipsed Mitral Regurgitation.

Eclipsed mitral regurgitation (MR) is a rare phenomenon of transient severe MR in patients with normal left ventricular function. This paper presents a case of a patient with recurrent heart failure exacerbations and transient, positional severe MR consistent with eclipsed MR, which improved after mitral transcatheter edge-to-edge repair.

Cardiac Damage in Early Aortic Stenosis: Is the Valve to Blame?

Background: Despite the close association between aortic stenosis (AS) and cardiac damage (CD), it is unclear if CD is limited to patients with moderate and severe AS and which factors affect its progression. Although altered valvular hemodynamic status may drive the development of CD in AS, commonly occurring comorbidities may contribute.

Objectives: The aim of this study was to determine the prevalence of and factors associated with CD in mild AS.

Self-Expanding or Balloon-Expandable TAVR in Patients with a Small Aortic Annulus.

Background: Patients with severe aortic stenosis and a small aortic annulus are at risk for impaired valvular hemodynamic performance and associated adverse cardiovascular clinical outcomes after transcatheter aortic-valve replacement (TAVR).

Methods: We randomly assigned patients with symptomatic severe aortic stenosis and an aortic-valve annulus area of 430 mm or less in a 1:1 ratio to undergo TAVR with either a self-expanding supraannular valve or a balloon-expandable valve. The coprimary end points, each assessed through 12 months, were a composite of death, disabling stroke, or rehospitalization for heart failure (tested for noninferiority) and a composite end point measuring bioprosthetic-valve dysfunction (tested for superiority).

Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival.

Background: Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes.

Methods: Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated.

Aortic Valve Calcium Score by Computed Tomography as an Adjunct to Echocardiographic Assessment-A Review of Clinical Utility and Applications.

Aortic valve stenosis (AS) is increasing in prevalence due to the aging population, and severe AS is associated with significant morbidity and mortality. Echocardiography remains the mainstay for the initial detection and diagnosis of AS, as well as for grading of severity. However, there are important subgroups of patients, for example, patients with low-flow low-gradient or paradoxical low-gradient AS, where quantification of severity of AS is challenging by echocardiography and underestimation of severity may delay appropriate management and impart a worse prognosis.