Myocardial Remodelling in Aortic Regurgitation: Time to Think Beyond Volumes and Function?

Current guideline criteria for surgical intervention in chronic aortic regurgitation (AR) rely on fixed thresholds of left ventricular size and ejection fraction, but these metrics may overlook early myocardial injury and under-appreciate patient heterogeneity, particularly in women and older adults. Cardiovascular magnetic resonance (CMR) offers robust quantification of regurgitant volume, three-dimensional ventricular volumes, and both focal (late gadolinium enhancement) and diffuse (T1-mapping-derived extracellular volume) fibrosis. Observational studies have linked CMR-detected fibrosis to worse clinical outcomes and less favourable reverse remodelling after valve intervention, suggesting that fibrosis may mark the transition from compensated overload to irreversible myocardial damage.

Tricuspid regurgitation velocity reflects pulmonary artery mean pressure better than systolic pressure in cardiogenic shock.

In this exploratory analysis of 35 patients with ischemic cardiogenic shock, we evaluated the correlation between tricuspid regurgitation velocity (TRV) and pulmonary artery catheter-derived pressures. TRV correlated best with pulmonary artery mean pressure ( = 0.54,  = 0.

EACVI survey on evaluation and quantification of aortic regurgitation by multi-modality imaging.

Aims: To investigate the real-world, current clinical practice of the assessment and management of aortic regurgitation (AR).

Methods And Results: An electronic survey was distributed to cardiovascular imaging specialists by the European Society Association of Cardiovascular Imaging Scientific Initiatives Committee. Three hundred respondents from 66 countries completed the survey.

Integration of Right Ventricular Systolic and Diastolic Function With Invasive Cardiac Output: Association with Renal Replacement Therapy in Ischemic Cardiogenic Shock.

Objective: To investigate echocardiographic parameters of right ventricular (RV) systolic and diastolic function associated with renal replacement therapy (RRT) in acute myocardial infarction complicated by cardiogenic shock (AMI-CS).

Design, Setting, And Participants: Post hoc exploratory analysis of 43 prospectively identified patients admitted to a tertiary cardiac intensive care unit in London, UK, with AMI-CS.

Interventions: Comprehensive transthoracic echocardiographic, clinical, and hemodynamic data were collected concurrently.

Shorter Time to Transcatheter Aortic Valve Implantation Is Associated With Improved Outcomes in Acute Decompensated Aortic Stenosis.

Background: Acute decompensated aortic stenosis is an increasingly common condition associated with a high rate of morbidity, mortality, and health care resource utilization. Among patients with acute decompensated aortic stenosis, this study aimed to assess the impact of time to transcatheter aortic valve implantation (TAVI) on outcomes, hypothesizing that longer durations are associated with worse outcomes.

Methods: Using a single-center registry, patients with their first presentation of acute decompensated aortic stenosis who underwent an urgent TAVI during their index admission were included.

Doppler echocardiography: The noninvasive method for accurately estimating stroke volume in ischaemic cardiogenic shock.

Accurate stroke volume (SV) assessment is crucial in ischaemic cardiogenic shock. While pulmonary artery catheterisation remains the gold standard, its invasive nature necessitates reliable noninvasive alternatives. However, the literature on echocardiographic SV accuracy is inconsistent.

Prevalence, progression, and clinical outcomes of mitral valve prolapse: a systematic review and meta-analysis.

Aims: The prevalence of mitral valve prolapse (MVP) varies across populations and age groups; its natural history and clinical outcomes remain unclear. This meta-analysis established the prevalence of MVP in the general population, in associated syndromes and at different ages. It also determined the rate of progression and the incidence of adverse outcomes.

Exercise capacity in moderate aortic stenosis: a cardiopulmonary stress echocardiography study.

Background: Patients with moderate aortic stenosis (AS) may experience symptoms and adverse outcomes. The aim of this study was to determine whether patients with moderate AS exhibited objective evidence of exercise limitation, compared with age and sex matched controls and if so, to determine which echocardiographic parameters predicted exercise ability.

Methods: This was a prospective case control study of patients with moderate AS (peak velocity (Vmax) 3.

Echocardiographic assessment of aortic regurgitation: a practical guideline from the British Society of Echocardiography.

Aortic regurgitation is the third most common valve lesion with increasing prevalence secondary to an ageing population. Transthoracic echocardiography plays a vital role in the identification and assessment of aortic regurgitation and proves essential in monitoring severity and determining the timing of intervention. Building on the foundations of previous British Society of Echocardiography (BSE) recommendations, this BSE guideline presents an update on how to approach an echocardiographic assessment of aortic regurgitation.

Echocardiographic image quality deteriorates with the severity of cardiogenic shock.

Background: Transthoracic echocardiography (TTE) is the primary tool for assessing left ventricular (LV) function in cardiogenic shock (CS). However, inadequate image quality often hinders it. In this retrospective study, we investigated factors associated with LV image quality in patients admitted to the intensive care unit (ICU) with ischemic CS.

Prevalence, characteristics and clinical impact of work-related musculoskeletal pain in echocardiography.

Background: Work-related musculoskeletal pain (WRMSP) is increasingly recognised in cardiac ultrasound practice. WRMSP can impact workforce health, productivity and sustainability. We sought to investigate the prevalence, characteristics and clinical impact of WRMSP.

Echocardiographic assessment of aortic regurgitation: a narrative review.

Aortic regurgitation (AR) is the third most frequently encountered valve lesion and may be caused by abnormalities of the valve cusps or the aorta. Echocardiography is instrumental in the assessment of AR as it enables the delineation of valvular morphology, the mechanism of the lesion and the grading of severity. Severe AR has a major impact on the myocardium and carries a significant risk of morbidity and mortality if left untreated.

Predictors of outcome in patients with moderate mixed aortic valve disease.

Objectives: Grading the severity of moderate mixed aortic stenosis and regurgitation (MAVD) is challenging and the disease poorly understood. Identifying markers of haemodynamic severity will improve risk stratification and potentially guide timely treatment. This study aims to identify prognostic haemodynamic markers in patients with moderate MAVD.

Ultrasound-Enhancing Agent Safely Enhances Left Ventricular Visualization by Transthoracic Echocardiography in Patients on ECMO Support.

Objective: The authors investigated if the use of ultrasound-enhancing agents (UEA) can safely improve left ventricular (LV) image quality by transthoracic echocardiography (TTE) in patients on extracorporeal membrane oxygenation (ECMO).

Design And Setting: This study was performed in a tertiary cardiothoracic and ECMO center in London, United Kingdom.

Participants: The authors included 18 prospectively identified consecutive patients requiring TEE supported on peripherally implanted ECMO.

Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury.

Cardiac surgery performed on patients in cardiogenic shock is associated with a high mortality and morbidity. Preoperative Extra Corporeal Membrane Oxygenation (ECMO) in cardiogenic shock gives critically-ill patients a chance for surgical intervention and is associated with better surgical outcomes. We present a 29-year-old male who had a ventricular septal defect closure as a child and presented with multi-organ injuries following polytrauma.