Wiley: Echocardiography: Table of Contents

Assessment of Index of Cardio‐Electrophysiological Balance and Left Ventricular Mechanical Dispersion in Obese Individuals

Tue, 09 Jun 2026 08:13:12 -0700

Advanced echocardiographic and electrocardiographic assessment revealed increased left ventricular mechanical dispersion and cardio-electrophysiological imbalance in obese individuals, suggesting elevated arrhythmogenic risk.

ABSTRACT

Objective

To evaluate the corrected index of cardio-electrophysiological balance (ICEBc) and left ventricular mechanical dispersion (LVMD), in obese individuals and to examine their associations with obesity severity and electromechanical myocardial heterogeneity.

Methods

This prospective case–control study included obese individuals (BMI ≥30 kg/m²) and normal-weight healthy controls. All participants underwent standard 12-lead electrocardiography and transthoracic echocardiography. The ICEB and corrected ICEB (ICEBc) were calculated from ECG recordings. LVMD was assessed using two-dimensional speckle-tracking echocardiography. Comparisons between groups and correlation analyses between ICEBc, LVMD, and body mass index (BMI) were performed using appropriate statistical methods, with p < 0.05 considered statistically significant.

Results

Obese individuals had higher systolic and diastolic blood pressures. LVMD was significantly higher and global longitudinal strain was significantly lower in obese participants. QTc and ICEBc were significantly higher in obesity. Among obese subgroups, LVMD and ICEBc increased with obesity severity. LVMD showed a good positive correlation with ICEBc (r = 0.675, p < 0.001). BMI correlated moderately with LVMD (r = 0.543, p < 0.001) and weakly with ICEBc (r = 0.257, p = 0.021).

Conclusion

Obesity was associated with higher LVMD and ICEBc values, suggesting increased electrical and mechanical myocardial heterogeneity. LVMD and ICEBc may serve as complementary, non-invasive surrogate markers of obesity-related electromechanical remodeling. Larger longitudinal studies with rhythm monitoring are required to determine whether these parameters predict clinical arrhythmic events.

Left Ventricular Strain‐Volume Loops in a Healthy Population: The Role of Sex and Age

Mon, 08 Jun 2026 05:42:26 -0700

This study provides an overview of novel SV-loop derived parameters in a healthy adult population, identifying sex- and age- related differences in myocardial mechanics.

ABSTRACT

Background

By combining left ventricular (LV) global longitudinal strain (GLS) with LV volume during the cardiac cycle, LV strain-volume loops (SV-loops) can be generated. LV SV-loop derived parameters provide new insights into the interaction between cardiac contraction and volume in a variety of cardiac diseases and may even have prognostic value. The aim of this study is to describe SV-loops in a healthy adult population and investigate potential sex- and age-related differences of LV SV-loop characteristics.

Methods

In 125 healthy volunteers aged 18–72 years, apical 2-, 3- and 4-chamber views were acquired to measure GLS. Custom software was used to combine strain and volume data to construct SV-loops. Different parameters were derived: (i) linear slope of systolic strain-volume relation (S-Slope); (ii) linear slope of early-systolic strain-volume relation (ES-Slope); (iii) linear slope of early-diastolic strain-volume relation (ED-Slope); (iv) linear slope of late-diastolic strain-volume relation (LD-slope) and (v) uncoupling between systolic and diastolic strain-volume relation (UNCOUP).

Results

For systolic strain-volume relation, higher values were observed in females compared to males, with S-Slope values of 0.19 %/mL m⁻² [0.17–0.22] and 0.13 %/mL m⁻² [0.11–0.14], respectively (p < 0.001). Similarly, ED-Slope was higher in females than in males, with values of 0.18 %/mL m⁻² [0.10–0.28] and 0.12 %/mL m⁻² [0.06–0.18] respectively (p = 0.003). Low values for uncoupling between the systolic and diastolic strain-volume relation were observed, with a mean value of 0.34 ± 1.1. Additionally, UNCOUP was positively correlated with age (r = 0.4; p < 0.05).

Conclusions

Higher values observed in systolic and early-diastolic strain-volume relation in females may reflect sex-specific differences in LV contraction. While the exact mechanisms remain unclear, these findings suggest potential variations in myocardial deformation patterns that warrant further investigation. Consistent with previous work, relative coupling of the systolic and diastolic strain-volume relationship was identified in our cohort of healthy individuals. However, with increasing age, higher values for uncoupling were observed, suggesting age-related alterations in ventricular mechanics that may contribute to changes in cardiac function over time.

Noninvasive Left Ventricular Pressure‐Strain Loop for Evaluating Changes in Left Ventricular Function in Colorectal Cancer Patients After Chemotherapy

Sat, 06 Jun 2026 00:05:46 -0700

This study performed echocardiographic examinations on 66 colorectal cancer patients to acquire and analyze left ventricular myocardial work parameters (including GLS, GWI, GCW, GWW, and GWE). The results demonstrated that the noninvasive pressure-strain loop technique has the potential for early detection of subclinical myocardial dysfunction in colorectal cancer patients undergoing FOLFOX/CAPEOX chemotherapy .

ABSTRACT

Objective

To noninvasively monitor cardiac functional changes throughout chemotherapy in colorectal cancer patients using pressure-strain analysis, validate their predictive value for early detection of subclinical cardiac dysfunction.

Methods

This retrospective observational study included colorectal cancer patients receiving FOLFOX/CAPEOX chemotherapy. Myocardial work parameters—including global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE)—were serially assessed using noninvasive pressure-strain loop technology at baseline (T0), after the first cycle (T1), mid-therapy (T2), and treatment completion (T3). Its predictive performance was evaluated by analyzing the trends of the aforementioned parameters and using receiver operating characteristic (ROC) curves.

Results

Significant cardiac dysfunction emerged as early as the first chemotherapy cycle: GLS decreased by 8.7% (p < 0.001), GWI declined by 6.2% (p < 0.001), GWE reduced by 0.5% (p < 0.001), and GWW markedly increased (p < 0.001). The combined myocardial work model (GWI + GCW + GWE + GWW) predicted subclinical dysfunction with superior AUC (0.875) versus the GLS-only model (AUC = 0.813, p = 0.037).

Conclusions

FOLFOX/CAPEOX chemotherapy induces early myocardial mechanical inefficiency. Myocardial work parameters are sensitive monitoring markers, and their integrated model enhances early detection of subclinical cardiac injury.

Sex Differences in TAVR: Time for Earlier Intervention in Women?

Ana G. Almeida — Sat, 06 Jun 2026 00:05:09 -0700

Echocardiography, Volume 43, Issue 6, June 2026.

Changes in Echocardiographic Parameters of Cardiac Function Following Parathyroidectomy: A Meta‐Analysis

Arsalan Anees, Femi E. Ayeni, Senarath Edirimanne — Thu, 04 Jun 2026 00:00:00 -0700

Patients with symptomatic primary hyperparathyroidism (PHPT) have increased cardiovascular risk related to biochemical abnormalities and structural cardiac changes. We performed a meta‑analysis of 24 studies (881 patients) to evaluate echocardiographic changes following parathyroidectomy. Global longitudinal strain significantly improved after surgery, whereas left ventricular and most other parameters did not, suggesting that GLS is a sensitive marker of early functional improvement in left ventricular function following parathyroidectomy.

ABSTRACT

Background

Primary Hyperparathyroidism (PHPT) is associated with increased cardiovascular risk, partly driven by elevated calcium and parathyroid hormone levels that contribute to structural cardiac changes, including left ventricular hypertrophy. Parathyroidectomy is the definitive treatment for symptomatic PHPT, yet evidence on postoperative cardiac improvement remains inconsistent. This study aims to evaluate echocardiographic changes following parathyroidectomy to clarify its impact on cardiac structure and function.

Methods

We followed the PRISMA guidelines and searched through electronic databases including Medline, Embase and Cochrane. We identified a total of 24 studies encompassing data from 881 patients with PTHP undergoing parathyroidectomy with measurements of echocardiographic parameters. Echocardiographic parameters included strain, ejection fraction, relaxation time, chamber diameters and flow velocities.

Results

Although the pooled standardized mean difference demonstrated that left ventricular ejection fraction did not undergo a statistically significant change (SMD: 0.15, 95% CI: –0.12 to 0.49, p = 0.40), global longitudinal strain exhibited a significant post‑parathyroidectomy improvement (SMD: 0.60, 95% CI: 0.37 to 0.83, p < 0.00001). Furthermore, we identified a reduction in the E/A ratio and an increase in left ventricular mass, collectively suggesting the presence of ongoing cardiac remodeling after parathyroidectomy.

Conclusion

Global longitudinal strain may represent a more sensitive marker of subtle improvements in left ventricular function following parathyroidectomy in patients with PHPT. Further studies are needed to determine whether this parameter confers additional prognostic value in individuals with cardiovascular disease.

Assessment of Right Atrial Function in Patients With Chronic Thromboembolic Pulmonary Hypertension

Wed, 03 Jun 2026 03:35:28 -0700

This study evaluated right atrial function in patients with chronic thromboembolic pulmonary hypertension using echocardiography, identifying impaired reservoir and conduit function, compensatory enhanced contractile function, and reliable ultrasound parameters for assessing disease severity.

ABSTRACT

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) leads to right atrial (RA) dysfunction, which correlates with poor prognosis. However, most studies on RA function in pulmonary hypertension (PH) focus on heterogeneous PH etiologies, with limited data on CTEPH alone. This study aimed to assess RA function in CTEPH patients using standard two-dimensional (2DE) and M-mode echocardiography, and validate the clinical value of RA-related parameters.

Methods

We enrolled 91 CTEPH patients and 30 healthy controls. RA volume/function parameters (maximal volume index [RAVmaxI], total/passive/active emptying fractions [TotEF/PassEF/ActEF]) and tricuspid annular plane systolic excursion (TAPSE, decomposed into atrial [TAPSEra] and ventricular [TAPSErv] components; TAPSEra% = TAPSEra/TAPSE) were measured via 2DE/M-mode echocardiography. Correlations with clinical (WHO functional class [WHO-FC], 6-min walk distance [6MWD]) and laboratory (NT-proBNP) indices were analyzed; receiver operating characteristic (ROC) curves evaluated predictive value for WHO-FC ≥ III.

Results

Compared to controls, CTEPH patients had higher RAVmaxI (43.46 ± 13.34 vs. 22.52 ± 2.89 mL/m², P < 0.001), lower TotEF (39.45 ± 9.43 vs. 50.07 ± 7.52%, P < 0.001) and PassEF (14.33 ± 6.43 vs. 30.03 ± 5.26%, P < 0.001), and higher ActEV/TotEV (59.76 ± 17.37 vs. 34.05 ± 12.75%, P < 0.001). TAPSEra% was higher in CTEPH patients (58.69 ± 19.54 vs. 30.52 ± 7.92%, P < 0.001). RAVmaxI (≥37.47 mL/m², AUC = 0.899, sensitivity = 75.4%, specificity = 91.7%) and TAPSEra% (≥45.05%, AUC = 0.849, sensitivity = 90.2%, specificity = 70.0%) effectively predicted WHO-FC ≥ III (both P < 0.001).

Conclusions

Impaired RA reservoir and conduit functions are hallmarks of CTEPH, with compensatory active contraction counteracting the reduction in passive filling. Given their noninvasive nature and high reliability, RAVmaxI and TAPSEra% are valuable indices for identifying patients with WHO-FC ≥ III and quantifying CTEPH severity, justifying their integration into standard echocardiographic protocols.

Issue Information

Tue, 02 Jun 2026 01:16:23 -0700

Echocardiography, Volume 43, Issue 6, June 2026.

Impact of Reverse Dipper and Non‐Dipper Blood Pressure Patterns on Myocardial Performance Index in Hypertensive Patients

Mon, 01 Jun 2026 04:44:13 -0700

Circadian blood pressure patterns are associated with myocardial performance in HT. MPI values increase from dipper to reverse dipper profiles, suggesting subclinical myocardial dysfunction.

ABSTRACT

Background

Abnormal nocturnal blood pressure patterns are associated with subclinical cardiac dysfunction in hypertension (HT). However, their relationship with the myocardial performance index (MPI) is not well-defined.

Methods

This retrospective study included 196 hypertensive patients who underwent 24-h ambulatory blood pressure monitoring (ABPM). Patients were classified as dipper, non-dipper, and reverse dipper according to nocturnal systolic blood pressure variation. Echocardiographic parameters, including MPI, were compared. Multivariate linear regression analysis was performed.

Results

The highest MPI values were found in the reverse dipper group (p < 0.001). Reverse dipper (B = 0.054, p < 0.001) and non-dipper (B = 0.023, p = 0.002) patterns were independently associated with increased MPI. MPI showed moderate discriminatory power in predicting the reverse dipper pattern (area under the curve [AUC] = 0.693).

Conclusion

Reverse dipper and non-dipper patterns are associated with increased MPI. This finding suggests an association between abnormal circadian blood pressure patterns and subclinical cardiac dysfunction. Further prospective studies are required to determine clinical relevance.

Left Ventricular and Left Atrial Mechanics in Resistant Hypertension—The Role of Two‐Dimensional Speckle Tracking Echocardiography

Thu, 28 May 2026 03:46:59 -0700

Speckle tracking echocardiography enables early detection of subclinical left ventricular and left atrial dysfunction in patients with resistant hypertension.

BP, blood pressure; CAD, coronary artery disease; GAS, global area strain; GCS, global circumferential strain; GLS, global longitudinal strain; GRS, global radial strain; LA, left atrial; LV, left ventricular; MRI, magnetic resonance imaging; RH, resistant hypertension; 2D-STE, two-dimensional speckle tracking echocardiography.

Created in BioRender. Akhmimi, A. (2026) https://BioRender.com/qgvf7da.

ABSTRACT

Resistant hypertension (RH) is associated with a high burden of cardiovascular morbidity and mortality. Early detection of subclinical myocardial dysfunction is essential for risk stratification and timely therapeutic intervention. Speckle tracking echocardiography (STE) is an advanced imaging technique that enables sensitive assessment of myocardial mechanics and can identify subtle functional abnormalities before changes in conventional parameters such as ejection fraction become apparent. This review summarizes the current evidence on the role of STE in evaluating left ventricular (LV) and left atrial (LA) myocardial deformation in patients with uncontrolled hypertension and RH. Available data indicate that STE-derived indices, particularly LV global longitudinal strain and LA phasic strain parameters, are frequently impaired in these populations, reflecting early myocardial dysfunction. However, other components of myocardial deformation, including circumferential strain, radial strain and twist mechanics, remain insufficiently investigated in patients with RH. In addition, the absence of multimodality imaging validation and incomplete exclusion of coexisting coronary artery disease in several studies represent important limitations. Overall, STE appears to be a valuable tool for the early detection of subclinical LV and LA dysfunction in RH, and may enhance clinical risk stratification. Further well-designed prospective studies incorporating comprehensive strain analysis and multimodality imaging are required to better define its prognostic and therapeutic implications.

Left Atrial Strain Predicts Outcome in Populations With and Without Specific Cardiovascular Diseases Across the Range of Ejection Fraction: A Systematic Review and Meta‐Analysis

Thu, 28 May 2026 03:42:51 -0700

Left atrial strain (LAS) is a powerful, non-invasive predictor of major cardiovascular events that detects early subclinical dysfunction even when left ventricualr ejection fraction (LVEF) is preserved, making it an essential tool for risk stratification across diverse cardiovascular diseases.

ABSTRACT

Aims

Atrial function measured by left atrial strain (LAS) could represent an early marker of disease and poor cardiovascular outcome. Given the importance of identifying early markers of adverse outcome beyond let ventricular ejection fraction (LVEF) and left atrial volume (LAV), our aim was to assess the association of LAS with major cardiovascular events, both in the general population and in specific cardiovascular diseases.

Methods and results

We systematically searched PUBMED, COCHRANE Central Register of Controlled Trials and WEB OF SCIENCE (WoS) up to October 2023. Studies were included if they assessed LAS, measured by speckle-tracking echocardiography and analyzed as a continuous variable, and cardiovascular outcome. The primary endpoint was a composite of all-cause death and heart failure (HF) hospitalizations. A meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was conducted. Sixteen reports including 13156 participants were eligible. LAS predicted outcome in a population with and without a variety of cardiovascular conditions (HR 0.91; 95% CI 0.86–0.96). The result was confirmed in patients with HF (HR, 0.93; 95% CI, 0.89–0.97), IHD (HR, 0.95; 95% CI 0.91–0.99) or VHD (HR, 0.94; 95% CI, 0.90–0.97), but not in patients with LVH (HR, 0.98; 95% CI, 0.84–1.15). The metaregression conducted considering LVEF values as a covariate showed no significant effect on the main effect size.

Conclusions

LAS represents a powerful predictor of major cardiovascular events in the general population and in patients with different cardiovascular diseases across left ventricular ejection fraction (LVEF) ranges.

Prognostic Value of Preoperative Left Ventricular End‐Diastolic Dimension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation With the Venus‐A Valve

Thu, 28 May 2026 03:42:13 -0700

Preoperative LVEDD dilation is an independent influencing factor for poor postoperative prognoses in patients. It helps predict poor prognoses within 1 year postoperatively, elevates risks of readmission for heart failure and complications, and reduces survival.

ABSTRACT

Objective

Severe aortic stenosis (AS) leads to chronic pressure overload of the left ventricle (LV). We explored the prognostic value of preoperative left ventricular end-diastolic dimension (LVEDD) dilation in patients with severe AS.

Methods

This is a retrospective study of 108 patients with severe AS who underwent transcatheter aortic valve implantation with the Venus-A valve. These participants were assigned to the large LVEDD and non-large LVEDD groups. The receiver operating characteristic and Kaplan–Meier curves were generated to assess the predictive value of preoperative LVEDD dilation for poor patient prognosis (readmission or death within 1 year postoperatively), as well as its effects on the readmission risk owing to heart failure, and complications and survival rates within 1 year postoperatively.

Results

Significant differences were observed between the two groups in B-type natriuretic peptide, creatinine, aortic valve area, transfemoral access, aortic valve peak velocity, mean transvalvular pressure gradient, LVEDD, left ventricular end-systolic dimension, left atrial dimension, interventricular septal thickness, relative wall thickness, left ventricular mass index, left ventricular ejection fraction, E/A ratio, E/e′ ratio, and stroke volume index. Preoperative LVEDD dilation showed a predictive value for poor patient prognosis (AUC = 0.843; 95%CI: 0.761–0.906, 50.9 mm cut-off value, 99.9% sensitivity, 62.07% specificity). Preoperative LVEDD dilation was an independent influencing factor for poor prognosis within 1 year postoperatively, associated with increased readmission risk and reduced patient survival rate.

Conclusion

Preoperative LVEDD dilation is an independent influencing factor for poor postoperative prognosis in patients. It helps predict poor prognosis within 1 year postoperatively.

Clinical Utility and Limitations of TAPSE in Pediatric Echocardiography: A Narrative Review

Matei Mselle, Ronald mbwasi — Thu, 28 May 2026 03:40:08 -0700

This graphical abstract summarizes the clinical applications and limitations of Tricuspid Annular Plane Systolic Excursion (TAPSE) in pediatric echocardiography. TAPSE is a simple and reproducible echocardiographic parameter used to assess right ventricular systolic function in children with congenital and acquired heart diseases. The figure highlights its diagnostic utility, correlation with clinical outcomes, age-related variability, and technical limitations, including load dependency and reduced accuracy in complex congenital cardiac anatomy. The graphical abstract emphasizes the importance of integrating TAPSE with comprehensive echocardiographic assessment in pediatric cardiac evaluation.

ABSTRACT

Background

Tricuspid annular plane systolic excursion (TAPSE) is widely used to assess right ventricular (RV) longitudinal systolic function in pediatric echocardiography; however, its reliability is influenced by developmental physiology.

Objective

To evaluate the clinical utility, age-dependent variability, and limitations of TAPSE in pediatric populations.

Methods

A narrative review of literature published between 1990 and 2025 was conducted using PubMed, Scopus, and Google Scholar. Studies evaluating TAPSE in pediatric populations (0–18 years) were included.

Results

Thirty-two studies were included. TAPSE correlates well with RV systolic function in older children and adolescents, supported by age- and body surface area–adjusted reference values. In neonates and infants, TAPSE is lower and more variable due to transitional physiology and altered loading conditions. TAPSE is clinically useful in pulmonary hypertension, congenital heart disease, cardiomyopathy, and posttransplant monitoring.

Conclusion

TAPSE is a practical and reproducible marker of RV systolic function in children, particularly beyond infancy. In infants, interpretation should be cautious and integrated with complementary echocardiographic indices. Composite measures such as TAPSE/PASP may improve prognostic assessment.

A Comprehensive Echocardiographic Assessment of Patients With Chronic Myeloid Leukemia on Dasatinib

Thu, 28 May 2026 03:39:30 -0700

In a retrospective cohort of 199 adult patients with CML on Dasatinib in a single quaternary center, approximately 25% patients had routine baseline and follow-up echocardiogram. Dasatinib was associated with significant changes in structural and diastolic parameters. Patients with baseline heart failure with preserved ejection fraction were more likely to have progression in diastolic dysfunction after initiation of Dasatinib.

ABSTRACT

Purpose

Dasatinib, a tyrosine kinase inhibitor used to treat chronic myeloid leukemia (CML), is known to cause cardiopulmonary toxicities; however, little is known about the echocardiographic changes associated with this therapy. We present a comprehensive echocardiographic assessment of patients with CML on Dasatinib therapy.

Methods

We performed a retrospective cohort analysis on adult patients with CML receiving Dasatinib between 2017 and 2023. Comprehensive clinical and echocardiographic data with speckle-tracking analyses were included.

Results

Of 199 patients with CML on Dasatinib, 75 (38%) patients had a pre-Dasatinib echocardiogram, and 49 (25%) patients had both pre- and post-Dasatinib echocardiograms. Among 44 patients with analyzable echocardiograms (average age 59 ± 15 years old, 39% female), 7 (16%) patients had baseline heart failure with preserved ejection fraction (HFpEF). After initiation of Dasatinib, there was a significant increase in left ventricular (LV) end-diastolic diameter index (2.4 [2.2, 2.6] vs. 2.6 [2.4, 2.8]cm/m², p < 0.01), LV end-systolic volume index (16 [13, 26] vs. 21 [14, 26] mL/m², p = 0.04) and LV mass index (85.3 [75.4, 94.4] vs. 93.1 [80.6, 114.7]g/m², p < 0.01). There was a significant increase in left atrial (LA) volume index (LAVI, 29.0 ± 10.6 vs. 33.4 ± 13.0 mL/m², p = 0.01), decrease in lateral e’ velocity (11.8 ± 3.3 vs. 10.4 ± 2.8 cm/sec, p < 0.01) and increase in E/e’ (9.5 ± 2.8 vs. 10.7 ± 3.5, p = 0.04) post-Dasatinib. Among patients with abnormal LAVI post-Dasatinib, higher LAVI correlated with worsened LA reservoir strain (r = −0.59, p = 0.01). LV ejection fraction and global longitudinal strain were not significantly changed. Patients with baseline HFpEF were significantly more likely to have progression in diastolic dysfunction compared to patients without HFpEF (p = 0.03).

Conclusion

Dasatinib was associated with significant changes in LV structure, LA volume, and diastolic parameters in patients with CML. Patients with baseline HFpEF were more likely to progress in diastolic dysfunction on Dasatinib.

Cardiopulmonary Performance Through Right Ventricle –Pulmonary Artery Coupling

Mariana Floria, Paula Cristina Morariu, Daniela Maria Tanase — Thu, 28 May 2026 03:39:29 -0700

Echocardiography, Volume 43, Issue 6, June 2026.