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Purpose Echocardiography is a common tool for cardiac and hemodynamic assessments in critical care research. However, interpretation (and applications) of results and between-study comparisons are often difficult due to the lack of certain important details in the studies. PRICES (Preferred Reporting Items for Critical care Echocardiography Studies) is a project endorsed by the European Society of Intensive Care Medicine and conducted by the Echocardiography Working Group, aiming at producing recommendations for standardized reporting of critical care echocardiography (CCE) research studies. Methods The PRICE panel identified lists of clinical and echocardiographic parameters (the “items”) deemed important in four main areas of CCE research: left ventricular systolic and diastolic functions, right ventricular function and fluid management. Each item was graded using a critical index (CI) that combined the relative importance of each item and the fraction of studies that did not report it, also taking experts’ opinion into account. Results A list of items in each area that deemed essential for the proper interpretation and application of research results is recommended. Additional items which aid interpretation were also proposed. Conclusion The PRICES recommendations reported in this document, as a checklist, represent an international consensus of experts as to which parameters and information should be included in the design of echocardiography research studies. PRICES recommendations provide guidance to scientists in the field of CCE with the objective of providing a recommended framework for reporting of CCE methodology and results.

This study aims to assess the surgical outcome of borderline hypoplastic left ventricle before and after the induction of the left ventricle rehabilitation strategy. A retrospective review investigated patients with borderline hypoplastic left ventricle who underwent surgical intervention between 2012 and 2022. The patient cohort was stratified into two groups based on the initiation of left ventricle rehabilitation: an early-era group (E group, 2012-2017) and a late-era group (L group, 2018-2022). Left ventricle rehabilitation was defined as palliation combined with other procedures aimed at promoting left ventricular growth such as restriction of atrial septal defect, relief of inflow/outflow obstructive lesions, and resection of endocardial fibroelastosis. A total of 58 patients were included. Primary diagnosis included 12 hypoplastic left heart syndromes, 11 critical aortic valve stenosis, and others. A total of 9 patients underwent left ventricle rehabilitation, 8 of whom underwent restriction of atrial septal defect. As for clinical outcomes, 9 of 23 patients achieved biventricular repair in the E group, whereas in the L group, 27 of 35 patients achieved biventricular repair (39% vs. 77%, = 0.004). Mortality did not differ statistically between the two groups (log-rank test = 0.182). As for the changes after left ventricle rehabilitation, left ventricular growth was observed in 8 of 9 patients. The left ventricular end-diastolic volume index (from 11.4 to 30.1 ml/m , = 0.017) and left ventricular apex-to-right ventricular apex ratio (from 86 to 106 %, = 0.014) significantly increased after left ventricle rehabilitation. The introduction of the left ventricle rehabilitation strategy resulted in an increased proportion of patients achieving biventricular repair without a concomitant increase in mortality. Left ventricle rehabilitation was associated with enhanced left ventricular growth and the formation of a well-defined left ventricle apex. Our study underscores the significance of left ventricle rehabilitation strategies facilitating successful biventricular repair. The data suggest establishing restrictive atrial communication may be a key factor in promoting left ventricular growth.

Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for about half of heart failure cases, but the progression of cardiac biomechanics during pathogenesis is not completely understood. We investigated a published porcine model of HFpEF, generated by progressive constriction of an aortic cuff causing progressive left ventricle (LV) pressure overload, and characterized by hypertrophy, diastolic dysfunction and overt HF with elevated plasma beta natriuretic peptide (BNP). We characterized morphological and functional features and performed image-based finite element modelling over multiple time points, so as to understand how biomechanics evolved with morphological and functional changes during pathogenesis, and to provide data for future growth and remodeling investigations. Results showed that the hypertrophic responses quickly manifested and were effective at preventing an elevation of systolic myocardial stresses, suggesting active compensated remodeling. Consequent to the hypertrophy, diastolic myocardial stresses decreased despite the elevations in diastolic pressures. The left ventricle hypertrophy (LVH) myocardium also exhibited a quick elevation of active tension at the onset of the disease. There was a progressive and significant decrease in myocardial strain, which was more significant in the longitudinal direction. Further, elevated myocardial stiffness and diastolic pressures, which reflected diastolic dysfunction, also manifested, but this was delayed from the onset of the disease. Correlation analysis showed that hypertrophy was closely correlated to systolic pressure, active tension and systolic myocardial stress, suggesting that these factors may play a role in initiating hypertrophy. Myocardial stiffness was weakly correlated to LV pressures and myocardial stresses.

Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. Hence, implementing cost-effective imaging techniques with accuracy and reproducibility may improve long-term prognosis. A growing body of evidence supports using cardiac magnetic resonance (CMR) to quantify deformation parameters. Tissue-tagging (TT-CMR) and feature-tracking CMR (FT-CMR) can measure longitudinal, circumferential, and radial strains and recent research emphasize their diagnostic and prognostic roles in ischemic heart disease and primary myocardial illnesses. Additionally, these methods can accurately determine LV wringing and functional dynamic geometry parameters, such as LV torsion, twist/untwist, LV sphericity index, and long-axis strain, and several studies have proved their utility in prognostic prediction in various cardiovascular patients. More recently, few yet important studies have suggested the superiority of fast strain-encoded imaging CMR-derived myocardial strain in terms of accuracy and significantly reduced acquisition time, however, more studies need to be carried out to establish its clinical impact. Herein, the current review aims to provide an overview of currently available data regarding the role of CMR in evaluating myocardial strain and biomechanics.

Surgical aortic valve replacement (SAVR) is the treatment of choice for young patients with severe aortic stenosis (AS). Left ventricular (LV) reverse remodeling (RR) after surgery is expected to occur, even though its definition is largely heterogenous and ill-defined. However, LV RR not always occurs following afterload relief, and such may impact the prognosis. Single-centre prospective study including patients referred for SAVR due to severe symptomatic AS, with no previous history of ischemic cardiomyopathy. Both pre- and post-operative transthoracic echocardiographic (TTE) and cardiac magnetic resonance (CMR) study (at the 3rd to 6th month after SAVR) were performed. LV RR was defined when in presence of at least one of the imaging criteria: >15% decrease in end-diastolic volume (CMR); >15% decrease in LV indexed mass (CMR); >10% decrease in geometric remodeling (LV mass/EDV ratio) by CMR; >10% increase in LV ejection fraction (CMR); >50% increase on global longitudinal strain (TTE). We assess the prognostic value of RR definitions for the outcome after SAVR using Cox regression and Kaplan-Meier analysis. The primary endpoint was defined as all-cause mortality, heart failure (HF) hospitalization or worsening HF. We enrolled 140 patients – mean age 71 ± 9 years-old, 49% male, predominantly high-gradient-normal flow AS submitted to SAVR. At a mean follow-up of 34 ± 12 months, 16% patients met the primary endpoint, with an overall mortality rate of 6%. Twelve patients (9%) were admitted for HF and 7 (5%) had at least one episode of worsening HF. 118 patients had complete pre and post-surgery imaging study (mean follow-up: 36 ± 10 months): 103 patients (87%) met at least one RR parameter. Post-operative RR was not independently associated with the primary endpoint. LV mass regression was the sole predictor of the outcome. LV RR after SAVR is highly prevalent in a cohort of patients with classical severe symptomatic AS. However, only LV mass regression independently predicts the clinical outcome after surgery. LV structural remodeling, rather than functional improvement after surgery, may better define the prognosis after pressure overload relief.

Simulating the cardiac valves is one of the most complex tasks in cardiovascular modeling. As fluid–structure interaction simulations are highly computationally demanding, machine-learning techniques can be considered a good alternative. Nevertheless, it is necessary to design many aortic valve geometries to generate a training set. A method for the design of a synthetic database of geometric models is presented in this study. We suggest using synthetic geometries that enable the development of several aortic valve and left ventricular models in a range of sizes and shapes. In particular, we developed 22 variations of left ventricular geometries, including one original model, seven models with varying wall thicknesses, seven models with varying heights, and seven models with varying shapes. To guarantee anatomical accuracy and physiologically acceptable fluid volumes, these models were verified using actual patient data. Numerical simulations of left ventricle contraction and aortic valve leaflet opening/closing were performed to evaluate the electro-physiological potential distribution in the left ventricle and wall shear stress distribution in aortic valve leaflets. The proposed synthetic database aims to increase the predictive power of machine-learning models in cardiovascular research and, eventually, improve patient outcomes after aortic valve surgery.

Background: Hypertrophic cardiomyopathy (HCM) is frequently associated with preserved left ventricular ejection fraction (LVEF), yet subclinical myocardial dysfunction often escapes detection using conventional imaging. Cardiac magnetic resonance (CMR) with feature tracking (FT) enables precise assessment of myocardial deformation and mechanics. Methods: In this prospective case–control study, we evaluated 150 HCM patients and 100 age- and sex-matched healthy controls using standardized CMR protocols. Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), and left ventricular (LV) torsion were quantified via FT-CMR. Myocardial fibrosis was assessed through late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV). Results: HCM patients showed significantly impaired strain and torsion metrics compared with controls: GLS (−16% vs. −20%), GCS (−18% vs. −21%), GRS (29% vs. 38%), and global LV torsion (1.27°/cm vs. 1.95°/cm), all p < 0.001. These abnormalities were also observed in LGE-negative patients, suggesting early functional remodeling. Global LV torsion demonstrated the highest diagnostic performance for LGE detection (AUC = 0.995), surpassing those of GLS (0.877), native T1 (0.731), and ECV (0.657). A cut-off value of 0.7°/cm provided optimal sensitivity and specificity, and was associated with adverse prognosis in survival analysis. Conclusions: CMR-derived strain and torsion parameters detect early myocardial dysfunction in HCM beyond conventional markers. Global LV torsion, in particular, emerges as a sensitive and robust non-invasive marker with diagnostic and prognostic potential.

Introduction: Transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) are the most important modalities used in clinical practice to assess cardiac chambers. However, different imaging techniques may affect their results and conclusions. The aim of our study was to compare left-ventricle (LV) remodeling assessed using TTE and CMR in the context of various cardiovascular diseases. Methods: A total of 202 consecutive patients sent for an elective cardiovascular diagnosis were scheduled for a 2D TTE and CMR, performed within 2 weeks. The study group was divided and analyzed based on the clinical indications for CMR, including coronary artery disease, heart failure, native aortic valve regurgitation or paravalvular leak after aortic valve replacement, or cardiomyopathies. Results: The mean LV mass index (LVMi) values calculated using TTE were significantly larger (127.1 ± 44.5 g/m²) compared to the LVMi assessed using CMR (77.1 ± 26.2 g/m²; p < 0.001). The LV end-diastolic volumes assessed using TTE were underestimated for all the study patients (78.6 ± 43 mL vs. 100.5 ± 39 mL; p < 0.0001) and subgroups, but a statistical trend was observed in patients with cardiomyopathy. Those differences in single parameters led to differences in LV remodeling and the final treatment decision. CMR and TTE provided similar conclusions on LV systolic dysfunction in 68% of the patients. Conclusions: Our results showed that the greater the degree of LV remodeling and dysfunction, the greater the difference between the modalities. Therefore, CMR should be introduced into routine clinical practice, especially for patients undergoing LV remodeling, which may change clinical decisions in a considerable number of cases.

Abstract Aims We explored the association between indexed left ventricular end-diastolic volume (iLVEDV) on cardiac magnetic resonance (CMR) and the risk of incident heart failure (HF) (stage C) in patients with suspected coronary heart disease without overt HF (stages A and B). We also examined the risk-modifying effect of left ventricular ejection fraction (LVEF) and sex. Methods and results We retrospectively included 5471 patients who underwent vasodilator stress CMR for suspected coronary artery disease and without a history of HF. Multivariate Cox proportional hazards regression adapted for competing events models assessed the relationship between iLVEDV and new-onset HF (stage C), considering LVEF status as a potential modifier. The mean age was 651 ± 11.6 years, and 2123 (38.8%) were women. The medians of CMR-iLVEDV and CMR-LVEF were 67 mL/m2 (55–80) and 66% (58–72), respectively. At a median (p25% to p75%) follow-up of 5.1 years (2.3–8.2), we registered 287 new-onset HF diagnosis. iLVEDV was associated with a U-shaped risk of incident HF. The risk was most pronounced with an iLVEDV > 100 mL/m2 and <45 mL/m2. Notably, the association between iLVEDV and HF risk was influenced by LVEF status. In patients with LVEF < 50%, a higher risk was found in those with larger iLVEDV. On the contrary, LVEF > 60%, lower iLVEDV identified those at increased risk. Conclusion In subjects with higher LVEF, smaller left ventricle volumes identified a subset of patients with an increased risk of incident HF. These findings reveal a need for a better understanding of the pathophysiological mechanisms of HF with supranormal ejection fraction. Lay Summary Heart failure is usually associated with a weak or enlarged heart, but our study shows that even people with normal or strong heart function may be at risk—especially if their heart chambers are unusually small. We studied over 5400 people who underwent a heart magnetic resonance to evaluate possible coronary artery disease. Over the following 5 years, we observed how many of them developed heart failure and looked at how the size of their heart's main pumping chamber (the left ventricle) might be related. We found that people with either very large or very small hearts (in terms of the volume of blood the left ventricle holds) were more likely to develop heart failure. Interestingly, those with small hearts but high ejection fraction—meaning the heart pumps a large proportion of the blood it holds—were also at higher risk. Our findings highlight that heart failure can develop even in people whose heart function appears normal or above normal. Paying attention to heart size might help doctors better identify those at risk.People with very large or very small left ventricles had a higher risk of developing heart failure.Even with a high ejection fraction, a small heart chamber may signal increased heart failure risk. Graphical Abstract Graphical Abstract Left ventricular diastolic volume and risk of new-onset HF. HF: heart failure; iLVEDV: indexed left ventricle end-diastolic volume; LVEF: left ventricle ejection fraction; CMR: magnetic resonance.

Double inlet left ventricle (DILV) is a rare congenital cardiac anomaly characterized by a functionally univentricular atrioventricular connection, in which most or all atrial inflow is directed to the dominant, morphologic left ventricle via either two separate atrioventricular valves or a common atrioventricular valve. The second ventricle is typically a rudimentary (incomplete) morphologic right ventricle. While well-documented in humans, the occurrence of DILV in veterinary medicine remains poorly studied. This report describes a male European bison ( Bison bonasus ) that survived for 12 years with DILV and additional cardiac malformations. Surprisingly, despite the severity and complexity of these defects, the animal was culled for reasons unrelated to cardiac disease. A complete field necropsy was performed, but only the heart was subjected to further investigation. Due to specimen disruption, the heart was reconstructed with the assistance of pediatric cardiac surgeons and analyzed using post-mortem computed tomography imaging, which provided valuable insights into its anatomical structure and spatial relationships. This case highlights the importance of integrated pathology and advanced imaging in congenital heart disease, while acknowledging the practical limitations of ante-mortem investigations in free-ranging animals.