Diagnostic and Prognostic Utility of Mitral Annular Plane Systolic Excursion: A Systematic Review and Meta‐Analysis

Echocardiographic assessment of left atrioventricular coupling index: technical approaches and clinical implementation strategies

Two-dimensional ultrasound is optimal for screening; RT-3DE shows highest consistency with cardiovascular magnetic resonance for precise diagnosis, and 3DE-LACI has demonstrated independent prognostic value in cardiac amyloidosis.

Prognostic Value of Strain Imaging Measurements in Patients with Non-ischemic Cardiomyopathy: A Scoping Review.

Nonischemic cardiomyopathy (NICM) carries significant morbidity and mortality. While left ventricular ejection fraction (LVEF) remains central to risk stratification, it may not fully capture the extent of myocardial impairment, and strain imaging can provide independent prognostic information beyond LVEF alone. Myocardial strain imaging may provide additional prognostic value, but its role in NICM remains incompletely defined. This scoping review, conducted per PRISMA-ScR guidelines, searched PubMed, Embase, and Cochrane Library from inception through October 25, 2025, to identify studies evaluating myocardial strain parameters, specifically left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain, left ventricular global radial strain, and right ventricular global longitudinal strain, in adult NICM populations using speckle-tracking echocardiography or cardiac magnetic resonance feature tracking. Data were extracted by 2 independent reviewers and synthesized descriptively. From 1356 records, 36 studies (7903 patients) were included, with follow-up ranging from 9 months to 7.8 years. LVGLS was the most frequently assessed parameter. Across 21 studies evaluating major adverse cardiovascular events, worse baseline strain values were consistently associated with increased risk (hazard ratios 1.06-2.70 per unit decrease in strain magnitude). Two studies reported significant associations with ventricular arrhythmias, and 4 showed that more favorable baseline strain predicted a higher likelihood of left ventricular reverse remodeling. Strain parameters, particularly LVGLS, remained independently associated with outcomes in 34 of 36 studies after multivariable adjustment, often providing incremental value beyond LVEF and late gadolinium enhancement. These findings support strain imaging, especially LVGLS, as an adjunct to conventional risk stratification in diverse NICM populations. Standardized, multicenter prospective studies are needed to establish its role in clinical decision-making.

Diagnostic Value of 3D Transesophageal Vena Contracta Area versus 2D Echocardiographic Assessment of Secondary Mitral Regurgitation.

BACKGROUND Secondary mitral regurgitation (MR) is associated with substantial cardiovascular morbidity and mortality, making accurate severity assessment essential for clinical management. Conventional 2D echocardiography has important limitations, particularly in the presence of noncircular regurgitant orifices. Three-dimensional transesophageal echocardiography (3D-TEE) enables direct measurement of Vena Contracta area (VCA) and may provide more accurate quantification of MR severity. AIM OF THE WORK To assess the diagnostic value of three-dimensional transesophageal Vena Contracta area versus two-dimensional echocardiographic assessment of secondary mitral regurgitation. METHODS This study included 52 patients with moderate-to-severe secondary MR, recruited at Alzahraa University Hospital between December 2024 and January 2026. All patients underwent TTE followed by TEE. MR severity was assessed according to current echocardiographic guidelines using an integrative approach that included qualitative, semi-quantitative, and quantitative assessments. Three-dimensional VCA was measured by both TTE and TEE using multiplanar reconstruction. Statistical analysis was performed using Jamovi version 2.3.28 for Windows, with P-values < 0.05 considered statistically significant. RESULTS The mean age of the patients studied was 58.08 ± 9.52 years, with a male-to-female ratio of 43:9. The mean PISA-derived EROA for patients with severe MR was 0.36 ± 0.09 cm2, and the mean regurgitant volume for these patients was 48.6 ± 6.79 mL. VCA measured by 3D TTE (0.69 ± 0.16 cm2) showed a strong positive correlation with 3D TEE VCA (0.67 ± 0.16 cm2) (r = 0.857, p < 0.001). Bland-Altman analysis demonstrated minimal bias (0.035 cm2) and good agreement between both techniques. ROC analysis showed good diagnostic accuracy for severe MR, with slightly higher accuracy for TEE VCA (AUC = 0.874) compared with TTE VCA (AUC = 0.841). CONCLUSION Three-dimensional TEE-derived Vena Contracta area (3D TEE VCA) is a reliable and accurate method for assessing the severity of secondary mitral regurgitation. The strong correlation and good agreement between 3D TEE and 3D TTE VCA measurements, as well as their correlation with PISA-derived EROA, support the value of 3D VCA as a robust quantitative parameter. Moreover, our findings suggest that 3D TTE VCA may represent a feasible, less invasive alternative in selected patients; however, its use as a replacement for TEE warrants confirmation in larger multicenter studies with external validation. Larger multicenter studies with external validation are required before it can be considered a replacement for TEE.

Multimodality Quantitative Assessment of Left Atrial Remodeling Characteristics Using Echocardiography and LGE-CMR in Isolated Degenerative Mitral Regurgitation: Association With Atrial Fibrillation

Cardiac magnetic resonance parameters and ventricular tachycardia recurrence after catheter ablation: a systematic review and meta-analysis.

BACKGROUND Cardiac magnetic resonance (CMR) may provide insights into arrhythmogenic substrate in patients undergoing ventricular tachycardia (VT) ablation, but its prognostic value remains uncertain. METHODS We performed a systematic review and meta-analysis, following PRISMA guidelines, of available studies comparing CMR-derived parameters in patients with and without VT recurrence after ablation, from inception to March 2026. Primary outcomes included functional parameters - left ventricular ejection fraction (LVEF) and left ventricular (LV) mass, while secondary outcomes included ventricular volumes and late gadolinium enhancement (LGE) derived structural characteristics. Random-effects models were applied. RESULTS Seven studies including 415 patients were analyzed, with 36.1% experiencing VT recurrence. Lower LVEF was associated with recurrence in the primary analysis (mean difference: - 4.41%; 95% CI: - 8.66 to - 0.16; p = 0.044; I²=27.3%), however, this finding was not robust in leave-one-out analysis. No significant associations were observed for LV mass or ventricular volumes. Among structural parameters, transmural, epicardial, or septal LGE were not associated with recurrence. CONCLUSION Available evidence suggests that CMR-derived parameters have limited and inconsistent associations with VT recurrence after catheter ablation. Although reduced LVEF may be associated with recurrence, this finding was not robust in sensitivity analyses, while structural CMR characteristics showed no consistent associations. Larger prospective studies using standardized CMR protocols and time-to-event analyses are needed to better define the prognostic role of CMR.

Predictive value of right ventricular functional indices for bronchopulmonary dysplasia in preterm infants: A systematic review and meta-analysis

Background: To comprehensively determine whether echocardiographic measures of right-sided cardiac performance can identify premature neonates at risk of developing bronchopulmonary dysplasia. Methods: We systematically queried 4 electronic databases – PubMed, Embase, the Cochrane Library, and Web of Science – from their respective launch dates through April 2025 to retrieve eligible studies examining whether echocardiographic markers of right-sided cardiac performance could anticipate bronchopulmonary dysplasia in premature neonates. Study rigor was evaluated with the Newcastle–Ottawa Scale, while the review was designed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and the Cochrane Handbook. Pooled effect estimates were calculated in RevMan 5.3, whereas sensitivity analyses and Egger regression test were performed with Stata/SE 15.1. Results: Twelve studies were incorporated, involving 1316 preterm infants, with 414 of them diagnosed with bronchopulmonary dysplasia (BPD). Meta-analysis indicated that tricuspid annular plane systolic excursion (TAPSE) (weighted mean difference [WMD] = −0.08, 95% confidence interval [CI] −0.12 to −0.04, P = .0002), myocardial performance index (MPI) (WMD = 0.05, 95% CI 0.02–0.08, P = .004), fractional area change (FAC) (WMD = −3.51, 95% CI −6.68 to −0.33, P = .03), pulmonary artery acceleration time (PAAT) (WMD = −6.54, 95% CI −10.71 to −2.37, P = .002), and PAAT to right ventricular ejection time ratio (PAAT/RVET) (WMD = −0.04, 95% CI −0.07 to −0.01, P = .005) can aid BPD prediction. Subgroup analyses showed that measurements obtained before 36 weeks’ postmenstrual age (PMA) had better predictive performance for TAPSE, MPI, and FAC than measurements obtained at 36 weeks’ PMA. PAAT/RVET remained predictive of BPD both before 36 weeks’ PMA and at 36 weeks’ PMA. Among infants with birth weight ≥1000 g, MPI demonstrated better predictive performance for BPD. Sensitivity analyses (leave-one-out) showed that exclusion of individual studies had no meaningful effect on the summary estimates, supporting the stability of the results. Conclusion: TAPSE, MPI, FAC, PAAT, and PAAT/RVET have predictive value for BPD in preterm infants.