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      Is myocardial fibrosis appropriately assessed by calibrated and 2D strain derived integrated backscatter?

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          Abstract

          Aims

          Increased collagen content of the myocardium modifies tissue reflectivity and integrated backscatter (IBS) indexes are suggested as markers of myocardial fibrosis (MF). We sought to assess the correlation between calibrated (c) IBS and bidimensional (2D) strain derived IBS with left ventricular (LV) MF in patients with severe aortic stenosis (AS).

          Methods and results

          We made a prospective observational cohort study including 157 patients with severe AS referred for surgical aortic valve replacement (AVR), with complete preoperative transthoracic echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) obtained from the anterior basal septum at the time of surgery. Two groups of 30 patients were specifically evaluated, with and without late gadolinium enhancement (LGE) at CMR. IBS was obtained at QRS peak from both parasternal long axis (PLAX) and apical-three-chamber (AP3C) views and measured in decibels (dB). Whole-cardiac cycle IBS at basal anterior septum was obtained from 2D longitudinal strain. Correlation analysis of reflectivity indexes was performed with global and segmental (anterior basal septum) values of native T1 and extracellular volume (ECV), and EMB collagen volume fraction (CVF) (Masson´s Trichrome). IBS values were compared in both group of patients (LGE + vs. LGE –). 60 patients (74 [36–74] years, 45% male) with high gradient (mean gradient: 63 ± 20mmHg), normal flow (45 ± 10mL/m 2) AS and preserved left ventricular ejection fraction (60 ± 9%) were included. Basal septum cIBS was − 17.45 (–31.2–10.95) and − 9.17 ± 9.45dB from PLAX and A3C views, respectively. No significant correlations were found between IBS and both non-invasive CMR tissue characterization and CVF: median MF of 9.7(2.1–79.9)%. Acoustic indexes were not significantly different according to the presence of pre-operative LGE.

          Conclusion

          In this group of patients with classical severe AS, IBS reflectivity indexes are of no added value to discriminate the presence of MF.

          Graphical Abstract

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12947-023-00311-x.

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          Most cited references34

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          Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

          The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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            Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

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              2021 ESC/EACTS Guidelines for the management of valvular heart disease

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                Author and article information

                Contributors
                mlima@chlo.min-saude.pt
                Journal
                Cardiovasc Ultrasound
                Cardiovasc Ultrasound
                Cardiovascular Ultrasound
                BioMed Central (London )
                1476-7120
                12 August 2023
                12 August 2023
                2023
                : 21
                : 14
                Affiliations
                [1 ]GRID grid.418335.8, ISNI 0000 0000 9104 7306, Cardiology Department, , Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, ; Lisbon, Portugal
                [2 ]GRID grid.10772.33, ISNI 0000000121511713, Nova Medical School, ; Lisbon, Portugal
                [3 ]GRID grid.418335.8, ISNI 0000 0000 9104 7306, Cardiac Surgery Department, , Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, ; Lisbon, Portugal
                [4 ]GRID grid.414429.e, ISNI 0000 0001 0163 5700, Hospital da Luz, ; Lisbon, Portugal
                [5 ]GRID grid.418335.8, ISNI 0000 0000 9104 7306, Pathology Anatomy Department, , Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, ; Lisbon, Portugal
                Article
                311
                10.1186/s12947-023-00311-x
                10422833
                37568167
                8179806c-58b5-4bb5-a723-12b516daca8f
                © BioMed Central Ltd., part of Springer Nature 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 May 2023
                : 18 July 2023
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2023

                Cardiovascular Medicine
                ultrasound calibrated integrated backscatter,myocardial fibrosis,collagen volume fraction,cardiac magnetic resonance,aortic stenosis

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