In transcatheter aortic valve implantation (TAVI), assessment of aortic valve calcification is not as standardized as aortic annulus measurement. Aortic valve calcification is important for stable ...

Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (≥moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction. In this international, multicentre BAV registry, 1345 patients [51.0 (37.0–63.0) years, 71% male] with significant AV disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m² in males and >95 g/m² in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) ≤0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT ≤0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m², 95% confidence interval (CI) 1.00–1.17, P = 0.046] and AR (HR 1.19 per 25 g/m², 95% CI 1.11–1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06–2.23, P = 0.024; HR 1.68, 95% CI 1.17–2.42, P = 0.005; HR 1.59, 95% CI 1.03–2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35–4.60, P = 0.004 and HR 3.05, 95% CI 1.71–5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD. LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD.

The aim of this study is to evaluate the agreement between three-dimensional (3D) transesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) for assessing mitral annular (MA) dimensions. A total of 105 patients (79 ± 9 years old, 52% male) who underwent clinically indicated 3D TEE and MDCT feasible for MA geometrical assessment were included. Using dedicated semi-automated postprocessing software, MA geometry, including mitral annular area (MAA), perimeter, septal-lateral (SL) diameter, and inter-trigonal (TT) diameter, was evaluated using 3D TEE and MDCT. Compared to 3D TEE, MAA, perimeter, and SL distance measured on MDCT data were larger (9.9 ± 3.0 vs. 9.3 ± 3.1 cm² for MAA; 115 ± 18 vs. 108 ± 18 mm for perimeter; and 35 ± 5 vs. 32 ± 5 cm for SL distance, all p < 0.001). By contrast, the TT distance was comparable between MDCT and 3D TEE (26 ± 4 vs. 26 ± 4 cm, p = 0.258). The correlations of all the MA dimensions were good to excellent between the two modalities (R = 0.911 for MAA, 0.890 for perimeter, 0.739 for TT distance, and 0.857 for SL distance, respectively, all p < 0.001). This study showed good agreement between 3D TEE- and MDCT-derived MA measurements although MDCT systematically provided larger MAA, perimeter, and SL distance compared with 3D TEE.

Heart transplantation remains the gold-standard therapy for selected patients with end-stage heart failure, yet acute rejection and cardiac allograft vasculopathy (CAV) continue to limit long-term survival. While endomyocardial biopsy and coronary angiography remain the reference standards for diagnosing rejection and CAV, respectively, echocardiography offers a non-invasive, repeatable tool for the longitudinal surveillance of heart transplant recipients. This review summarizes the expected echocardiographic findings following orthotopic heart transplantation according to surgical technique (biatrial versus bicaval) and describes the echocardiographic features of early graft dysfunction, acute allograft rejection, and late graft failure due to cardiac allograft vasculopathy. We also discuss the incremental value of newer echocardiographic techniques—including speckle-tracking-derived strain, myocardial work, and three-dimensional echocardiography—in detecting subclinical left ventricular and right ventricular dysfunction that may precede changes detectable by conventional parameters. No single echocardiographic parameter reliably diagnoses rejection or vasculopathy in isolation; an integrated, multiparametric approach combined with clinical data is required. Emerging techniques hold promise for reducing reliance on invasive surveillance, although further validation in larger, multicenter cohorts is needed. This review aims to provide echocardiographers and transplant cardiologists with a practical, imaging-based framework for the follow-up of heart transplant recipients across the early postoperative period and long-term surveillance.