bluuebunny/crossref_metadata_2025 huggingface dataset:
P1768 The value of global longitudinal strain in non-alcoholic steatohepatitis-associated cirrhosis
Authors: Dimitroglou Y , Aggeli C , Alexopoulou A , Alexopoulos T , Nitsa A , Apostolou I , Patsourakos D , Vasilieva L , Dourakis S P , Tousoulis D
Published: January 2020

Introduction

Non-alcoholic steatohepatitis (NASH) in patients with metabolic syndrome is a common cause of cirrhosis and has been associated with increased cardiovascular mortality. In patients with liver cirrhosis systolic or diastolic dysfunction can be observed and is independent of the cirrhosis etiology. Only few studies using newer echocardiography indices such as Global Longitudinal Strain (GLS) have been published in cirrhotic patients.

Purpose

To evaluate GLS in patients with NASH cirrhosis when compared to other etiologies.

Methods

A total of consecutive 36 cirrhotic patients aged 18-70 were included in our study. Standard speckle-tracking software was used for offline analysis of standard apical views and GLS was calculated. Stroke Volume Index (SVI) was calculated with the Simpson method and a standard 2D, Doppler and Tissue Doppler examination was performed in all patients.

Results

Median age of the study population was 58 (IQR 50-64) years, 78% were male and 17% had ascites. Cirrhosis was considered decompensated in 21 (58%) of patients. The 28%, 42% and 19% had NASH-associated, alcoholic and viral etiology of cirrhosis, respectively. Median ejection fraction (EF) was 60% (IQR: 57%; 65%) and GLS was -21.1% (-19.7%; -23.1%) in the total population. Absolute value of GLS was lower in patients with NASH cirrhosis compared to other etiologies (p = 0.009) (figure 1). EF, SVI, left atrial volume index (LAVI), E/e’ ratio and mitral annular velocity (e’) did not differ significantly between those with NASH associated cirrhosis and the rest. GLS values were significantly correlated with EF (r=-0.588, p = 0.002), SVI (r=-0.469, p = 0.016) and BNP levels (r=-0.571, p = 0.007), but not with age, left ventricular end diastolic volume, left atrial volume index, E/e’, mitral annular velocity and blood pressure. According to a multivariable linear regression model, NASH etiology [B = 2.1 (0.6; 3.7), p = 0.008)] and EF (per 10% increase) [B=-1.7 (-3.3; -0.2), p = 0.03)] were the only independent factors associated with GLS values in cirrhotic patients.

Conclusions

GLS values are within normal limits in cirrhotic patients but seem to be affected in patients with NASH associated cirrhosis. Further studies are needed to assess the prognostic implications of this finding.

Abstract P1768 Figure 1
P1771 Gender differences of the blood pressure effects on early changes of left ventricle mechanics in untreated hypertension
Authors: Tsai W C , Tsai H R , Huang M S , Lee W H
Published: January 2020

Background

Left ventricular (LV) diastolic dyssynchrony and global and layer-specific strain can be used for evaluation of early myocardial changes in hypertension. We tried to investigate the gender differences in these early changes in untreated uncomplicated hypertension.

Methods

This study included 43 consecutive patients (mean age 51.3 ±12.5 years, 56% men) with newly diagnosed hypertension from an out-patient clinic. All subjects were free of complications including renal dysfunction, LV hypertrophy, and diabetes. Comprehensive transthoracic echocardiography (E9, GE, USA) was conducted before treatment of hypertension. Diastolic and systolic parameters were measured by two-dimension (2D), Doppler, tissue Doppler imaging and 2D speckle tracking echocardiography (STE). The time-to-peak early diastolic myocardial annulus velocity (Te) at 6 LV segments from apical-4-chamber, apical-2-chamber and apical-3-chamber views were measured with reference to the QRS complex. The time to peak early diastolic strain rate (TDSr), global longitudinal strain (GLS), layer-specific longitudinal strain included sub-epicardial strain (EpiLS) and sub-endocardial strain (EndLS) were measured from 18 LV segments by STE. Diastolic dyssynchrony parameters were defined as the standard deviation (SD) of Te of all LV segments (Te-SD), SD of TDSr of 18 LV segments (TDSr-SD), and the maximal difference between any two TDSr of the 18 LV segments (MaxD-TDSr).

Results

There were no differences between men (56%) and women (44%) regarding age, initial blood pressure, hypertension duration, LV mass index, LV ejection fraction, and early mitral velocity to average early annulus velocity ratio. Regarding diastolic dyssynchrony parameters, men were significantly higher than women including Te-SD (22.3 ± 13.8 vs. 14.7 ± 4.2 ms; p = 0.016), TDSrSD (46.0 ± 13.3 vs. 35.3 ± 11.4 ±ms; p = 0.008), and MaxD-TDSr (162.0 ± 40.3 vs. 128.1 ± 50.7 ms; p = 0.019). Men also had worse GLS (-17.6 ± 1.9 vs. -19.5 ± 2.5 %; p = 0.007), EpiLS (-15.1 ± 1.7 vs. -17.0 ± 2.3, p = 0.003), and EndLS (-20.5 ± 2.2 vs. -22.4 ± 2.8 %; p = 0.018) than women. After multivariate analysis controlling age, systolic blood pressure, and LV mass index, TeSD (p = 0.039), TDSrSD (p = 0.018), MaxD-TDSr (p = 0.035) were still significantly higher than women. GLS (p = 0.046), and EpiLS (p = 0.025) were still worse in men.

Conclusion

In the same age, blood pressure, hypertension duration and LV mass index, men have more diastolic dyssynchrony and worse myocardial strain in untreated hypertension.
P252 Incidental finding of a chronic left ventricular pseudoaneurysm years after surgical aortic valve replacement
Authors: Klappacher G , Beitzke D
Published: January 2020

Case presentation

A 35-years old female was referred to our outpatient clinic with unclear thoracic pain and dyspnea. Clinical chemistry testing was unremarkable. Electrocardiography (ECG) showed T-wave inversion in the anterior-lateral leads. Chest X-ray displayed an oval bulge on the left border of the heart. The physical exam revealed a systolic murmur on top of the closing click sound of a mechanical aortic valve prothesis which had been implanted nine years ago. Since that time, the patient had not had regular checkups and the actual consultation was motivated by her aggravating symptoms only.

Findings. In transthoracic echocardiography, the mechanical aortic valve prothesis exhibited an acceptable peak velocity of 2.7 m/s with a mean gradient of 18 mm Hg and only mild paravalvular regurgitation. The native mitral and tricuspid valves were functionally and morphologically normal. Left and right ventricle were of normal systolic and diastolic function and normal size. No signs of pericardial effusion were detected. However, a big (40x22mm) saccular structure with a narrow (10 mm) neck was visible at the apex of the left ventricle, see left panel of figure. At the neck, a bidirectional flow between the saccular structure and the left ventricle was detected with a peak velocity of 2,5 m/sec indicating the presence of a pseudoaneurysm. Its linings were calcified and free of discernable thrombus formation, although the flow inside was turbulent as evidenced in the contrast echocardiogram, see right panel of figure. Subsequently, CT-imaging confirmed the diagnosis and surgical resection of the pseudoaneurysm was successfully performed 10 days later. The surgeon noted that the walls of the resected cavity contained thrombotic masses despite respective negative findings on CT and echo. The postoperative course was uneventful, and the patient was discharged in good condition with normal left and right ventricular function and no regional left ventricular wall abnormalities. A year later, she was however re-admitted with prosthetic aortic valve stenosis due to thrombus formation on one the leaflets in the second trimester of a pregnancy.

Discussion

This is an exceptional case of chronic left ventricular pseudoaneurysm following aortic valve replacement. Since the patient had no history of myocardial infarction or of other potential causes that could explain the formation of a pseudoaneurysm, it is likely to be a remnant of venting the left ventricle during the original surgical procedure. The patient had been unattended and asymptomatic for several years which allowed chronification as indicated by the calcifications of the inner linings. Still, immediate surgical repair was mandatory due to the high risk of rupture and thromboembolism.

Abstract P252 Figure.
P1776 Longitudinal change of regional left ventricular deformation by 2D speckle tracking for chemotherapy-induced cardiotoxicity in patients with breast cancer
Authors: Fujiwara J , Nochioka K N , Sugimura K S , Terui Y T , Sato H S , Tada H T , Ota H O , Funamizu Y F , Miki T M , Saijo Y S , Takase K T , Ishida T I , Shimokawa H S
Published: January 2020

Funding Acknowledgements

Japan Agency for Medical Research and Development, Japan Heart Foundation Research Grant

Background

In breast cancer patients, chemotherapy-induced cardiotoxicity (CIC) may affect deformation in left ventricle segmentation differently over time.

Purpose

To evaluate longitudinal change of regional LV deformation caused by CIC in patients with breast cancer by 2D speckle tracking echocardiography (STE).

Methods

From 2017 to 2019, we enrolled 21 women with breast cancer and followed with continuous echocardiographic examination at enrollment (before chemotherapy), 3 months, 6 months, 9 months, and 12 months after chemotherapy at our hospital. We assessed conventional 2D echocardiographic indices and regional LV deformation analyzing longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) by 2D STE.

Results

During the follow-period, there was no change in BNP (12.3 at baseline vs. 14.7 at 3 months vs. 16.6 at 6 months vs 18.3 at 9 months vs 10.9 pg/ml at 12 months, P = 0.96) and LVEF (62.2 vs. 62.0 vs. 61.2 vs 61.1 vs 62.9%, P = 0.84). However, significant decreases were observed in GLS (-20.3 vs. -19.0 vs. -17.9 vs -17.1 vs -17.7%, P < 0.01), and Troponin T (0.006 vs. 0.018 vs. 0.015 vs 0.009 vs 0.007 ng/ml, P < 0.01) after chemotherapy while there were no difference in global CS (-30.3 vs. - 29.1 vs. -27.0 vs -26.7 vs -28.0%, P = 0.15) and RS (46.8 vs. 47.9 vs. 49.6 vs 42.4 vs 46.3%, P = 0.17). When assessing regional deformation, we observed significant decrease in mid-inferoseptal region LS, mid-anterolateral region LS, mid-anterior region LS and apical-inferior region LS (Figure 1A). Of note, CS was impaired in basal- anterolateral region and mid-anteroseptal region (Figure 1B). However, none of regional RS showed significant difference after chemotherapy.

Conclusion

These results suggest that BNP and LVEF may not be ideal to detect CIC at early phase, and impaired GLS and increased Troponin T between 3 and 6 months after treatment may be initial signs by CIC. Longitudinal change of regional deformation implied that Mid-wall segmentation was vulnerable by chemotherapy more than other segmentations.

Abstract P1776 Figure 1
P1791 Outcome prediction with regional wall motion abnormalities during stress echocardiography
Authors: Zagatina A , Ciampi Q , Cortigiani L , Gaibazzi N , Djordjevic-Dikic A , Borguezan Daros C , Wierzbowska-Drabik K , Kasprzak J D , Boshchenko A , Vrublevsky A , Zhuravskaya N , Dekleva M , Lattanzi F , Carpeggiani C , Picano E
Published: January 2020

OnBehalf

Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging

Background

Over the last 3 decades, we observed a progressive decline in the prognostic value of a negative stress echo (SE) test based on regional wall motion abnormalities (RWMA), likely reflecting both an increase in risk in patients (older and more often diabetics) as well as a potential decrease in test performance due to concomitant anti-ischemic therapy.

Aim

To assess the value of SE in predicting outcome in contemporary populations

Methods

From September 2016 to December 2018, we enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 543, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. Wall motion score index (WMSI) was evaluated at rest and peak stress (17-segment model, from 1 = normal-hyperkinetic to 4 = dyskinetic).All patients were followed-up for a median of 16 months.

Results WMSI was 1.09 ± 0.23 at rest and increased during stress (1.17 ± 0.32, p<.001). At individual patient analysis, inducible ischemia with RWMA was present in 352 pts (18.8%). At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 hospital admissions for acute heart failures, and 112 late (>3 months from SE) myocardial revascularizations. Multivariable analysis identified stress-induced RWMA (Hazard Ratio 2.754, 95% Confidence Intervals: 2.053-3.963, p<.0.001) as an independent predictor of events. Kaplan-Meier curves showed progressively worsening event-free survival for 1247 pts with normal (WMSI = 1.0), 298 pts with mildly (1.05-1.39), 250 pts with moderately (1.4-1.99) or 73 pts with severely (>2.0) abnormal peak WMSI: see figure. In patients with negative SE, event-rate was 1.4% per year considering hard events (death and myocardial infarction) and 0.8 % per year considering only death.

Conclusion RWMA show risk stratification capability in contemporary patients referred to SE testing. The higher the peak WMSI, and the worse the prognosis. Nevertheless, the positivity rate is low (< 20%) and patients with normal baseline and stress function still have a significant event rate. A more comprehensive risk assessment with other parameters is warranted

Abstract P1791 Figure. Survival curves and peak WMSI
P1802 Prevalence and prognostic significance of pulmonary artery aneurysms in patients with pulmonary artery hypertension
Authors: Sakata K , Mitsuda H , Ito J , Isaka A , Furuya M , Minamishima T , Matsushita K , Soejima K
Published: January 2020

Background

Pulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH) and can be accompanied by various complications.

Objective

The aim of the this study is to evaluate the characteristics of cardiac dysfunction and the prognostic impact of PAA by analysing the outcome of patients with PAH complicated by PAA.

Methods

We performed echocardiography and right-heart catheterization in 130 PAH patients. We measured the maximum dimensions of the main pulmonary artery (MPA) trunk. We evaluated the right ventricular (RV) function and the five-year prognosis of patients with PAA.

Results

The maximum MPA trunk diameter of >40 mm by echocardiography was defined as PAA. PAA appeared in 32 of the 130 PAH patients (24.6%: Group PAA), other 98 patients were defined as Group non-PAA. Systolic pulmonary artery pressure (76 ±18 vs. 61 ± 21 mmHg, P = 0.0008) and mean right atrial pressure (10.0 ± 8.1 vs. 5.4 ± 3.8 mmHg, P < 0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index was significantly larger (37.3 ± 8.8 vs. 32.3 ± 7.8 mmHg, P = 0.0048), and RV fractional area change (32 ± 8 vs. 36 ± 9 %, P = 0.0176) and RV longitudinal strain amplitude (-16 ±5 vs. -20 ± 6, P = 0.0017) were significantly lower in Group PAA than those in Group non-PAA. During the five-year follow-up period, 20 patients (15%) died. The five-year mortality rate was significantly higher in Group PAA compared to Group non-PAA (30% vs. 10%, P = 0.007).

Conclusion

In PAH patients with PAA, RV dysfunction was more severe and the prognosis was poor. Assessment of PAA can be a useful index for the extraction of high-risk PAH patients.
P1809 Intraoperative myocardial protection in patients with septic endocarditis
Authors: Islambekova S H A , Nazirova L A , Aliev S H M
Published: January 2020

Funding Acknowledgements

there was not financial support

OnBehalf

cardiosurgery

Introduction The choice of myocardial protection method in patients with septic endocarditis (SE) during heart surgery is currently controversial. The results of several studies have shown positive aspects of the use of crystalloid cardioplegia del Nido. However, the use of this method in adults is not sufficiently studied.

Purpose.To determine the effectiveness of the use of crystalloid cardioplegia Del Nido in adult patients with septic endocarditis during a heart surgery with cardiopulmonary bypass.

Methods

We analyzed data of 100 patients with SE underwent surgical correction with cardiopulmonary bypass. There were 64 males and 36 females. Patients age ranged from 20 to 56 years (mean 44,4 ± 10,8years). The patients were divided into two groups: the main group (n = 50) with the use of cardioplegia Del Nido and the control group (n = 50) using conventional crystalloid cardioplegia. The dose of cardioplegia was 30 ml / kg for 1-2 minutes.

Results

Patients in the del Nido group required significantly less cardioplegia (1007,6 ± 347.3ml vs. 2450,4 ± 491,1ml, p < 0.001). The duration of asystole after clamping of the aorta in the main group lasted up to a maximum of 103 minutes, versus to the control group, where it was necessary to administer an additional dose every 25-30min, due to the appearance of spontaneous electrical activity of the heart. Both groups did not differ in the time of onset of asystole since the introduction of cardioplegia (1,62 ± 0.2min and 1,69 ± 0.3min). Cardiac activity was restored through the resolution of the complete blockade or through ventricular fibrillation. The frequency of rhythm disturbance (ventricular tachycardia, atrial fibrillation and ventricular fibrillation) was more often observed in the control group (25/50 – control group, 7/52 –main group, p < 0,005). The need for inotropic support was significantly less in the main group (10/50 main group, 20/50 control group). Postoperative mortality in the main group was lower (2%) compared with the control (13%).

Conclusion

Crystalloid cardioplegia del Nido provides better protection of the myocardium in adult patients with septic endocarditis and reduces postoperative cardiac rhythm disturbances and mortality.
P1818 Baseline clinical, echocardiographic and laboratory characteristics of HFrEF patients who were started with sacubitryl+ walsartan in different clinical status: long-term stabile vs after acute heart f
Authors: Wisniowska-Smialek S , Karabinowska A , Holcman K , Dziewiecka E , Lesniak-Sobelga A , Hlawaty M , Podolec P , Rubis P
Published: January 2020

Background

According to the latest approach new class ARNI with sacubitryl-valsartan may be ordered in clinically stable heart failure patients with reduced ejection fraction ( HFrEF) or short time after acute heart failure exacerbation. Methods: Since July 2016 till February 2019 we started ARNI in 50 HFrEF patients; 33 (66%) were clinically stabile during at least 3 months and 17 (34%) were short time after HF exacerbation. Results: There were no differences in age (63 vs 58) and BMI between groups. Clinically stabile patients presented significantly lower NYHA class (2 ± 0,5 vs 3 ± 0,7) and lower NT-proBNP level (1948 pg/ml vs 5570 pg/ml) in comparison to those after HF decompensation. There were no differences in left ventricular end-diastolic diameter (LVEDD), volume (LVEDV) and ejection fraction (EF) between both groups. Patients after HF decompensation had greater left and right atrium area(LAA, RAA respectively), higher estimated pulmonary artery pressure (PASP) and reduced right ventricular systolic function expressed with TAPSE (tricuspid annular plane systolic excursion) in comparison to stabile patients. Patients from both groups presented similar physical activity tolerance estimated with 6-minute walking test ( 6- MWT): 369 m vs 402 m (tbl). Conclusions: Clinical, echocardiographic and laboratory differences were observed between groups of HFrEF patients with different clinical status when ARNI was administrated.

Parameter Stabile n = 33 After HF decompensation n= 17 p- value BMI [kg/m2] 25(23-36) 25(21-26) 0,72 Age [years] 63 (39-68) 58 (42-67) 0,81 NYHA 2 ± 0,5 3 ± 0,7 0,001 NT-proBNP [pg/ml] 1948(601-2933) 5570(4147-8021) P< 0,001 6 MWT dystans [m] 369(327-432) 402(240-480) 0,32 FW [%] 23 (18-28) 19(15-26) 0,17 LVEDD [mm] 69(59-76) 64(63-71) 0,32 LVEDvol [ml] 242(153-324) 225(178-235) 0,29 TAPSE [mm] 19(14-21) 14(13-16) 0,02 LAA [cm2] 28(24-34) 36(27-39) 0,032 RAA [cm2] 19(16-30) 26(23-32) 0,046 PASP [mmHg] 31(23-43) 43(38-55) 0,046
P1830 Single-beat aortic arch pulse wave velocity by dual-gate simultaneous Doppler technique: a novel method for arterial stiffness evaluation
Authors: Antonini-Canterin F , Pepe A , Strazzanti M , Rivaben D , Nicolosi E , Pagliani L , Luzza G , Penzo M , Piaser P
Published: January 2020

Background

Guidelines recommend increased aortic stiffness as a negative prognostic factor to be considered in primary and secondary prevention. Pulse wave velocity (PWV) is a frequently employed surrogate marker of aortic stiffness. Carotid-femoral PWV is the most common index in research and clinical practice, but recently several velocity-encoded magnetic resonance imaging (MRI) techniques have been used for the evaluation of regional aortic arch PWV, where the stiffness seems to be particularly relevant from a prognostic point of view.

Purposes. We developed a new ultrasound method for the assessment of aortic arch PWV, using a single-beat dual-gate simultaneous pulsed wave Doppler tracing. The aim of the study is to evaluate the feasibility of this new technique in a group of healthy volunteers.

Methods

We examined 126 healthy volunteers (81 females, 45 males, mean age 42 + 15 years, range 13-83 years) using a commercially available machine equipped with simultaneous dual-gate pulsed Doppler. Using the suprasternal approach, the first sample volume was placed in ascending aorta and the second one in descending aorta. The distance between the two sites was directly measured with a curvilinear tracing in the middle of the vessel, following the shape of the aortic arch. PWV was calculated as the ratio of distance (in millimiters) and the transit time (in milliseconds) measured using the "foot-to-foot" method. The results are then easily transformed, simplifying in the commonly unit of meters/second.

Results

Feasibility was 99%; in one case it was not possible to measure accurately the aortic arch PWV due to unfavorable suprasternal acustic window. The procedure time was very fast, requiring 2 + 1 minutes. Intraobserver and interobserver variability were 7% and 9% respectively. Aortic arch PWV, as expected, showed a strong correlation with age in males as well as in females (r= 0.71 and r = 0.60 respectively, p < 0.001 for both); there was also a significant correlation with body mass index (r = 0.31; p < 0.001). Aortic arch PWV values ranged from 3.1 to 8.5 m/s, showing a substantial overlap with normal values reported in MRI studies.

Conclusions

The direct measurement of aortic arch PWV is feasible and reproducible with ultrasound, using the novel single-beat dual-gate simultaneous pulsed wave Doppler tracing. This technique could be implemented in a standard echo examination, that is much more available than MRI studies. Further studies are needed to evaluate if Doppler-derived aortic arch PWV could provide additional prognostic information.

Abstract P1830 Figure. Aortic Arch PWV
P1831 Predictors and clinical consequences of silent ischaemic brain lesions following transcatheter aortic valve implantation
Authors: Nagy A I , Bartykowszki A I , Varga A I , Suhai F , Apor A A , Szilveszter B , Kolozsvary M , Karady J , Panajotu A A , Jermendy A , Molnar L , Simon J , Papp R , Merkely B , Maurovich Horvat P
Published: January 2020

Funding Acknowledgements

This study was supported by the János Bolyai Scholarship of the Hungarian Academy of Sciences

Background

A number of studies aimed to identify the predictors of periprocedural cerebral embolizations related to transcatheter aortic valve implantation (TAVI). Much less investigated is the prevalence and determinants of subacute ischaemic brain lesions that develop following TAVI.

Purpose

We sought to identify predictors of subacute clinically silent ischaemic brain lesions in patients following TAVI.

Methods

Patients were included from the Rule out Transcatheter Aortic Valve Thrombosis with Post Implantation Computed Tomography (RETORIC) prospective trial. Echocardiography and brain MRI were performed after TAVI procedure, before hospital discharge. Cardiac CT was performed 6 months later to identify subclinical leaflet thrombosis (HALT), as well as repeat brain MRI, to identify any silent ischaemic lesions that appeared since the intervention. The cognitive trajectory of patients was assessed using the Addenbrookes cognitive test (ACE), performed shortly after TAVI and at 6-month follow-up (FU). All-cause mortality data was retrieved from the National Mortality Database.

Results

79 consecutive patients were included in the present analysis. 28% had known history of atrial fibrillation (AF). 33% of the cohort was treated with oral anticoagulant, of these 56% with single and 25% with dual antiplatelet therapy (DAPT). The mean CHA2DS2VASC score was 4. From discharge to the 6-month FU, 20 patients (25%) developed new silent ischaemic brain lesions on MRI. Clinically manifest stroke did not occur. On the 6-month CT, HALT was identified in 6 patients (8%). Clinical and imaging parameters, including age, body mass index, hypertension, dyslipidaemia, diabetes, smoking, statin-, OAC- and DAPT therapy, history of AF, history of stroke, echocardiographic metrics of left ventricular (ejection fraction, stroke volume index) and atrial (left atrial strain) function as well as HALT were analysed for association with ischaemic brain lesions. Of the above, only HALT showed significant association (OR:6,58; p = 0.04) with silent brain embolizations. The cognitive trajectory from discharge till 6-month FU did not differ between patients with or without ischaemic focuses (ΔACEscore: 1.0 vs. 0.1; p = NS). Over a median FU of 553 (IQR 453 – 665) days, 8 patients died; 2 with and 6 without ischaemic lesions. Kaplan-Meyer analysis showed no difference in outcome between the two groups (p = 0.68)

Conclusion

Subclinical leaflet thrombosis was identified as a significant predictor of subacute silent ischaemic brain lesions after TAVI. These lesions did not affect the overall cognitive performance or outcome of the patients.
P1832 T1 mapping and echo-global longitudinal strain are early markers of cardiac involvement in patients with fabry disease
Authors: Gatterer C , Beitzke D , Bartko P E , Schneider M , Binder T , Hengstenberg C , Bergler-Klein J , Sunder-Plassmann G , Mundigler G , Graf S
Published: January 2020

OnBehalf

Constantin Gatterer

Introduction

Fabry disease (FD) is one of the most common lysosomal storage diseases caused by deficiency of Alpha-Galactosidase A and accumulation of glycosphingolipids in all cells containing lysosomes. Cardiac involvement is characterized by left ventricular hypertrophy, conduction abnormalities and myocardial fibrosis with consecutive cardiomyopathy in late stages.

Purpose

As the detection of early signs of cardiac involvement is crucial for the initiation of enzyme replacement therapy (ERT) or Chaperon therapy, we intended to find early imaging markers.

Methods

Cardiac MRI (CMR) including Late Gadolinium Enhancement (LGE), representing fibrosis, and T1-mapping as well as echocardiography with measurement of global longitudinal strain (GLS) were done as part of the regular check-ups for patients with FD.

Results

The study cohort of 30 FD patients (20-69 years, 53% women) in different stages of disease showed low GLS values already at the time of baseline echocardiography (mean: -17,22%), correlating with the amount of LGE (r = 0,73; p = 0,003) and ejection fraction measured by CMR (CMR-EF; r=-0,74; p = 0,002).

After an average follow-up of 39 months (STD 18), GLS values were significantly declined (-15,51 %; p = 0,009) and correlated with T1 times (r = 0,7; p = 0,04), while LGE and CMR-EF did not significantly change compared to baseline.

Baseline T1 times correlated negatively with the reduction of GLS (r=-0,7; p = 0,003), while LGE and CMR-EF showed no correlation with the course of GLS. ERT appeared to have no influence on the extend of GLS reduction.

Conclusion

Low native CMR T1 times, indicating sphingolipid accumulation in the myocardium, seem to represent the beginning of cardiac involvement in FD and might predict the course of GLS. GLS is a sensitive parameter for early detection of cardiac manifestation and disease progression, while LGE and CMR-EF could not recognize slight deterioration of left ventricular function.
P1835 Recognising extracardiac findings in cardiac imaging - a comparison between cardiologists and radiologists
Authors: Sapiano K , Borg A
Published: January 2020

Background

In the past, cardiac imaging modalities did not obtain much information about extracardiac structures. With the introduction of newer modalities such as CT and MRI, diagnostic quality images of structures surrounding the heart are now being obtained. This has led to the need for interpretation of images of extracardiac structures. Nowadays, this is being performed by cardiologists and radiologists; either separately or conjointly.

Purpose

To evaluate whether there is any difference in the rate of positive extracardiac findings (ECF) between radiologists and cardiologists and to assess whether these ECF are of any clinical importance.

Methods

All patients having had a cardiac MRI and cardiac CT performed in the year 2017 in a single centre were enrolled (n = 733). Reports of these images were reviewed retrospectively and information was obtained as regards to any differences in number of ECF picked up by cardiologists, radiologists or both working together. These ECF were then stratified according to their clinical importance and these subdivisions compared in the context of reporting physician.

Results

A total of 733 scans were reviewed, 219 (29.9%) of these had positive ECF whilst 514 (70.1%) had none. Of the total amount, 314 (42.8%) were reported by cardiologists, 318 (43.4%) by radiologists and 101 (13.8%) jointly by both a cardiologist and a radiologist. Cardiologists found positive ECF in 18.2% of scans reviewed, radiologists reported findings in 37.4% of scans and, of those reported jointly, 42.6% were positive, p= <0.001. A pattern emerged where cardiologists found less clinically significant ECF with only 5.3% of findings classified as will definitely change management, in comparison to 19.3% by radiologists and 16.3% when reviewed jointly; and, only 15.8% of findings classified as will probably change management when compared to 23.5% by radiologists and 23.3% when reviewed jointly. However, it is important to note that this pattern was not statistically significant, p = 0.1432.

Conclusions

A strongly statistically significant difference in the reporting of extracardiac findings has been highlighted in this article with cardiologists picking up less than half of extracardiac findings reported by radiologists. There was a pattern of cardiologists recognising less clinically important extracardiac findings, however this was not found to be statistically significant. These results should be reviewed with caution, taking into consideration the limitations of results obtained from a single centre. However, should this pattern keep repeating itself, one might consider increasing cardiologist training in ECF or having cardiac imaging reported conjointly by a cardiologist and a radiologist. Further studies are also necessary to ascertain the clinical relevance of the difference in ECF between cardiologists, radiologists or both specialists working together.
P1424 Long-term follow-up in patients undergoing early surgery (repair) for severe degenerative mitral regurgitation
Authors: Tamborini G , Mantegazza V , Muratori M , Fusini L , Manfredonia L , Ghulam Ali S , Cefalu C , Italiano G , Volpato V , Gripari P , Pepi M
Published: January 2020

Discordance between studies drives debate regarding the "ideal" (early surgery vs watchful waiting) management of asymptomatic severe mitral regurgitation (MR) in valve prolapse (MVP). Independently on disagreement between studies, strategies are mainly oriented towards early surgery in centers that can achieve <1% mortality rates and >95% repair rates. Data on a detailed evaluation of outcomes in terms of left ventricular ejection fraction (LV EF) in the early repair strategy are lacking. Aims of this study in a large population undergoing early MVP repair are: a) to assess LV function comparing EF and volumes in the follow-up (FU) at 6 month (6ms) and 3 year (3ys) b) to verify whether pre-op volumes and EF may predict functional results c) to compare these findings to the surgical procedure (simple or complex) and to the residual MR.

Between 2008 and 2018, 1000 cases underwent early MV repair in our Center. We retrospectively selected 300 pts with pre-op 2D and 3DTTE, 6 ms and 3ys 2DTTE FU. Results: 286 pts (200 males; 61 ± 12 ys; 222 Barlow, 78 fibroelastic deficiency at 3DTTE examination) had MV surgery (96% reparability; 14 MV replacement after a first attempt of repair). 87 had complex MVP and in 56 the surgical procedure was complex. MR at 6ms <1+ (262 pts) predicted stability of MR at 3ys, while in the 38 cases with MR >1+, MR increased at 3ys (2,6±.6+). Complexity of pre-op 3D morphology predicted complexity of MV repair and identified pts with higher risk of MR recurrence. Table summarizes functional results showing that early restoration of MR, causes significant morphological and haemodynamic improvements at 6 ms without significant additional changes at 3ys. Pre-op systolic LV volume and EF significantly correlated with LV remodelling.

In conclusions

a) early MV repair is associated with favourable LV remodelling and stable systolic function at FU; b) 2DTTE predicts in an early surgical strategy favourable LV remodelling c) pre-operative 3DTTE morphology (simple vs complex MVP) predicts repair procedure (simple vs complex) that in the large majority (91%) is associated with freedom from MR recurrence.

Table Pre-op 6-month FU 3-years FU Left ventricular end diastolic volume (ml) 140 ± 41 104 ± 30 * 103 ± 35 Left ventricular end systolic volume (ml) 49 ± 19 45 ± 19* 43 ± 22 Left ventricular ejection fraction (%) 65 ± 7 58 ± 8* 59 ± 7§ Mitral regurgitation (+) 3.9 ± 0.2 0.6±.6* 0.9±.9§ Left atrial volume (ml) 123 ± 48 91 ± 35* 87 ± 45 *= p < 0.01 6 ms vs pre-op; §=p < 0.01 3ys vs 6 ms
P267 Dextrocardia with single ventricle and symptomatic erythrocytosis: a case report
Authors: Shen L S , Li M J , Chen Y
Published: January 2020

Introduction

Dextrocardia is a rare cardiac anomaly which refers to a right-sided location of the heart within the thoracic cavity. Dextrocardia may be associated with other complex cardiac malformations which could result in cyanosis. We reported a case of cyanotic dextrocardia with symptomatic erythrocytosis.

Case Report

A 54-year-old Asian male was admitted to hospital with the complaint of numbness and tingling of limbs for one month. There was no history of chronic cardio-cerebrovascular diseases or diabetes. On examination vital signs were as follows: blood pressure 112/73 mmHg, pulse 72 beats/min, oxygen saturation 85% on room air, temperature 37.1°C, respiratory rate 18 breaths/min. Cardiac physical examination was indicative of dextrocardia: the apex of the heart was located in the right side of the chest accompanied with a systolic murmur at the apex. Other pertinent examinations showed cyanosis of lips, flushing of face and limbs, and a normal neurological examination. Echocardiography and computed tomography (CT) demonstrated heterotaxy and dextrocardia, normal atriums, common mitral valve, lengthy leaflets of tricuspid valve, dilated single ventricle, double-inlet and outlet left ventricle, mild atrioventricular valve regurgitation (AVVR) and no pulmonary stenosis. Laboratory data showed increased hemoglobin of 19.9 g/dl and hematocrit of 58.8%, decreased oxygen partial pressure of 49.5mmHg and oxygen saturation of 81.3%.

The patient was diagnosed with erythrocytosis perhaps secondary to cyanotic congenital heart disease and was given intravenous drip of normal saline to resolute the hyperviscosity status. He refused bone marrow aspiration and surgical evaluation for single-ventricle palliation. During the 16-month follow up, no other symptoms emerged except for mild numbness of limbs.

Conclusion

Dextrocardia with single ventricle malformation can remain symptom free for a long time until the emergence of complications such as secondary erythrocytosis. It is important to give an early diagnosis and complete evaluation, and echocardiography is an effective method to detect this anomaly.

Abstract P267 Figure. The echo and CT images of this case
P270 Complex cyanotic heart disease in adult patient with down syndrome accompanied by mild pulmonary hypertension
Authors: Siama A , Fountoulakis P , Tsoukas A , Manolis A J
Published: January 2020

Funding Acknowledgements

No funding

Introduction

Patients with Down syndrome and complex unrepaired cyanotic heart disease have impaired life expectancy. The clinical status of each patient depends both on the primary lesion type as well as the cummulative haemodynamic burden in the cardiovascular system. Assessment of an adult patient with complex congenital heart disease that has not been surgically repaired presents several challenges since initial haemodynamic parameters and compensatory mechanisms have to be taken into account.

Case presentation

A 43 year old male patient with known history of Down syndrome and no regular follow up presented to the Outpatient Department of our hospital to undergo pre-operative control for minor soft tissue surgery. The patient exhibited typical morphological features of Down syndrome as well as central cyanosis and digital clubbing. On auscultation a holosystolic type murmur 3/6 on the 3rd left parasternal border was audible. His blood gases revealed hypoxia and mild metabolic acidosis. Electrocardiogram displayed right axis deviation and signs of right ventricular hypertrophy. Transthoracic echocardiography demonstrated a large perimembranous ventricular septal defect (VSD) with normal anatomy and function of the aortic valve and no overiding aorta. Of note was excessive infundibular subpulmonary stenosis which resulted in a functionally double chambered right ventricle. Left ventricle was of normal diamater with good overall systolic function while the right ventricle was non-dilated with significant hypertrophy. Intracavitary gradient was estimated at 60 mmHg. Continuous Doppler showed mild mitral regurgitaion and mild tricuspid regurgitaion with estimated systolic pulmonary pressure of 40 mmHg. Bidirectional flow with low velocities at the level of the defect was recorded. Inferior vena cava was mildly dilated with normal respiratory variation.

Discussion/ Conclusion: The natural history of large VSDs results in progressive dilatation of the right ventricle, the left ventricle and the left atrium with gradually increasing pylmonary vascular resistance and development of pulmonary hypertension, followed by right ventricular hypertrophy, flow reversal and Eisenmenger syndrome. However when RVOT obstruction at any level coexists, significant right ventricular hypertrophy develops and the incresed right ventricular systolic pressures acts protectively by minimizing the shunt at the VSD level. Thus a restrictive VSD due to a functionally double chambered right ventricle created a very fragile balance; a cyanotic heart disease with mild bidirectional flow depending on preload and afterload conditions that survived to adulthood.

Abstract P270 Figure. Complex unrepaired CHD
P284 Patients with reduced systolic function benefit most from recanalisation of chronic total occlusion
Authors: Juricic S , Petrovic O , Tesic M , Dobric M , Orlic D , Aleksandric S , Trifunovic-Zamaklar D , Vukcevic V , Djordjevic-Dikic A , Mehmedbegovic Z , Milasinovic D , Zivkovic M , Stankovic G , Beleslin B , Stojkovic S
Published: January 2020

Background

Percutaneous coronary intervention of chronic total coronary occlusion (PCI of CTO) is proved to reduce symptoms of angina and long term survival.

Purpose

This study aimed to assess systolic and diastolic left ventricular function with standard echocardiographic indices.

Methods

We analyzed total of 46 CTO patients (age 58 ± 9, 73% male). Measures were obtained with the transducer in the apical four-chamber view. Doppler time intervals were measured from mitral inflow and left ventricular outflow Doppler tracings by pulsed wave Doppler. The isovolumetric relaxation time (IVRT) was measured from closure of the aortic valve to opening of the mitral valve. The isovolumetric contraction time (IVCT) was measured from closure of the mitral valve to opening of the aortic valve. Ejection time (ET) was measured from the opening to the closure of the aortic valve on the LV outflow velocity profile. Myocardial performance index (MPI) is simple method for evaluation of overall cardiac function and is independent of heart rate and blood pressure. MPI was equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e") which was measured as average value between septal and lateral side of the mitral annulus using Doppler tissue imaging. The E/e’ ratio was calculated to estimate the LV filling pressures

Results

Six months after PCI of CTO patients showed no change in ejection fraction (EF) (55.69 ± 8.56% vs. 54.83 ± 8.44%, p = 0.10). MPI was significantly decreased (0.676 ± 0.99 vs. 0.632 ± 0.96 p < 0.01), E/e" was significantly reduced, (13,10 ± 6.90 vs. 12.05 ± 5.1 p < 0.05), and when we analyzed only patients with baseline EF < 50% (n = 9) improvement of diastolic function (reduction of E/e") was even greater (22.53 ± 5.52 vs. 15.65 ± 4.8 p < 0.01).

Conclusion

PCI of CTO improves overall cardiac function, particularly diastolic function in patients with reduced ejection fraction.
P305 The evaluation of left ventricle filling pressure and lung ultrasound B-lines in the diagnosis of cardiogenic dyspnea
Authors: Valova T
Published: January 2020

Introduction

Dyspnea is the most frequent symptom of acute heart failure but it could also be a clinical presentation of some other noncardiogenic conditions. The differentiation of the origin of dyspnea could sometimes be a difficult task. The estimated elevation of left ventricle filling pressure with lung ultrasound proved positive B-lines score > 15 could be reliable as diagnostic methods for acute decompensated heart failure and proof of the cardiogenic origin of dyspnea.

Purpose

To evaluate the reliability of elevated left ventricle filling pressure and positive lung ultrasound B-lines score in differentiation of the origin of dyspnea.

Methods

Elevated E/e´>15 as a proof for elevated left ventricle filling pressure and multiple bilateral LUS B-lines (>15) were tested against conventional X-ray and NT-proBNP in 44 patients with cardiogenic dyspnea (23 NYHA III patients and 21 NYHA IV patients) and 42 patients with noncardiogenic dyspnea.

Results

Elevated left ventricle filling pressure detected with echocardography (E/e´>15) as a proof of acute decompensated heart failure was found in 18 NYHA IV patients and strongly correlated with multiple bilateral LUS B-lines > 15 (all 21 NYHA IV patients), alveolar edema from conventional X-ray (21 NYHA IV patients) and NTproBNP > 1000pg/ml in 17 NYHA IV patients. The results for NYHA III patients differ very much. Elevated filling pressure (E/e´ > 15) from echocardiography was found in 10 patients NYHA III. For the left 13 patients NYHA III E/e´ was in grey zone between 8-14. Multiple bilateral LUS B-lines >15 were found in 18 NYHA III patients. Interstitial pulmonary edema was found in 15 NYHA III patients and NTproBNP > 1000pg/ml was found in 16 NYHA III patients. E/e´ between 8-14 (grey zone) moderately correlated with NT-proBNP and strongly with pulmonary blood flow redistribution and interstitial edema from X-ray. Normal left ventricle filling pressure (E/e´ < 8) was found in 36 noncardiogenic patients. Only 6 patients with noncardiogenic dyspnea were with elevated left ventricle filling pressure (E/e´ > 15) which was explained with their overweight (BMI > 30) and hypervolemia and correlated with negative LUS B-lines. Only 1 patient with noncardiogenic dyspnea was with false positive B-lines score > 15 typical for pneumonia.

Conclusions

Elevated left ventricle filling pressure detected with Tissue Doppler echocardiography (E/e´>15) and positive LUS B-lines score > 15 are reliable modalities for the diagnosis of cardiogenic dyspnea in patients NYHA IV. In patient NYHA III with cardiogenic dyspnea the two presented modalities proved to be with moderate reliability and need references from conventional X-ray and NT-proBNP.
P320 Left atrial mechanics in moderate mitral valve disease: earlier markers of damage
Authors: Alves P , Marinho A V , Ferreira J A , Milner J , Freitas A , Ferreira C , Almeida J P , Martinho S , Baptista R , Martins R , Goncalves L
Published: January 2020

BACKGROUND

Left atrial (LA) mechanics is impaired in mitral valve disease, but it is not clear whether reservoir, conduit or contractile functions are differentially impaired in stenosis (MS) or regurgitation (MR). We aimed to study LA mechanics in patients with moderate MR or moderate MS and identify discriminators of disease.

METHODS

We conducted a prospective, observational study of 100 patients with isolated moderate MR and 100 patients with moderate MS. LA mechanics with speckle tracking echocardiography (STE) assessed LA reservoir (LA ɛsys and SRs), conduit(LAɛe, SRe), and contractile (LAɛa, SRa) functions. Left ventricle (LV) functional parameters were assessed as well, including LV ejection fraction (LVEF), LV end-diastolic diameter (LVDD) and LV global longitudinal strain (LV-GLS).

RESULTS

The mean age was 67 ± 14 years and 75% were female. Mean left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVDD), LV global longitudinal strain (LV-GLS) and systolic pulmonary artery pressure (sPAP) did not differ between MR and MS (table 1).LA indexed volume (LAVi) and LA strain did not vary between MR and MS, but strain rate did. SRs and SRe had better values in MR, whereas SRa had worse values in MR (table 1). SRe (<-0.7%) had the superior discriminative power for MR, with an area under the curve of 0.85, sensitivity of 76% and specificity of 85%.

CONCLUSIONS

LA strain rate phases were the only parameters that varied between MR and MS. Contractile phase strain rate was more impaired in MR and conduit phase strain rate in MS. This highly specific data reflect the earlier hemodynamic changes occurring in LA in the setting of mitral valve disease.

mMR mMS P value LVEF (±SD,%) 57.4 ± 6.4 59.6 ± 4.6 0.145 LV-GLS (±SD, %) -17.7 ± 4.5 -17.1 ± 3.5 0.587 sPAP (±SD, mmHg) 30.3 ± 10.5 32.4 ± 8.3 0.387 LAVi (± SD, ml/m2) 46.3 ± 6.4 48.2 ± 7.4 0.281 LAɛs (± SD, %) 15.8 ± 7.3 13.3 ± 9 0.062 LAɛe (± SD, %) 8.4 ± 4.7 7.1 ± 5.4 0.074 LAɛa (± SD, %) 6.3 ± 4.8 7.4 ± 4.5 0.081 LA SRs (± SD, %) 0.8 ± 0.4 0.6 ± 0.3 0.004 LA SRe (± SD, %) -0.9 ± 0.5 -0.5 ± 0.3 <0.001 LA SRa (± SD, %) -0.5 ± 0.4 -0.8 ± 0.5 0.007