bluuebunny/crossref_metadata_2025 huggingface dataset:
1158 Autograft degeneration, clinical outcomes and predictors after 21 years follow up in Ross procedure. A single center experience
Authors: Pericet Rodriguez C , Pardo Gonzalez L , Fernandez Ruiz A , Gonzalez Manzanares R , Ruiz Ortiz M , Delgado Ortega M , Rodriguez Almodovar A , Carnero Montoro L , Luque Moreno A , Oneto Fernandez M J , Paredes Hurtado N , Villalba Montoro R , Casares Mediavilla J , Pan Alvarez-Ossorio M , Mesa Rubio D
Published: January 2020

Background

Autograft regurgitation and the need of autograft reintervention are possible complications of Ross procedure.

Purpose

Our Aim was to identify rates of autograft degeneration, reintervention and predictive

factors valvular disease in a prospective series of a reference cardiovascular surgery hospital.

Methods

Since November 1997 to July 2009, a total of 107 patients diagnosed of aortic valvular disease requiring surgical treatment underwent Ross surgery (mean age 30 ± 11 years, 69% male, 21 patients <18 years). In all of them, a comprehensive clinical and echocardiographic evaluation was performed before the intervention and at discharge, at 6, 12 months and annually after surgery.

Results

At the end of follow-up (21 years, median: 17 years, interquartile rank 12-19 years), echocardiographic and clinical data were available in 95 (89%) and 105 (98%) patients, respectively. 30 patients (32%) developed at least moderate aortic regurgitation and 18 of them (17%) required autograft reintervention. Probability of survival free from at least moderate autograft regurgitation and reintervention at the end of follow up was 71% and 83% respectively. Two patients died because of reintervention related complications. A larger native pulmonary annulus size was the only factor, associated to autograft reintervention (HR 1.24 95% [CI] 1.04-1.48, p = 0.01) and at least moderate autograft regurgitation (HR 1.19 95% [CI] 1.03-1.37, p = 0.02). Autograft reintervention was also associated to intervention in the learning curve period (first 12 cases, HR 3.78, [CI] 95% 1.42-10.08, p = 0.008). We found no significant association of these outcomes with previous cardiac surgery, age, sex, aetiology of aortic lesion or native aortic annulus diameter.

Conclusion

At long term follow-up after Ross procedure, 32% of patients developed at least moderate autograft regurgitation and 17% required autograft reintervention. A larger size of the native pulmonary annulus and intervention in the learning curve period were associated with the need of autograft surgery in the long term follow up.
1175 Comparison of fractional myocardial mass, a vessel-specific myocardial mass-at-risk, with coronary angiographic scoring systems for predicting myocardial ischemia
Authors: Kim H Y , Choi J H , Kim K H , Kim S M
Published: January 2020

Aims The burden of coronary artery disease has been assessed by various semi-quantitative angiographic scores, which are frequently different each other. A non-invasive and quantitative modality may substitute angiographic sores for prognostic implication and decision of revascularization strategy. We compared fractional myocardial mass (FMM) with angiographic scores for predicting myocardial ischemia.

Methods In this multicenter registry, 411 patients who underwent coronary computed tomography angiography (CCTA) were followed by invasive coronary angiography and FFR measurement. CCTA–derived %FMM with diameter stenosis ≥70% (%FMM-70) or ≥50% (%FMM-50) were compared with 9 angiographic scores (APPROACH, Duke Jeopardy, BARI, CASS, SYNTAX, Jenkins, BCIS-1, Leaman, Modified Duke) and were tested regarding their performance for predicting FFR ≤ 0.80. Predictive performance of %FMM or angiographic scores for FFR ≤ 0.80 established in derivation cohort (N = 250) and tested in validation cohort (N = 161).

Results The performance of %FMM-70 and %FMM-50 were similar to most angiographic scores (%FMM-70, c-statistics = 0.76; %FMM-50, 0.71; angiographic scores, 0.68 – 0.79). The frequency of FFR ≤ 0.80 increased consistently according to %FMM-70, %FMM-50, and all angiographic scores (p < 0.001, all). The optimal cutoff of %FMM-50 and %FMM-70 for FFR ≤ 0.80 were ≥34.5% and ≥9.8%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of %FMM-50 were 83%, 56%, 73%, 70%, 72%, and of %FMM-70 were 72%, 78%, 75%, 75%, and 75% using these cutoffs. Validation cohort showed consistent results.

Conclusion %FMM correlated well with angiographic scores and had a potential to be used as a non-invasive alternative to the angiographic scores. The integration of the severity of stenosis and the amount of subtended myocardium may improve the detection of clinically significant coronary artery stenosis.

Abstract 1175 Figure. FMM vs angiographic score
1177 The additive prognostic value of end-systolic pressure-volume relation by CMR in patients with with known or suspected coronary artery disease
Authors: Cavallaro C , De Luca A , Meloni A , Nugara C , Cappelletto C , Grigoratos C , Aquaro G , Barison A , Todiere G , Novo G , Di Sciascio G , Sinagra G , Pepe A
Published: January 2020

Background

The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. This index is easily obtained during routine stress echocardiography but can be derived also during a stress cardiovascular magnetic resonance (CMR) exam, that is the gold standard for the quantification of biventricular volumes.

Purpose

The aim of this study was to assess for the first time the prognostic value ofdelta rest-stress ESPVR (DESPVR) by dipyridamole stress-CMR in patients with known or suspected coronary artery disease (CAD).

Methods

One hundred and sixty-six consecutive patients (37 females, main age 61.96 ± 10.05 years) who underwent dipyridamole stress-CMR in a high volume CMR Laboratory were considered. Abnormal wall motion and perfusion at rest and after dipyridamole were analysed. Macroscopic myocardial fibrosis was detected by the late gadolinium enhancement (LGE) technique. The ESPVR was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson method.

Results

An abnormal stress CMR was found in 39 (23.5%) patients; 24 patients had a reversible stress perfusion defect in at least one myocardial segment and 15 a reversible stress perfusion defect plus worsening of stress wall motion in comparison with rest. Myocardial fibrosis was detected in 69 patients (41.6%). A DESPVR < 0.009 was detected in 74 patients (44.6%).

During a median follow up of 55.51 months (IQ range 33.20 months), 54 patients (32.5%) experienced major cardiac events: 5 deaths, 2 ventricular arrhythmias, 18 coronary syndromes, and 29 heart failure hospitalization.Reversible perfusion deficit, DESPVR < 0.009, diabetes and family history were significant univariate prognosticators. In the multivariate analysisthe independent predictive factors were reversible perfusion deficit (hazard ratio-HR = 2.17, P = 0.010), DESPVR < 0.009 (HR = 1.92, P = 0.028) and diabetes (HR = 2.42, P = 0.004). The Kaplan–Meier curve for DESPVR is shown in Figure 1. The log-rank test revealed a significant difference (P = 0.003).

Conclusions

DESPRV assessed by CMR provides a prognostic stratification in patients with known or suspected coronary artery disease, in addition to that supplied by reversible perfusion deficit and diabetes.

Abstract 1177 Figure 1
1182 Clinical evidence of the mitral valve leaflet remodeling after st-elevation acute myocardial infarction: longitudinal observation using real-time 3D echocardiography
Authors: Nishino S , Watanabe N , Kimura T , Ashikaga K , Kuriyama N , Shibata Y
Published: January 2020

Background

Mitral valve (MV) leaflet remodeling after acute myocardial infarction (AMI) has been proposed as biological and physiological reaction under the ischemic environment mainly by animal experiments. Clinical evidence of leaflet growth after AMI is lacking.

Purpose

We aimed to assess the clinical evidence of the mitral valve leaflet remodeling after acute myocardial infarction by serial 2D/3D transthoracic echocardiography.

Methods

Sixty-six patients with first-onset ST-elevation MI (33 anterior and 33 inferior) were serially examined by 2D/3D-transthoracic echocardiography. MV complex geometry including leaflet surface area and leaflet thickness was quantitatively analyzed in acute phase and 6-month follow-up.

Results

3D-leaflet surface area was significantly increased in 6-month follow-up (anterior MI; 5.58 [4.93-6.00] versus 5.98 [5.68-6.40] cm²/m²; P < 0.001, inferior MI; 5.48 [4.69-6.07] versus 5.79 [4.74-6.37] cm²/m²; P < 0.001). In anterior MI, both anterior and posterior leaflet lengths significantly increased (anterior leaflet; 12.78 [11.55-13.55] versus 13.63 [12.52-14.15] mm/m²; P = 0.001, posterior leaflet; 9.61 [8.73-10.77] versus 9.84 [8.94-10.96] mm/m²; P = 0.037). In inferior MI, posterior leaflet length significantly increased (9.18 [8.50-10.38] versus 10.00 [8.56-10.85] mm/m²; P = 0.029), while there was no significant change in anterior leaflet length (12.54 [11.61-13.56] versus 12.56 [12.08-14.06] mm/m²; P = 0.214). Leaflet thickness was found to become greater in both groups in 6-month follow-up (anterior MI; 1.08 [0.92-1.21] versus 1.32 [1.25-1.45] mm; P < 0.001, inferior MI; 1.14 [0.98-1.25] versus 1.32 [1.21-1.49] mm; P < 0.001) (Figure).

Conclusions

In six months from the onset of AMI, MV enlarged in area and increased in thickness. Anterior leaflet mainly enlarged in anterior MI, while posterior leaflet enlarged in inferior MI. This is the first clinical evidence of the MV remodeling after AMI, and long-year follow-up should contribute to assess the course of valve growth with relation to ischemic mitral regurgitation.

Abstract 1182 Figure. 3D analysis of the mitral valve
1186 Three-dimensional analysis of right ventricle strain in transplanted hearts and rejection: an ongoing prospective study
Authors: Costa RCPLD , Rodrigues A C T , Fischer C H , Lira-Filho E B , Monaco C G , Afonso T R , Vieira M L C , Caixeta A M , Morhy S S
Published: January 2020

Background

The main obstacle for success after heart transplantation is graft rejection, since is mainly asymptomatic and diagnosed by endomyocardial biopsy (EMB). New echocardiographic technologies could bring benefits to that population if subtle changes in heart mechanics were related to an incipient state of rejection.

Purpose

To quantify echocardiographic parameters of right ventricle strain and volumes by a semi-automated offline software and to identify the presence of any relation between those findings and the histopathologic diagnose of rejection.

Methods

a prospective cohort of 35 postoperative heart transplant patients who were submitted to echocardiographic evaluation up to six hours after EMB, including two-dimensional chamber quantification of left ventricular (LV) volumes and ejection fraction; conventional and tissue Doppler measurements were used for flow and functional analysis. Offline assessment of the right ventricle (RV) was made by TOMTEC software, with the acquisition of RV volumes (EDV, ESV, SV) and ejection fraction, TAPSE, FAC and three-dimensional(3D) RV free wall and septal strain using speckle tracking. EMB results were classified as positive for cellular rejection if graded as 2R (two or more interstitial infiltrate spots and myocyte damage) and positive for humoral rejection if they show any response by immunofluorescence assay.

Results

We studied 35 patients, aged 50 ±11, 21 male (67%), totaling 58 examinations, and then we made two analysis of EMB: one in two groups regarding cellular rejection (53 negative and 5 positive) and other regarding humoral rejection (50 negative and 8 positive). RVEDV was higher in the cellular rejection group (112,5 ± 29,6 ml) compared to those with negative biopsy (86,8 ± 24,7 mL; p = 0,01). RV stroke volume showed a similar behavior (53,5 ± 22,3 mL vs. 34,5 ± 11,3 mL; p < 0,01). Regarding humoral rejection by immunofluorescence, patients who tested positive showed lower RVEDV (79,5 ± 10,5 mL vs. 90,57 ± 27,31 mL; p = 0,02) and RVESV (45,53 ± 6,33 mL vs. 53,87 ± 19,87 mL; p = 0,01). RV free wall strain was lower in the group with positive immunofluorescence (-18,35 ± 2,79% vs. -15,34 ± 5,35%; p = 0,01). Regarding 2D measurements , interventricular septal (11,5 ± 1,06 mm vs. 10,56 ± 1,38 mm; p = 0,02) and left ventricular posterior wall (10,75 ± 1,03 mm vs. 10,04 ± 1,1 mm; p = 0,05) were also thicker in the group with positive immunofluorescence for rejection.

Conclusion

Both cellular and humoral rejection after heart transplantation are associated to increased 3D RV volumes whereas a decrease in RV free wall strain is only observed in humoral rejection; in patients with positive immunofluorescence results a significant increase is seen for septal and posterior wall thickness.
1227 Risk stratification of patients with asymptomatic moderate mitral regurgitation: the prognostic value of left atrial strain
Authors: Cameli M , Pastore M C , Righini F M , Mandoli G E , D"ascenzi F , Lisi M , Nistor D , Sparla S , Curci V , Di Tommaso C , Marino F , Stricagnoli M , Mondillo S
Published: January 2020

Background

In asymptomatic moderate mitral regurgitation (MR), the criteria for risk stratification are still uncertain. Therefore, in these patients, optimal time of surgery remains controversial.

Purpose

Our aim was to compare left atrial (LA) strain to other echocardiographic parameters for the prediction of cardiovascular (CV) events in patients with asymptomatic moderate MR.

Methods

401 patients with primary degenerative asymptomatic moderate MR was enrolled and prospectively followed for the development of CV events (i.e. atrial fibrillation, stroke/transient ischemic attack, acute heart failure, CV death). Patients with history of atrial fibrillation, myocardial infarction, heart failure, cardiac surgery or heart transplantation, severe MR, mitral valve surgery during follow-up were excluded.

Results

During a mean follow up of 3.4 ± 2 years, of the 326 patients eligible (mean age 65 ± 9 years), 122 patients had 149 new events. There were no significative differences in mean age and sex, clinical and therapeutic characteristics between the two groups. The event-group presented reduced global peak atrial longitudinal strain (PALS), LA emptying fraction, LV strain at baseline, and larger LA volume indexed (p <0.0001). Receiver operating characteristics curves proved the greatest predictive performance for global PALS < 35% (AUC 0.88). Bland-Altman analysis demonstrated good intra- and inter-observer agreement and Kaplan Meier analysis showed a graded association between PALS and event-free-survival.

Conclusions

Speckle tracking echocardiography could provide a useful index, global PALS, to estimate LA function in patients with asymptomatic moderate MR in order to optimize surgical timing before the development of irreversible myocardial dysfunction.

Echo-data of our study population Variable No CV events (n = 204) CV events (n = 122) LV ejection fraction (%) 59 ± 9 58 ± 10 LV global longitudinal strain (%) - 18.5 ± 3.4 -17.6 ± 3.6* LA volume indexed (ml/m2) 32.5 ± 6.7 36.4 ± 7.1* LA emptying fraction (%) 68 ± 13 62 ± 15* Mitral E/A ratio 0.94 ± 0.14 0.95 ± 0.16 Mitral E/E’ ratio 11.2 ± 6.5 12.4 ± 7.1 Mitral regurgitant fraction (%) 38.9 ± 8.1 39.1 ± 9.4 End regurgitation orifice area (cm2) 0.34 ± 0.05 0.34 ± 0.06 Global PALS (%) 32.5 ± 8.5 19.7 ± 8.1* *Significative variation between groups. Cardiovascular, CV; Left atrial, LA; Left ventricular, LV; Peak atrial longitudinal strain, PALS

Abstract 1227 Figure. Event-free survival according to PALS
P1244 Mitral valve abscess caused by Klebsiella pneumoniae in a patient with diabetes melitus
Authors: Mekhryakov S , Kulesh A , Syromyatnikova L
Published: January 2020

Introduction

Infective endocarditis (IE) still leads to high mortality, despite the achievements of modern medicine. Particular attention should be paid to the group of patients in whom the occurence of IE is caused by rare atypical bacteria, such as Klebsiella pneumoniae. It is known that Klebsiella is the cause of IE in only 1.2% of cases in patients with native valves (Anderson MJ, Janoff EN, 1998), at the same time disease proceeds extremely aggressive.

Case presentation

Patient M., 47 years old, complained of shortness of breath, fever up to 40 degrees Celcius and general weakness. In medical history patient had diabetes melitus (DM) for a 15 years. 10 days before hospitalization the patient was subjected to hypothermia, after that he noted the appearance of fever, chills and general weakness. 4 days after the symptoms appears he turned to a general practitioner and was diagnosed with acute respiratory viral infection. Since the patient did not notice the effect of treatment for 5 days (general weakness and fever persisted, shortness of breath appeared), he called an ambulance and was taken to our clinic with suspected pneumonia. Conducted computer tomography (CT) revealed no signs of pneumonia. During hospitalization, transthoracic echocardiography (TTE) was performed. There was no heart disease in the patient"s medical history. TTE revealed the hyperechoic mobile mass (15x15 mm) on the posterior cusp of a mitral valve. Mitral regurgitation was within physiological range. For the verification, patient was recommended to undergo transesophageal echocardiography (TEE), but he categorically refused this examination. Against the background of ongoing antibiotic therapy fever persisted. Subsequently, the patient was consulted by a neurologist about a complaint of double vision, and a brain CT was performed and revealed acute infarction in the right occipital lobe. Stroke was regarded as cardioembolic. The patient"s condition progressively worsened, miltiple organ failure was increasing, he was intubated and transferred to the intensive care unit. We performed an ultrasound as heart murmur appeared. TEE revealed a large hyperechoic formation 30x30 mm with anechoic collapsing cavity in the center and defect in the posterior cusp up to 20 mm, mitral regurgitation reached 4 degrees. Despite adequate therapy the patient"s condition progressively worsened, and the next morning biological death was diagnosed. The autopsy results confirmed IE caused by Klebsiella pneuminiae.

Conclusion

Our clinical case shows that we cannot neglect a small percentage of cases of IE caused by such atypical bacteria as Klebsiella. The disease in this case was extremely severe and difficult to treat, which can be explained by the tendency of patients with DM to the occurence of infections.

Abstract P1244 Figure.
P1250 Thymoma invading the right atrium - multimodality imaging and its importance for managing and therapeutics
Authors: Ferreira V , Bravio I , Moura Branco L , Ranchordas S , Duarte X , Pedro C , Abecasis N , Neves J , Castelo A , Garcia Bras P , Cruz Ferreira R
Published: January 2020

Introduction

Thymoma is the most common primary neoplasm of the anterior mediastinum. Most invasive thymomas are limited to the pericardium. Only few cases of transcaval extension with intracardiac involvement have been reported.

Case report

We present the case of a 15-year-old boy with previous history of infectious cerebelitis without neurologic sequelae. He presented with interscapular pain for 6 weeks (not improving with symptomatic therapy) and fever for 3 days. On admission, chest radiograph exhibited an opacification in the right hilum (Figure A). He was discharged with antibiotic prescription for presumptive pneumonia. Due to persistence of complaints he was revaluated after 5 days. Signs of superior vena cava (SVC) syndrome were noted. A computerized tomography showed a large soft tissue mass of the anterior mediastinum, in right antero-lateral topography, measuring 12.5x10x9.5 cm with central calcification and extension to the right lung (Figure B). Transthoracic and transoesophageal echocardiography showed an anterior mass compressing the pulmonary artery branch (PA) and SVC with marginal invasion of the right atrium (RA) (Figure C and D). Cardiac MRI confirmed a large mass of the anterior mediastinum with extension and invasion of the right superior lobe, invasion of the superior vena cava with extension into the RA (Figure E). Transthoracic core-needle biopsy was performed and histopathological diagnosis confirmed an invasive thymoma. The case was discussed at joint cardiothoracic surgery and oncology multidisciplinary meeting and it was agreed to neoadjuvant chemotherapy regimen followed by surgery. Intraoperatively, a large tumor invading the SVC and proximal RA was found, in accordance with the echocardiographic and MRI findings. Due to unforeseen metastatic implants on the adventitia of the main PA and ascending aorta, resection of the tumor was not performed. Palliative decompression of the venous system was performed with interposition of a ringed vascular prosthesis between the left brachiocephalic vein and the right atrial appendage. (Figure F). The patient received postoperative radiotherapy and is asymptomatic without signs of SVC syndrome for 3 months.

Discussion and conclusion

This report illustrates a rare case of an invasive thymoma with extension to cardiac structures. Multimodality imaging for quality decision-making was imperative in the management and for surgical planning of this case. Transthoracic and transoesophageal echocardiography remain the exams of choice for the diagnosis of intracardiac disease. As demonstrated, a high index of suspicion is needed because clinical symptoms are unspecific and late diagnosis of potentially resectable tumors are associated with a poor prognosis.

Abstract P1250 Figure. Multimodality imaging
P1252 Left ventricular dysfunction masking symptoms of acute aortic dissection in a postpartum woman with peripartum cardiomyopathy: a case study
Authors: Wahjoepramono N , Hasan M , Prameswari H S , Dewi T I , Martanto E
Published: January 2020

Acute aortic dissection carries a high mortality rate if left unrecognized and untreated, however only 60-70% of cases are accurately diagnosed in the early stages of hospital admission. This condition rarely occurs in young women but may manifest in the presence of predisposing factors such as pregnancy and preeclampsia; in which hormonal and hemodynamic alterations, exacerbated by high blood pressure, may adversely affect the aortic intima. Acute chest pain in pregnancy may caution physicians and warrant further examination, but left ventricular dysfunction can mask symptoms commonly associated with aortic dissection and delay timely diagnosis.

We present a 27-year old woman with acute aortic dissection confounded by peripartum cardiomyopathy. The patient was admitted for respiratory distress ten days after delivery by caesarean section due to severe preeclampsia. She had no complaints of chest or interscapular pain, and initially assessed with peripartum cardiomyopathy. Plain chest radiography showed cardiomegaly without mediastinal widening. Trans-thoracal echocardiography revealed severely reduced left ventricular function and a regurgitant, dilated aortic root with a visible intimal flap. Computed Tomography examination confirmed an aortic dissection Stanford Classification A extending up to the renal arteries.

Patients with acute aortic dissection may not always demonstrate classic signs or symptoms, especially when a different entity obscures the progression of disease. Nonetheless, acute aortic dissection is a life-threatening disease, and require immediate recognition. Pregnant women are at a risk towards developing a dissected aorta and different imaging modalities must be promptly utilized, even when present with atypical symptoms, to exclude such catastrophic events.
P1263 Acute cerebrovascular infarct in a young adult with double septal defect and double outlet ventricle
Authors: Nacional K , Lorilla R , Bagaoisan K E
Published: January 2020

Introduction

Double outlet right ventricle is a rare cause of acute cerebrovascular disease among young adults.

Case. We report a case of a 21 year old male who presented with aphasia and left sided weakness. This was associated with cyanosis, easy fatigablity, recurrent epistaxis and loss of consciousness since childhood. On admission, patient’s vital sign was stable at 100/60, 90 bpm regular, 20 cycles per minute afebrile 80% oxygen saturation on room air. Patient is conscious, aphasic but follows simple commands. He had central cyanosis, clubbing of the upper and lower extremities, adynamic precordium, single s2, right ventricular heave, grade 3/6 systolic ejection murmur at the 2nd left intercoastal space parasternal line, 4/6 holosystolic murmur at the 4th intercoastal space parasternal line, and clear breath sounds. Neurologic examination revealed a 0/5 motor response on both left upper and lower extremity. Cranial MRI showed acute ischemic infarcts at the right frontal centrum semiovale and left cerebral hemisphere. During his admission, cardiac work up was done to investigate cardioembolic cause of the acute cerebrovascular disease. Transesophageal echocardiogram revealed congenital heart disease situs solitus with atrioventricular discordance; double outlet right ventricle, pulmonic valve stenosis, interatrial septal aneurysm with atrial septal defect and persistent left superior vena cava syndrome. During his hospital course, patient was started on aspirin, citicholine and atorvastatin for his cerebrovascular disease which was noted to improve after 2 days. Patient was also referred to the thoracovascular surgery team for comanagement who did modified Blalock Tausig shunting. Patient was referred to cardiac rehabilitation post procedure. His vital signs remained to be stable, his oxygen saturation increased to 90% at room air, and his functional capacity improved. Patient was discharged stable.

Discussion

Double outlet right ventricle is a rare complex congenital heart disease characterized by a conotruncal malseptation from which more than or equal to 50% of each great artery arises from the morphologic right ventricle. Associated defects like atrial septal defect and persistent left superior vena cava were reported in some literature. Cerebrovascular infarcts in complex cyanotic congenital heart disease might be secondary to polycythemia and/or paradoxical emboli bypassing the interatrial defect. Prompt prophylaxis such as periodic phlebotomy and/or anticoagulation in patients high risk for deep vein thrombosis must be evaluated for each patient.
P1271 Systolic dysfunction in obese and extreme obese patients and preliminary results after bariatric surgery
Authors: Tsonev S , Kuneva Z , Grozdev K , Gateva A , Kamenov Z , Vasilev D
Published: January 2020

Background

Obesity is known to be associated with left ventricular (LV) diastolic dysfunction, heart failure and some risk factors for early atherosclerosis: diabetes mellitus, arterial hypertention, dyslipidemia. Very few studies investigate extremely obese patients and how this condition impairs LV systolic function.

The aim of the study is to explore the effect of obesity and extreme obesity on LV systolic function in patients without diabetes mellitus and the effect of bariatric surgery on that function.

Methods

We prospectively investigated 55 patients with obesity class 1 and 2 and 23 patients with extreme obesity who underwent bariatric surgery. The participants were grouped according to body mass index (obesity class 1 and 2 BMI ≥ 30 ≤ 40 kg/m2 and extreme obesity ≥ 40 kg/m2). Systolic function was assessed by ejection fraction by Simpson and Teicholz, global longitudinal strain, Tei index.

Results

In the studied groups statistical analysis proved the relation between all investigated echographic parameters and BMI. The mean left ventricular ejection fraction and GLS values were 55% (±10%) vs. − 17.3% (±3.3%) for obese and 51% (±8%) vs. − 16.5% (2.3%) for extreme obese (p < 0.05).

Patiets with extreme obesity, who underwent bariatric surgery increased LV ejection fraction faster and more than patients who underwent only diatry and medical treatment. 5.0 (9.0) % vs. 3.0 (10.0) % (p < 0.05).

Conclusion

Obesity and extreme obesity impair all studied parameters for LV systolic function. Bariatric surgery is treatment option for extreme obesity patients and a possibility for significant and fast improvement of LV systolic parameters.
P1291 Are we ready for machine learning in HCM risk stratification?
Authors: Adamczak D M , Bednarski M , Rogala A , Antoniak M , Kiebalo T , Oko-Sarnowska Z
Published: January 2020

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium. The disease is the most common cause of sudden cardiac death (SCD) in young people and competitive athletes due to fatal ventricular arrhythmias, but in most patients, however, HCM has a benign course. Therefore, it is of the utmost importance to properly evaluate patients and identify those who would benefit from a cardioverter-defibrillator (ICD) implantation. The HCM SCD-Risk Calculator is a useful tool for estimating the 5-year risk of SCD. Parameters included in the model at evaluation are: age, maximum left ventricular wall thickness, left atrial dimension, maximum gradient in left ventricular outflow tract, family history of SCD, non-sustained ventricular tachycardia and unexplained syncope. Patients’ risk of SCD is classified as low (<4%), intermediate (4-<6%) or high (≥6%). Those in the high-risk group should have an ICD implantation. It can also be considered in the intermediate-risk group. However, the calculator still needs improvement and machine learning (ML) has the potential to fulfill this task. ML algorithm creates a model for solving a specific problem without explicit programming - instead it relies only on available data - by discovering patterns and relations.

METHODS

252 HCM patients (aged 20-88 years, 49,6% were men) treated in our Department from 2005 to 2018, have been enrolled. The follow-up lasted 0-13 years (average: 3.8 years). SCD was defined as sudden cardiac arrest (SCA) or an appropriate ICD intervention. All parameters from HCM SCD-Risk Calculator have been obtained and the risk of SCD has been calculated for all patients during the first echocardiographic evaluation. ML model with variables from HCM SCD-Risk Calculator has been created. Both methods have been compared.

RESULTS

20 patients reached an SCD end-point. 1 patient died due to SCA and 19 had an appropriate ICD intervention. Among them, there were respectively 6, 7 and 7 patients in the low, intermediate and high-risk group of SCD. 1 patient, who died, had a low risk. The ML model correctly assessed the SCD event only in 1 patient. According to ML, the risk of SCD ≤2.07% was a negative predictor.

CONCLUSIONS

The study did not show an advantage of ML over HCM SCD-Risk Calculator. Because of the characteristic of the dataset (approximately the same number of features and observations), the selection of machine learning algorithms was limited. Best results (evaluated using LOOCV) were achieved with a decision tree. We expect that bigger dataset would allow improving model performance because of strong regularization need in the current setup.
P1293 Coronary artery flow velocity alteration by transthoracic echo in a group of young adult males
Authors: Sukhanova O , Zagatina A , Zhuravskaya N , Ivanov A V , Shmatov D
Published: January 2020

Funding Acknowledgements

university Grand

Background

Atherosclerosis is a chronic and progressive disease that causes high mortality primarily in persons over the age of forty. However, a lot of atherosclerosis cases are only discovered after a fatal cardiovascular event. Several techniques can be used to identify atherosclerosis when it is still in its subclinical stages and at ages before the symptoms of atherosclerosis became marked. The SCORE chart and other scores were developed for this purpose. However, the SCORE chart doesn’t cover the people under 40 years old. A significant portion of patients with a high risk of cardiovascular disease have major cardiac events before reaching 40 years of age. The aim of the study was to define subclinical coronary flow alteration in apparently healthy men between the ages of 30-39.

Methods

This is part of a study intended to facilitate risk estimation in apparently healthy persons between 30 and 39 years old with no documented cardiovascular disease. Seventy-two consecutive men (34 ± 3 years old) who were assumed healthy, were recruited into the study. A standard cardiology exam; analysis of blood lipids; basic transthoracic echocardiography examination with additional scans of the left main, left anterior descending, and circumflex arteries; and carotid ultrasound were performed.

Results

Among the study population there were eight obese patients (12.5%), twenty-two (22%) smokers, forty-eight (66%) had dyslipidaemias, and six (8%) had

a first-degree relative with known premature coronary or vascular events. All of them had a normal ejection fraction (65 ± 4%) and heart chamber sizes. The mean global longitudinal strain (GLS) was -19.3 ± 2%, myocardial mass index was 77 ± 12 g/m2, and intima-media thickness (IMT) was 0.74 ± 0.19 mm.

Intima-media thickening at standard site was found in twelve patients (17%, 95% CI 9-26%), atherosclerosis with pronounced plaques in carotid arteries was diagnosed in twenty-one man (29%, 95% CI 19-40%). The group with atherosclerotic plaques had a higher maximal velocity in coronary arteries (44 ± 16 vs. 33 ± 11 cm/s, p < 0.002) compared to other patients. Ejection fraction (65 ± 5 vs. 65 ± 4 %, p = 0.93), myocardial mass index (81 ± 13 vs. 75 ± 12, g/m2 p = 0.053), and GLS (-19 ± 3 vs. -19 ± 2 %, p = 0.55) were similar. There was a significant correlation between IMT and maximal velocity in coronary arteries (r=-0.44, p < 0.0005). Three patients of atherosclerotic group (14%, 95% CI 3-32%) had coronary flow velocity more than 68 cm/s corresponding significant coronary artery lesions.

Conclusion

There is a high prevalence of subclinical atherosclerosis among men between the ages of 30 and 39 in a population with a high risk of cardiovascular disease by SCORE chart. Coronary flow velocity assessment could be helpful for detection of coronary lesions in young adult patients with carotid plaques.
P1296 Effects of contact-to-balloon time on variations of the left ventricle global and regional function during hospitalization of STEMI patients: an echocardiographic study
Authors: Cammalleri V , Stelitano M , Muscoli S , Marsili G , Manzon W , Tavernese A , Monaco C , Zanin F , Uccello G , Bonanni M , Mauceri A , Macrini M , Di Landro A , Mollace R , Romeo F
Published: January 2020

Background

Ischemic time duration is one of the most important determinants of infarct size in patients with ST-segment elevation myocardial infarction (STEMI). An early reperfusion with percutaneous coronary intervention (PCI) therapy reduces the adverse events and mortality. It also influences the wall motion abnormalities and left ventricular ejection fraction (LVEF), which can be easily detected by a standard transthoracic echocardiogram (TTE).

Purpose

Aim of our study was to assess the immediate effects of an early percutaneous revascularization in STEMI patients on variations of the left ventricle (LV) global and regional function.

Methods

The study population consists of 141 consecutive patients with STEMI undergoing PCI from January to June 2018. The population was divided into two groups basing on first medical contact-to-balloon time (C2B), respectively ≤90 minutes and >90 minutes. Cardiac biomarkers were obtained uniformly. A standard TTE was performed in all patients, at moment of in-hospital admission and at the time of discharge, recording the LV wall motion abnormalities and LVEF, using the wall motion score index (WMSI) and modified Simpson’s rule, respectively. Finally, we performed a sub-analysis in the group of patients who showed an improvement of the LVEF ≥10% at discharge.

Results

In both groups at baseline, patients suffered from a moderately reduced LVEF (41 ± 8.3% in ≤90 min group vs 40.97 ± 8.91% in >90 min group, p = ns). A WMSI >1 was recorded uniformly: 1.78 ± 0.39 in patients with C2B ≤90 min and 1.81 ± 0.40 in patients with C2B >90 min, without significant differences between the two groups. At the time of discharge, a significant improvement of LVEF (from 41 ± 8% to 44 ± 9%, p = 0.013) and WMSI (from 1.78 ± 0.39 to 1.64 ± 0.38, p = 0.036) exclusively emerged in the ≤90 min group. Furthermore, we identified 37 patients who experienced, at the time of discharge, an improvement of the LVEF ≥10% compared to baseline values. In these patients the C2B time resulted significantly shorter, when compared with patients with LVEF improvement <10%: 42 min (IQR 18.5-77.5) vs. 104 (IQR 48-176), p < 0.0001. Additionally, these patients had lower significant levels of cardiac biomarkers. A significant improvement in WMSI was also observed in the ≥10% group (1,69 ± 0,41 vs 1,49 ± 0,41, p= 0.039).

Conclusion

Our study shows the immediate effects of an early revascularization. In particular, the duration of C2B time influences the recovery of ventricular function, in terms of ejection fraction and parietal kinetics. A standard TTE is a low cost and easily available examination, which may provide immediate results without impacting significantly on health costs.
P1312 Implications of a large atrial roof thrombus
Authors: Fountoulakis P , Hamodraka E , Siama A , Tsoukas A , Manolis A J
Published: January 2020

Funding Acknowledgements

No funding

Introduction

Rheumatic heart disease is the most common cause of mitral valve stenosis. Rheumatic valve disease presents a strong predisposing factor to intracardiac thrombi formation in the left atrium, particularly when there is a background of atrial fibrillation. The predominant location for thrombus creation is the left atrial appendage, due to its morphology, and rarely the free wall or roof of the left atrium. In either case, the presence of intracardiac thrombi in the left cardiac cavities poses a severe risk factor for systemic embolism which can prove detrimental for the patient leading to increased morbidity and mortality. Transesophageal echocardiography remains the gold standard for screening of the left atrium.

Case presentation

We present the case of a 72 year old woman who was admitted to the Emergency Department of our Hospital because of palpitations and progressive weakness over the last month. She had a known history of rheumatic mitral valve stenosis and chronic atrial fibrillation under standard anticoagulant treatment with acenocoumarol.

Methods - Results: On admission, the patient was hemodynamically stable without signs of heart failure. The electrocardiogram revealed atrial fibrillation with a ventricular rate of approximately 135 bpm. Chest X-Ray did not demonstrate any signs of pulmonary congestion. Blood tests were normal, except from a subtherapeutic INR 1.3. Transthoracic echocardiography depicted a suspicious large echogenous mass located on the posterior wall of the left atrium. Furthermore, there was severe mitral valve stenosis with calcification of the mitral annulus as well as reduced mobility of the leaflets (Mitral Valve Area ∼0.8 cm2, Mean gradient = 15 mmHg) and mild aortic valve stenosis. The left ventricle had normal dimensions and good overall systolic function. Systolic pulmonary pressure was estimated at 50 mmHg.

Transesophageal echocardiography confirmed the presence of a large echogenous mass (2,6 x 2,9 cm) located on the posterior wall of the left atrium between the right and left pulmonary veins as well as another mass at the left atrial appendage. Contrast echocardiography ensued, which revealed no absorption of the contrast medium by the mass thus suggesting a lesion with no vascularity, compatible with thrombus. Furthermore there was diffuse slow flow within the left atrium (smoke) indicating blood stasis. The patient was treated with a cardioselective beta blocker and combination of aspirin and acenocoumarol with a target INR of 2,5-3 and was referred for cardiothoracic consultation.

Conclusion/Discussion: We describe a rare case of moderate mitral stenosis with presence of a large thrombus with mobile parts in an unusual location. In this setting the indication for surgery (mitral valve replacement) is upgraded since there is increased risk of thrombus detachment and debilitating systemic embolism.

Abstract P1312 Figure.
P1314 A singular explanation of stroke in young adults
Authors: Campos I , Azevedo P , Costeira Pereira A , Salome N , Vieira C , Pereira V H , Costa Oliveira C , Marques Pires C , Medeiros P , Flores R , Mane F , Mare R , Marques J
Published: January 2020

INTRODUCTION

Although primary cardiac tumors are rare, papillary fibroelastoma (PFE) is the most common benign neoplasm of cardiac valvular structures. Because patients are often asymptomatic the true prevalence is unknown, being most commonly recognized given the evolution of higher-resolution imaging technology. The clinical presentation of PFEs can diverge between being asymptomatic to symptomatic based on the serious complications that can occur, such as acute valve dysfunction or embolization, giving rise to a wide variety of presenting features including neurologic events, acute coronary syndrome, and distal embolic events. The location on the mitral valve does not occur frequently, with rare cases reported in the literature. Here, we present an unusual case of a 32-year-old male with an acute stroke secondary to a PFE in the mitral valve.

CASE REPORT DESCRIPTION

A 32-year-old male patient with a history of crohn"s disease was admitted to our emergency department with a transient sudden-onset aphasia associated with a right hemiparesis. At admission, these symptoms had completely resolved. On further questioning, the patient described another episode of transient right hemiparesis in the last year. On physical examination, the patient"s vital signs were stable. The patient was awake, alert, and oriented with full Glasgow Coma Scale. There was no focal neurological deficit on neurological examination and his cardiovascular examination was normal with no murmurs, added sounds or carotid bruit. A cranial CT showed no signs of acute intracranial disease. Head MRI showed multiple areas of restricted diffusion in the left frontal lobe consistent with acute stroke. As part of the workup to determine the cause of his embolic stroke, a transthoracic echocardiogram and transoesophageal echocardiography were performed, showing a spherical and highly mobilemass attached on the downstream side of the anterior mitral valve leaflet of approximately 1.1 cm in diameter, suggesting the diagnosis of PFE. A bubble study was negative which out ruled patent foramen ovale. After completing the rest of the workup, it was determined that PFE was likely the cause of his stroke. Cardiothoracic surgery was consulted and the patient underwent surgical resection. Histology confirmed the diagnosis of PFE. After 5 years the patient remains asymptomatic, without new embolic events.

DISCUSSION AND CONCLUSIONS

We present a special case that illustrates the importance of diagnosing primary cardiac tumours in a young patient presenting with acute stroke with minimal or no risk factors.Although primary cardiac tumours are rare, diagnosis and treatment at an early stage may prevent serious complications and reduce the morbidity and mortality of embolic stroke.
P1337 Left ventricle outpouchings. Assesing diagnostic complexity
Authors: Blasco Turrion S , Marcos Fuentes L , Moruno Tirado A , Coserria Sanchez F , Valverde Perez I
Published: January 2020

Congenital left ventricle outpouchings (LVO) are a very rare condition that include left ventricle accessory chamber, left ventricle aneurysm (LVA), left ventricle diverticulum (LVD), double-chambered left ventricle and accessory left ventricle, without well-stablished diagnostic criteria. A recent article by Elaheh Malakan et al tries to show this difficulties and propose an algorithm to help define this different pathologies.

We present the case of a 26-day-old boy that was admitted to our Hospital with suspicion of dilated cardiomyopathy. In his physical exam a systolic murmur was detected, and his mother described tiredness during intakes and tachypnea. His ECG showed a sinus rhythm, with an 80º QRS axis. No signs of hypertrophy or dilated cavities were detected. As part of the study a TTE was performed, detecting a dilated left ventricle with a tract crossing the apical side from the LV lateral wall. The MRI confirmed the presence of an incomplete muscular septum from de LV lateral wall up to the apex encompassing the papillary muscles in the mid left ventricle, dividing the LV in two chambers with telediastolic size of 3.5x3cm and 2.6x2.4cm respectively. This secondary appendix, with a pseudoaneurysm morphology, distended in systole with a dyskinetic motion. Globally, the left ventricle was dilated and had mild systolic disfunction. The right cavities were morphological and functionally normal.

In this case initially a common dilated cardiomyopathy was suspected, being able to confirm the presence of a muscular tract crossing the mid left ventricle. The MRI described the image as an LV pseudoaneurysm, however the TTE images and the diagnostic algorithm proposed by Elaheh Malakan et al would include this case as a two-chamber left ventricle, denoting the still present difficulties in the diagnostic process in these cases, and its impact in their therapeutic approach.

Abstract P1337 Figure.
P1366 Low-flow, low-gradient severe aortic stenosis: might mitral regurgitation be a culprit?
Authors: Ferreira J , Beringuilho M , Faria D , Roque D , Ferreira H , Augusto J , Freitas A , Morais J , Morais C
Published: January 2020

Introduction

According to current guidelines, given a patient with low-gradient (aortic valve maximum velocity < 4m/s and/or aortic valve mean gradient <40mmHg), aortic valve area (AVA) < 1cm2 and low-flow (stroke volume (SV) < 35mL/min/m2), with preserved left ventricle function (ejection fraction (EF) ≥50%), an integrated approach for assessment of aortic stenosis severity is proposed. We aimed to investigate whether mitral regurgitation can play a role in those cases, possibly being responsible for low antegrade systolic flow.

Methods

We retrospectively analysed 121 consecutive transthoracic echocardiograms (TTEs) of patients with severe aortic stenosis, with AVA < 1.0cm2 as assessed by continuity equation. Patients with low ejection fraction (< 50%) were excluded. We therefore included 84 patients (females 53,6%, mean age 79,1+-10 years). Stroke volume was assessed by Doppler at the left ventricle outflow tract (LVOT). We then compared the prevalence of more than mild mitral regurgitation among patients with low-gradient and low-flow and the other patients.

Results

15 patients had both low-gradient, low-flow and preserved ejection fraction. There was a significant association regarding the presence of more than mild mitral regurgitation among these patients (p = 0.028, OR = 4.7, CI 95% 1.1-20.1). In these patients, it was also observed a higher prevalence of atrial fibrillation (p = 0.03, OR = 6.9, CI 95% 1.74-27.1), lower longitudinal systolic function of right ventricle as measured by TAPSE (16.6 vs 21.5mm, p = 0.028), and a tendency towards higher left atrial volume (113 vs 87mL, p = 0.06).

Conclusions

Given the findings that the prevalence of more than mild mitral regurgitation is higher in patients with severe aortic stenosis as assessed by AVA with both low-gradient, low-flow and preserved ejection fraction, we suggest that the presence of more than mild mitral regurgitation should be considered on the approach of aortic stenosis classification of these patients.