bluuebunny/crossref_metadata_2025 huggingface dataset:
P1498 Right atrial thrombus in a young septic patient with lymphoma
Authors: Habjan S , Erzen B , Miklic M , Skarlovnik A
Published: January 2020

Background

Catheter-related right atrial thrombosis is a rare, but potentially life threatening complication in patients with central venous catheters (CVCs). Echocardiography is an indispensable tool in the diagnosis of right atrial thrombosis. We present a case of a young man with lymphoma, Staphylococcus aureus sepsis and a peripherally inserted central catheter (PICC) who had a septic thrombus in the right atrium.

Case summary

A 23-year-old male patient with recently diagnosed Hodgkin’s lymphoma had an inserted PICC for the purpose of chemotherapy application. Three days after the first chemotherapy application a thrombosis of the cephalic and subclavian veins at the site of PICC was found. The PICC was removed and the patient was treated with therapeutic doses of dalteparin. A day after the discovery of thrombosis, the patient became clinically septic, with high inflammatory markers and Staphylococcus aureus was isolated from his blood cultures. He was promptly treated with flucloxacillin. Due to pain in his left knee, a knee puncture was performed, and Staphylococcus aureus was isolated also from the knee synovial fluid. A transthoracic echocardiography revealed a 2.8 x 2.8 cm sessile thrombus on the lateral wall of the right atrium. There were no vegetations on the tricuspid or other valves. Due to increasing pain in his left knee and an increase in inflammatory markers a synovectomy was performed. After the operation the clinical status improved and the inflammatory parameters decreased. A magnetic resonance imaging of the heart was performed, which confirmed the thrombus described by echocardiography and excluded the presence of abscesses.

All the time the patient was treated in the intensive care unit with standard heparin, flucloxacillin, and piperacillin/tazobactam due to neutropenia. The inflammatory markers slowly decreased and all further blood cultures were negative. Follow-up echocardiography after 16 days of antibiotic and anticoagulant therapy revealed that the mass in the right atrium, attached on the lateral atrium wall, was slightly smaller than before. The mass was centrally un-echogenic with echogenic cover, appearing as a partial regression of the septic thrombus with a central colliquation. The heart valves remained free of vegetations. There was a minor pericardial effusion, with no signs of constriction. Due to improved clinical status the patient was able to start with chemotherapy again after a pause of three weeks.

Conclusion

The patient had three important risk factors for thrombosis: PICC, sepsis and malignancy.

Echocardiography is an important tool for mass diagnosis and the exclusion of vegetations in a septic patient. Often there is a need for further specification of the mass etiology or for the exclusion of other pathology, like abscesses in our case. Magnetic resonance is an important tool that can complement the echocardiographic examination.

Abstract P1498 Figure. Right atrial thrombus
P1504 Inter-vendor comparison of left atrial 2-dimensional strain using multilayer analysis
Authors: Ferkh A , Stefani L , Trivedi S , Brown P , Pathan F , Thomas L
Published: January 2020

BACKGROUND

Left atrial strain (LAS) is increasingly being accepted as a marker of left atrial function. Different vendors utilise different techniques of measuring LAS in echocardiography.

AIMS

To determine the difference between multilayer endocardial and mid-myocardial measurements of LA strain on General Electric (GE) Echopac compared to the TOMTEC system which tracks endocardial strain.

METHODS

Peak reservoir left atrial strain (LAS) was measured on 50 healthy controls using the two different echocardiographic software packages. GE Echopac (v201) 2D-speckle tracking echocardiography technique (LV package) was used to measuremid-myocardial (GE-mid) and endocardial (GE-endo) LAS. This was compared to LAS measurement using TOMTEC (v4.6) which uses an endocardial tracking technique. LAS was measured in 4ch and 2ch views and average biplane strain measurement was obtained.

RESULTS

The mean of GE-mid LAS was 36.3 ± 6.3%, GE-endo LAS was higher with a mean of 44.1 ± 8.0%, while TOMTEC LAS was 42.1 ± 6.3 %. GE-mid and GE-endo LAS correlated well with TOMTEC LAS (r = 0.9, p < 0.001 for both). On Bland-Altman Analysis, GE-mid LAS measurements were systematically lower than TOMTEC LAS (mean difference -5.77), whereas GE-endo LAS had no systematic bias (mean difference 1.99).

CONCLUSIONS

Mid-myocardial peak reservoir left atrial strain, which is routinely measured using GE Echopac software, systematically underestimates LAS as compared to TOMTEC LAS or GE endocardial LAS. This suggests that serial follow up of LAS measurements for patients should be performed on the same software.
P1506 The correlation between left atrial volume index and cerebrovascular stroke
Authors: Almaghraby A , Abdelnabi M , Kemaloglu Oz T , Saleh Y , Shehata H , Shehata M , Badran H , Elgowelly M
Published: January 2020

OnBehalf

YIG-CVR

Introduction

Increased left atrial (LA) size was associated with poor cardiovascular outcomes such as the development of heart failure, atrial fibrillation (AF), and stroke in the elderly.

Aim of the work

To determine the relation between left atrial volume index (LAVI) and the occurrence of ischemic cerebrovascular stroke (CVS) in patients with sinus rhythm.

Patients and Methods

A prospective analysis of the data of patients admitted to a tertiary care center. Left atrial volume index (LAVI) was measured in 1222 patients admitted to our center with first attack of acute ischemic cerebrovascular stroke (CVS) and the data was matched with 1222 patients admitted by diagnoses other than acute ischemic stroke.

Patients with valvular heart diseases, history of AF and with known cardio-embolic source of stroke as left ventricular thrombi or masses were excluded from both groups.

Results

The mean age was 61.1 ± 14.4 years in the CVS group and 61.5 ± 12.4 years in the control group, males were 806 (71.43%) in the CVS group and 852 (73.47%) in the control group. LAVI was 35 ± 10.3 ml/m2 in the CVS group while it was only 25.8 ± 6.4 ml/m2 in the control group which was statistically significant (P value= 0.002).

Conclusion

LAVI is a strong parameter that can be used to predict the occurrence of CVS in patients with sinus rhythm.

Total (n = 2444) Acute CVS (n = 1222) No CVS (n = 1222) P-value Age (years) 61.1 ± 14.4 61.5 ± 12.4 0.75 Sex (Males) 806 (66%) 852 (70%) 0.65 Diabetes 655 (53.6%) 603 (49.3%) 0.6 Hypertension 702 (57.5%) 675 (55.2%) 0.55 Smoking 599 (49%) 564 (46.2%) 0.71 Dyslipidemia 310 (25.4%) 299 (24.5%) 0.81 Mean BP (mmHg) 122 ± 15 119 ± 17 0.88 Heart rate (bpm) 82 ± 16 85 ± 18 0.76 Hemoglobin (g/dl) 12.3 ± 1.3 12.9 ± 1.7 0.61 Platelets (103/l) 255 ± 110 235 ± 95 0.35 INR 1.15 ± 0.11 1.09 ± 0.18 0.75 Ejection fraction (%) 55 ± 12 51 ± 11 0.41 LAVI (ml/m2) 35 ± 10.3 25.8 ± 6.4 0.002* Results are represented as number (%) or mean ± standard deviation, BP = Blood Pressure, INR = International Normalization Ratio, * significant P value < 0.05

Abstract P1506 Figure. Comparison between both groups
P1511 Comparison between echocardiographic right ventricular-pulmonary arterial coupling and right ventricular longitudinal strain to identify pulmonary hypertension in heart failure
Authors: Seidova N , Manouras A , Lund L H , Venkateshvaran A
Published: January 2020

Background

Both the ratio between tricuspid annular plane systolic excursion (TAPSE) and doppler estimated systolic pulmonary artery pressure (SPAP) and right ventricular longitudinal strain (RVSL) have been proposed as sensitive measures of RV contractile function and demonstrate important prognostic implications in heart failure (HF). However, a comparison between measurements to discern pulmonary hypertension (PH) in heart failure has not been adequately explored.

Methods

Consecutive subjects undergoing right heart catheterization (RHC) and simultaneous echocardiography to evaluate HF were enrolled. Subjects with atrial fibrillation, recent acute coronary syndrome and poor diagnostic images were excluded. RV-PA coupling was assessed based on the ratio between invasively derived RV elastance and arterial elastance (Ees/Ea) and correlated with TAPSE/RVSP and speckle-tracking derived RVSL. ROC analysis was performed to identify PH, defined as invasive PA mean pressure ≥25mmHg.

Results

99 subjects were analysed (age: 59 ± 14; 49% female). Both TAPSE/RVSP (r = 0.47; p < 0.001) and RVSL (r = 0.48; p < 0.001) demonstrated significant associations with invasive Ees/Ea. TAPSE/RVSP was significantly lower in PH when compared with non-PH subjects (0.42 ± 0.27 vs 0.65 ± 0.34mm/mmHg; p < 0.001) and demonstrated strong differentiating ability (AUC = 0.80) for PH. RVSL, however, did not significantly differ between groups (p > 0.05).

Conclusions

Both TAPSE/RVSP and RVSL demonstrate significant association with invasive measures of RV-PA coupling. The stronger ability of TAPSE/RVSP to distinguish PH as compared with RVSL may be attributed to the lower load-dependency of this measure.
P1512 Combination of mitral annular peak systolic and early diastolic velocities with early transmitral peak flow velocity: a new prognostic echo index in patients with acute coronary syndrome
Authors: Nakamura K , Yamada A , Kato M , Jinno S , Takahashi A , Sugimoto K , Sugimoto K , Ishikawa T , Ozaki Y , Ishii J
Published: January 2020

Background

One of the novel echocardiographic indices reflecting left ventricular (LV) diastolic filling is the combination of mitral annular peak systolic (s’) and early diastolic velocities (e’) with early transmitral peak flow velocity (E); E/(e’ x s’). This index is reported to be useful to predict a prognosis of heart failure patients regardless of their LV ejection fraction (LVEF).Purpose: The aim of this study was to examine whether or not E/(e’ x s’) could predict cardiac events in patients with acute coronary syndrome (ACS).Methods: We studies consecutive ACS patients hospitalized in our institution between December 2009 and February 2012. They underwent echo examination within 7 days after admission. By use of Doppler tissue imaging, e’ and s’ were respectively calculated by averaging the peak velocities measured at both septal and lateral mitral annulus in 4-chamber view. The exclusion criteria were as follows: atrial fibrillation, significant valvular diseases and inadequate echo images. Cardiac events were defined as re-hospitalization due to recurrent ACS and/or heart failure, and cardiac mortality.Results: In total, 168 patients were eligible for this study (mean age 67 ± 11 years, mean LVEF 51.7 ± 10.3 %). Median follow-up period was 22.5 months. During the follow-up, cardiac events occurred in 27 patients (16.1%). Between the patients with cardiac events and those without, there were significant differences in LV end-systolic volume (44.2 ± 29.1 vs 33.2 ± 13.6 ml, p < 0.05), LV mass index (122.4 ± 38.9 vs 107.5 ± 26.4 g/m², p < 0.05), left atrial volume index (31.7 ± 9.2 vs 27.6 ± 9.4 ml/m², p < 0.05), LVEF (45.7 ± 13.5 vs 52.9 ± 9.2 %, p < 0.05), s’ (5.1 ± 1.6 vs 7.1 ± 1.7 cm/sec, p < 0.001), e’ (4.8 ± 1.3 vs 6.0 ± 1.9 cm/sec, p < 0.05), E/e’ (16.4 ± 6.6 vs 12.5 ± 4.9, p < 0.05), E/(e’ x s’) (3.78 ± 2.52 vs 1.94 ± 1.08, p < 0.001), and serum B-type natriuretic peptide (334.7 ± 420.1 vs 113.8 ± 177.2 pg/ml, p < 0.05). While Cox proportional hazard multivariate analysis detected that E/(e’ x s’) and E/e’ were independent predictors of cardiac events, E/(e’ x s’) was more powerful than E/e’ (p = 0.0002 vs p = 0.0072). ROC analysis revealed that 2.35 of E/(e’ x s’) was the optimal cutoff values to predict cardiac events in ACS patients (AUC 0.79). Patients with E/(e’ x s’) <2.35 had significantly better prognosis than the rest (p < 0.0001, Log-rank; Figure)Conclusion: E/(e’ x s’) could be a useful echo marker to predict cardiac events in ACS patients.

Abstract P1512 Figure.
P1517 Prognostic value of echocardiographic parameters for RV function in long term follow up of patients presenting with ST elevation myocardial infarction
Authors: Guzu C , Zamfir D , Onciul S , Pascal A , Scarlatescu A , Diaconeasa A , Stoian M , Cojocaru I , Petre I I , Iancovici S , Bataila V , Dorobantu M
Published: January 2020

Funding Acknowledgements

Funding Acknowledgements : This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by theERDF

Background

The prognostic value of right ventricular (RV) function assessed by echocardiography in patients with acute ST elevation myocardial infarction ( STEMI ) treated by primary percutaneous coronary intervention (PCI) remains controversial, especially in terms of long term follow up .

AIMS

To evaluate the relation between RV function assessed by various echocardiographic parameters in patients presenting with STEMI and the occurrence of major cardiovascular adverse events (MACE) whithin a long period of follow-up.

Methods

We have prospectively analyzed a cohort of 37 patients (mean age: 62.49+/- 1.67 years, 28 males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary diseases were excluded. All patients underwent serial conventional 2D echocardiography, tissue Doppler imaging ( TDI ), speckle tracking echocardiography (STE) and 3D echocardiography at 24 hours after the acute event, at discharge, at 6 month, 1 year and 4 years of follow up. We measured in each patient the following RV functional parameters : tricuspid annular plane systolic excursion (TAPSE) , RV free wall systolic velocity (St ) assessed by TDI , RV free wall strain (RVFWS) and RV global longitudinal strain (RVGLS), RV myocardial performance index assessed by pulsed wave Doppler (RV MPI -PW) and right ventricular ejection fraction (RVEF). The mean follow up duration was 36 +/-4 months . The combined end-point of MACE was defined as all cause mortality, recurrent myocardial infarction, need for repeat revascularization or stroke.

Results

During the follow-up period 8 patients ( 18.9 % ) reached the combined end-point . In the analyzed group we observed that of all the studied parameters that reflect RV function, only RV MPI –PW and St at discharge were predictors of worse outcomes independent of LVEF or the culprit coronary artery. RV MPI was predictive at a cut-off value greater than 0,56 with a sensitivity of 66,6% and a specificity of 85,7 % ( 95% CI 0.51 to 0.67, p = 0.017, AUC= 0.71), respectively St at a cut -off value lower than 0,13 m/s with a sensitivity of 92 % and a specificity of 41 % ( 95% CI 0.12 to 0.16 p = 0.012, AUC = 0.64 ).

Conclusions

In STEMI patients treated by primary PCI, RV global function and RV regional systolic function evaluated at discharge provide prognostic information for long term MACE, independendent of infarct size or location. Our results need to be confirmed in larger cohorts of patients.
P1518 Relationship between post-operative asymptomatic status and reverse remodeling of large left atrium in patients with aortic stenosis who underwent aortic valve replacement
Authors: Hozumi T , Morimoto J , Nishi T , Takemoto K , Fujita S , Wada T , Shimamura K , Kashiawagi M , Shiono Y , Kuroi A , Matsuo Y , Ino Y , Kubo T , Tanaka A , Akasaka T
Published: January 2020

Introduction

Recently, we have reported that large left atrial volume (minimum left atrial volume index : LAVImin ≥30ml/m²) at end-diastole determined by direct exposure of left ventricular (LV) end-diastolic pressure can predict post-operative symptomatic status after aortic valve replacement (AVR) in aortic stenosis (AS) patients with high sensitivity and modest specificity. Reverse remodeling of large LAVImin after AVR may contribute to false positive for the prediction of post-operative symptomatic status in patients with AS.

Purpose

The purpose of this study was to evaluate relationship between post-operative symptomatic status and reverse remodeling of large LAVImin in patients with AS who underwent AVR.

Methods

The study population consisted of 75 patients with AS who underwent AVR and were followed up for 600 days after AVR, after the exclusion of the followings; atrial fibrillation, significant coronary artery disease, significant mitral valve disease, pacemaker rhythm, and inadequate echocardiographic images. We measured LAVImin by biplane Simpson"s method before and after AVR. Preoperative large LAVImin (≥30ml/m²) according to the previous study was observed in 32 (43%) of 75 patients. We divided these 32 patients into two groups according to the post-operative symptomatic status during the follow-up period.

Results

There was no significant difference in pre-operative LAVImin between patients with and without post-operative symptom (46.5 ± 13.4 vs 40.4 ± 8.6 ml/m²). On the other hand, post-operative LAVImin in patients without post-operative symptom was significantly smaller than that in patients with post-operative symptom (31.5 ± 8.6 vs 54.8 ± 14.0 ml/m², p < 0.01). While significant regression in LAVImin after AVR was observed in patients without post-operative symptom (40.4 ± 8.6 to 31.5 ± 8.6 ml/m², p < 0.05), no regression in LAVImin after AVR was observed in patients with post-operative symptom (46.5 ± 13.4 to 54.8 ± 14.0 ml/m²).

Conclusions

Reverse remodeling of large LAVmin in patients with AS who underwent AVR was observed in post-operative asymptomatic group, but not in symptomatic group. These results suggest that reverse remodeling of large LAVImin after AVR could contribute to the post-operative asymptomatic status in patients with AS who underwent AVR.
P1531 Changes in mitral annular dynamics with three different types of annuloplasty devices: measurement using three-dimensional transoesophageal echocardiography
Authors: Ito S , Yoshitani K , Yahagi M , Onishi Y
Published: January 2020

OnBehalf

National Cerebral and Cardiovascular Center, Japan

Background/Purpose

Mitral annuloplasty plays a crucial role during mitral valve (MV) repair. The dynamics of the mitral annulus (MA) may be variously affected by the annuloplasty device. Therefore, we investigated the differences in MA dynamics when using a semi-rigid ring, semi-rigid band, and flexible ring.

Methods

We retrospectively reviewed 61 patients with mitral regurgitation who underwent MV repair, which included annuloplasty. Semi-rigid rings were used in 33 patients, flexible bands in 21, and semi-rigid bands in seven. Three-dimensional transoesophageal echocardiography (3D-TEE) images of the MV were recorded before and after annuloplasty. The 3D-TEE image datasets were analysed using semi-automated analysis software. We measured anterolateral–posteromedial (AL–PM) and anteroposterior (AP) diameter and height of the MV. The sphericity index (AP diameter divided by AL-PM diameter) and annular height to commissural width ratio (AHCWR) were calculated as the circular and saddle-shaped geometries, respectively. The differences in these values between end diastole (ED) and end systole (ES) were compared by t-test before and after mitral annuloplasty to analyse the MA among the semi-rigid ring, semi-rigid band, and flexible ring.

Results

Before annuloplasty (n = 61), the AL–PM diameter was significantly larger (ED: 4.26 ± 0.08 vs. ES: 4.24 ± 0.07, p = 0.016) and the sphericity index was significantly smaller (ED: 0.93 ± 0.01 vs. ES: 0.94 ± 0.01, p = 0.017) at ED than at ES. Table 1 shows the analysis after annuloplasty for each device. After annuloplasty, not every group demonstrated significant differences in AL–PM diameter or sphericity index. MA dynamics were reduced equally with the three devices.

Conclusion

Mitral annuloplasty reduced MA dynamics equally when using a semi-rigid ring, semi-rigid band, and flexible ring. There were no distinctive differences among the three devices in terms of maintaining flexibility and a saddle-shaped geometry.

MV dynamics after mitral annuloplasty Semi-rigid ring (n = 33) Flexible band (n = 21) Semi-rigid band (n = 7) ES ED P value ES ED P value ES ED P value AP (cm) 2.61 ± 0.38 2.67 ± 0.44 0.15 2.61 ± 0.38 2.67 ± 0.44 0.15 2.79 ± 0.44 2.80 ± 0.43 0.75 AL-PM (cm) 2.85 ± 0.31 2.91 ± 0.39 0.20 2.85 ± 0.31 2.91 ± 0.39 0.20 2.70 ± 0.39 2.73 ± 0.42 0.15 Height (cm) 0.49 ± 0.20 0.51 ± 0.21 0.35 0.63 ± 0.17 0.62 ± 0.17 0.48 0.63 ± 0.13 0.63 ± 0.13 1.00 SI 0.92 ± 0.09 0.92 ± 0.09 0.45 0.91 ± 0.09 0.91 ± 0.08 0.85 0.95 ± 0.12 0.95 ± 0.11 0.34 AHCWR(%) 17.1 ± 6.65 17.4 ± 6.67 0.56 20.4 ± 5.00 20.2 ± 5.10 0.52 21.3 ± 4.49 21.3 ± 4.80 0.95 Data are expressed mean ± standard deviation. AP: anterior posterior; AL-PM: anterolateral-posteromedial; SI: Sphericity index; AHCWR: annular height to commissure width ratio; ES: endsystole; ED: enddiastole.

Abstract P1531 Figure
P1538 Light exercise may induce an increase in the propagation velocity of naturally occurring shear waves
Authors: Strachinaru M , Keijzer L B H , Bowen D J , Geleijnse M L , Van Der Steen A F W , Bosch J G , De Jong N
Published: January 2020

Background

Shear waves (SW) are induced in the myocardium by the closure of the valves. Recent studies show variations in their propagation velocity with age, gender or pathology. However, these valve-induced waves occur during relaxation and contraction. This means that the instantaneous SW velocity, as measure for stiffness, might not only depend on the intrinsic elastic properties of the relaxed myocardium, but also on its contractility and the exact moment of valve closure. The latter can change with heart rate and loading conditions, which could induce variance in measurement.

Purpose

This study aimed to investigate the effect of light exercise on the propagation velocity of naturally occurring shear waves.

Methods

Ten healthy volunteers underwent high frame rate (over 500 Hz) color TDI studies at rest and during light physiological stress (handgrip exercise). Shear wave velocities were averaged over several heart beats. Values obtained were compared by using the Wilcoxon signed ranks test and a Bland-Altman analysis.

Results

The light physiological exercise test induced a small but statistically significant rise in diastolic blood pressure and heart rate (table). The shear wave velocity after aortic valve closure (ASW) could be quantified in each subject at rest and during stress. The shear wave tracking after mitral valve closure (MSW) was only feasible for 8 subjects at rest and 6 during stress. There was an average difference of 0.4 ± 0.3 m/s (LOA= -0.18 to 0.97 m/s) between stress and rest measurements for the ASW velocity, which was statistically significant(p = 0.01, Figure). For the MSW the average difference was 0.02 ± 0.5 m/s (LOA= -1.02 to 1.06 m/s), p = 0.9.

Conclusion

We observed a statistically significant rise in the shear wave velocity after aortic valve closure but not after mitral closure during a light exercise. Although the statistical power of this study is relatively small, the results may suggest that naturally occurring shear waves velocity can be influenced by heart rate and loading conditions.

Table Parameter Rest Stress P Age [yr] 30 ± 6 - - BMI [kg/m2] 22 ± 2 - - Heartrate [bpm] 62 ± 7 67 ± 8 <0.01 Systolic blood pressure [mmHg] 106 ± 13 110 ± 10 0.08 Diastolic blood pressure [mmHg] 62 ± 9 67 ± 9 0.01 Aortic shear wave velocity [m/s] 3.26 ± 0.4 3.65 ± 0.7 0.01 Mitral shear wave velocity [m/s] 4.56 ± 0.7 4.83 ± 0.8 0.9

Abstract P1538 Figure
P1540 Imaging parameters vs. operator dependence of global longitudinal strain values
Authors: Blessberger H , Bergler-Klein J , Graf S , Syeda B , Wagner H , Kammler J , Steinwender C , Binder T
Published: January 2020

Background

Speckle tracking based global longitudinal strain (GLS) values have proven useful in the assessment of subtle changes in left ventricular function. From a clinical point of view, robustness and reliability of measured values are critical to ensure a valid patient assessment and follow-up. However, it is still a matter of debate if imaging parameters systematically alter measured strain values and if these changes are relevant as compared with GLS fluctuations that are caused by different operators or different studies by the same operator.

Methods

In a consecutive everyday patient population (n = 35), we recorded the apical four chamber view several times in each patient with different ultrasound machine settings (modification of gain, frame rate, sector depth, and transducer frequencies) using a commercially available ultrasound imaging system. Furthermore, apical four chamber views with ‘optimized’ imaging settings at the operators’ discretion were recorded by two different observers (obA/obB) in each subject to compute inter- and intra-observer variability. GLS values were calculated offline with a dedicated software. We fitted a linear mixed effects model with random intercept and slope to assess the effect of imaging parameters on GLS and compared the two investigators with Bland-Altman plots.

Results

Ejection fraction ranged between 10% and 76% and was correlated well with GLS (r = -0.78). Neither gain settings (range: -24 to 24 arbitrary units, p = 0.68) nor frame rate (range: 51-113 sec-1, p = 0.77) systematically changed measured GLS values. Conversely, higher sector depth increased (range: 12 to 24 cm, mean effect: -0.16%/cm; 95% CI -0.24% to -0.07%, p < 0.01), and higher transducer imaging frequencies decreased absolute GLS values (range for harmonic imaging: 1.5/3.1 MHz to 2.0/4.3 MHz, mean effect 1.10%/MHz; 95% CI 0.61% to 1.59%, p < 0.01). According to our data, a 12 cm increase of sector depth would translate into an average change of -1.87% GLS (95% CI: -2.87% to -0.86%), whereas a switch of the second harmonic imaging frequency from 3.1 MHz to 4.3 MHz would cause a 1.32% GLS change (95% CI: 0.73% to 1.91%). Intra- and inter-observer variability showed good correlation and limits of agreement (obA: mean difference [MD]: -0.20%; 95% limits of agreement [LOA]: -2.42% to 2.02%, p = 0.86, obB: MD: -0.10%; 95% LOA: -4.28% to 4.07%, p = 0.12, obA vs. obB: MD: -0.53%; 95% LOA: -3.68% to 2.62%, p = 0.92).

Conclusion

Overall, GLS values were robust and reproducible in our cohort of patients. In comparison, potential systematic changes of GLS values caused by modification of imaging parameters (sector depth/transducer frequency) were much less in number than GLS variations caused by different operators or different studies by the same operator.
P1551 Exercise echocardiographic determinants of exercise tolerance in aortic stenosis
Authors: Fazendas P , Francisco A G , Manuel A G , Pereira H , Almeida A G
Published: January 2020

Introduction

A variation of 20 mmHg in the mean aortic gradient in asymptomatic aortic stenosis (AS) was proposed as an indicator of severity during exercise echocardiography.

Objective

to identify echocardiographic predictors of exercise tolerance in AS and analyze the association of the variation in mean aortic gradient (MAG) with exercise tolerance.

Methods

prospective study of patients (pts) referred for testing with asymptomatic AS. We performed exercise echocardiography using the modified Bruce Protocol. Baseline, peak and recovery imaging was performed. Exercise tolerance was expressed as METS and % of predicted METS for age and sex.

Population

24 pts, 14 males, age 72+-9 years, body mass index (BMI): 28+-4 Kg/m2, etiology: bicuspid 6 pts, degenerative tricuspid 18 pts, 4 pts were in sinus rhythm, the remaining were in atrial fibrillation.

Results

baseline parameters: indexed aortic valve area (AVAi): 0,51+-0,13 cm2/m2, MAG 37+-12 mmHg, left ventricle: ejection fraction (LVEF): 63+-9%, cardiac index L/min/m2(CI) 3,2+-0,6, global longitudinal strain (LVGLS) -16+-3%, VTI ratio: 0,26+-0,05, valvulo-arterial impedance mmHg.ml-1.m2(Zva): 3,9+-0,9 . Peak parameters: AVAi: 0,54+-0,14 cm2/m2, MAG 53+-17 mmHg, LVEF: 69 (IQR 10)%, CI 3,2+-0,6, LVGLS -19+-5% , VTI ratio: 0,28+-0,06, Zva: 4,3+-1,4. Exercise tolerance: METS 6+-2, representing 86+-26% of the predicted exercise tolerance for age and sex.

Statistics

we performed an univariate analysis to identify the echocardiographic parameters associated with exercise tolerance, which were then used in a multiple regression analysis. A higher peak CI correlated with a higher exercise capacity (r = 0,5, p 0,01) and higher mean aortic gradient variation (r = 0,6 p < 0,01). The strongest predictor was the peak CI (B coefficient 0,5, R = 0,75, R² 0,57): when corrected for age, sex and BMI, for each increase of 0,5 mL/min/m2 in the peak CI we would expect an increase of 1 MET. This model explains 57 % of the variation in exercise capacity in these patients.

Conclusions

higher mean aortic gradient variation is associated with higher exercise tolerance and the strongest determinant of exercise tolerance in AS is the peak CI.
P1552 Dobutamine stress echocardiography as a screening tool for coronary artery disease detection in patients with end-stage liver disease awaiting transplantation
Authors: Masoura C , Bonou M , Kapelios C , Dambasis D , Skouloudi M , Barbetseas J
Published: January 2020

Indroduction

The prevalence of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) is unknown. However, patients with CAD and ESLD are at increased perioperative risk during liver transplantation. Currently there is no standard protocol for CAD screening in patients with ESLD awaiting orthotopic liver transplantation. We present preliminary data of our experience with dobutamine stress echocardiography in those patients.

Methods

Fifty patients (26 males, mean age of 59 years) with end-stage liver disease awaiting transplantation and no history of CAD underwent dobutamine stress echo. The etiology of their hepatic disease was hepatitis B (6 patients), hepatitis C (6 patients), primary billiary cirrhosis (10 patients), sclerosing cholangitis (8 patients), alcoholic hepatitis (10 patients) and polycystic disease (2 patients), while 8 patients had end-stage liver disease of unknown etiology. Twenty-six patients had risk factors for CAD. Eighteen patients had one risk factor and only 8 patients had 2 risk CAD factors. All patients received dobutamine infusion (at escalating doses of 5, 10, 20, 30 and 40 μgr/kg/min), targeting a 85% or more of their age-predicted maximum heart rate. Atropine was administered in 6 patients.

Results

All 50 patients had normal inotropic response of left ventricle, without evidence of ischemia (100% studies were negative for ischaemia). No patient had major intolerance to dobutamine. Eight patients experienced hypotension responded to infusion of normal saline. One patient developed paroxysmal supraventricular tachycardia, which was treated with intravenous bolus of adenosine.

No patient had cardiovascular events during a follow-up ranging from 1 to 18 months. Twelve patients underwent liver transplantation without any periprocedural cardiovascular events.

Conclusions

Dobutamine stress echocardiography is a safe and reliable method for CAD screening in the labile patients with ESLD who are candidates for orthotopic liver transplantation. It seems that the prevalence of significant CAD in this high-risk population is low.
P1558 Diagnosis and prediction of late cardiotoxicity in non Hodgkin"s lymphoma by 3D echocardiography, vascular ultrasound, and cardiac biomarkers
Authors: Mihalcea D , Balinisteanu A , Cosmulescu G , Vladareanu A M , Vinereanu D
Published: January 2020

Funding Acknowledgements

Grant PCCDI 83/2018 (BIOVEA) and PN-III-P1-1-TE-2016-0669

CHOP chemotherapy in non-Hodgkin"s lymphoma (NHL) is limited by the risk of cardiotoxicity. Aim. To define new parameters, such as 3D LV deformation, arterial stiffness and biomarkers able to detect late cardiotoxicity. Methods. 69 patients (29 men, 59 ± 11 years) with NHL, scheduled to receive CHOP, with LVEF > 50%, were assessed at baseline, at the end of chemotherapy and 1.5 years after therapy completion by 3D echo for LV EF and deformation-longitudinal, radial, circumferential, area strain (LS, RS, CS, AS), by Echo-tracking for pulse wave velocity (PWV) and by biomarkers (troponin I, NTproBNP). Cardiotoxicity was defined as a decrease of LVEF <50%, with >10% from the baseline value. Results. 12 patients (group I) developed cardiotoxicity, while 57 patients did not (group II). There was a significant reduction of LS, CS, AS and an increase of arterial stiffness, but group I had greater changes (p = 0.001) (table). LVEF decrease correlated with changes of LS, AS, PWV and troponin (r = 0.62,r = 0.46,r=-0.33,r=-0.31, p < 0.05). LS reduction at the end of chemotherapy was the best independent predictor for LVEF decrease after 1.5 years from therapy completion (R²=0.41, p = 0.002). LS decrease with more than 23% at the end of treatment predicted late cardiotoxicity after 1.5 years (sensitivity of 84%; specificity of 73%). Conclusion. Assessment of 3D myocardial deformation, arterial stiffness and biomarkers is able to detect late cardiotoxicity and to predict further LVEF decline in NHL.

LV deformation and vascular parameters CHOP Group I Group II LS(-%) Baseline 22 ± 2 22 ± 2 Final 15 ± 2† 19 ± 2† After 1.5years 12 ± 1† 17 ± 1† CS(-%) Baseline 21 ± 2 21 ± 2 Final 15 ± 1† 18 ± 2 After 1.5years 13 ± 1† 16 ± 1† AS(%) Baseline 37 ± 3 38 ± 2 Final 29 ± 3† 35 ± 2† After 1.5years 25 ± 2† 32 ± 1† PWV(m/s) Baseline 7.1 ± 1.2 7.1 ± 0.9 Final 8.8 ± 1.1† 7.4 ± 1.1† After1.5years 10.4 ± 1.0† 8.1 ± 1.2† LS longitudinal strain; CS circumferential strain; AS area strain; PWV pulse wave velocity. † p < 0.001.
P1561 Three-dimensional speckle-tracking echocardiography-derived normal reference values of left atrial volumes and volume-based functional properties in healthy adults
Authors: Nemes A , Kormanyos A , Domsik P , Kalapos A , Ambrus N , Lengyel C , Forster T
Published: January 2020

Introduction

Three-dimensional speckle-tracking echocardiography (3DSTE) is a new promising imaging method based on block-matching algorithm. The present study was designed to define normal reference values of 3DSTE-derived LA volumes, stroke volumes and emptying fractions respecting the cardiac cycle and to determine their age- and gender-dependency in healthy adults.

Methods

The present study involved 256 healthy adult subjects in sinus rhythm, who underwent complete two-dimensional Doppler echocardiography and 3DSTE at the same time. However, due to inferior image quality 87 subjects have been excluded. The remaining population comprised 169 cases who gave informed consent to participate in the study (mean age: 33.2 ± 12.8 years, 77 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects.

Results

While systolic maximum LA volume (Vmax) and early diastolic LA volume before atrial contraction (VpreA) did not change over age decades, late-diastolic minimum LA volume decreased over age decades and was lowest in subjects aged 40-49 years with an increase after 50 years. Total atrial stroke volume (TASV) remained unchanged over age decades. Passive atrial stroke volume (PASV) showed a continuous increase over age decades and a significant difference could be demonstrated between subjects aged 18-29 years and >50 years. Active atrial stroke volume (AASV) did not change over age decades with a non-significant reduction in subjects aged >50 years. Total atrial emptying fraction (TAEF) increased over age decades with a reduction after 50 years. Passive atrial emptying fraction (PAEF) showed a significant continuous increase over age decades. Active atrial emptying fraction (AAEF) did not change in younger ages, was highest at ages 40-49 years with a significant impairment after 50 years. Females have tendentiously higher LA volumes than males. Significant difference could be demonstrated in Vmax and VpreA of females versus males at ages 30-39 years. No significant differences were found between genders in LA stroke volumes, while indexed TASV and indexed AASV were higher in females as compared to males at ages 30-39 years. Similarly, no significant differences were found between genders in LA emptying fractions, while indexed TAEF were higher in females as compared to males at ages 18-29 years and 30-39 years, indexed PAEF at ages 18-29 years and indexed AAEF at ages 30-39 years. No correlations could be demonstrated between transmitral flow E and A velocities as well as their ratio and any of LA volumes neither in younger age group (less than 50 year) nor in older age group (more than 50 years).

Conclusions

Age- and gender-dependency of normal values of 3DSTE-derived LA volumes, stroke volumes and emptying fractions respecting the cardiac cycle were defined in healthy adult subjects.
P1567 Left atrial function - association with left ventriculoarterial function in hypertensive patients
Authors: Georgieva N , Borizanova - Petkova A , Kinova E , Goudev A
Published: January 2020

BACKGROUND

Vascular stiffness and left atrial volume index (LAVI) are predictors of cardiovascular complications in hypertensive patients. The correlation of left atrium (LA) with left ventricle (LV) – arterial functional changes has not been well established.

PURPOSE

To investigate the relationship between LA remodeling and ventriculoarterial function.

METHODS

We studied 70 consecutive middle-aged patients (54 ± 13 years), separated in two groups: 55 with mild to moderate hypertension and duration up to 5 years and 15 healthy controls. All parameters for arterial stiffness – 24-hour central systolic pressure (cSys24h), central pulse pressure (cPP24h), augmentation index 24h (Aix24h) and 24-hour pulse wave velocity (PWV24h) were measured non–invasively with oscillometric method by Mobil-O-graph PWA. All patients underwent standard two-dimentional echocardiography with Spackle tracking analysis for LA and LV global longitudinal strain (GLS).

RESULTS

Statistically significant differences in parameters of vascular stiffness were found in patients with hypertension in comparison with healthy controls: cSys24h (116.64 ± 10.52 vs. 108.4 ± 6.19 mm Hg, p < 0.001), cPP24h (47.64 ± 9.43 vs. 40.4 ± 4.98 mmHg, p < 0.001), PWV24h (8.59 ± 1.49 vs. 6.29 ± 0.91 m/s, p < 0.0001). Patients with hypertension have higher LV filling pressures: E/e ratio (9.62 ± 3.13 vs. 7.62 ± 1.58, p < 0.006), higher velocities of A–wave transmitral blood flow (85.15 ± 16.88 vs. 64.57 ± 13.76 cm/s, p < 0.0001), dilated LA (LAVI: 33.78 ± 10.68 vs. 24.96 ± 4.89 ml/m², p < 0.001) and reduced LA GLS (29.34 ± 3.45 vs. 41.33 ± 4.37%, p < 0.0001) in comparison to control group. There were no statistically significant differences in Aix24h and cardiac output between the two groups. There is moderate positive correlation between LAVI with cPP24h (r = 0.491, p < 0.0001) and cSys24h (r = 0.366, p < 0.004). We found moderate positive correlation between LAVI and LV mass index (r = 0.386, p < 0.002). PWV24h correlated moderately and positively with LAVI (r = 0.404, p< 0.0001), and negatively with LA GLS (r = -0.471, p < 0.0001). CONCLUSION: LA remodeling is determined by the high 24-hour values of non-invasively measured central systolic pressure and pulse wave velocity. The parameters of arterial stiffness - cSys24h, cPP24h correlate positively with LA. PWV24h correlates negatively with reservoir strain of the left atrium. Using the method in clinical practice can improve risk stratification and therapeutic management. Further investigations are needed for prognostic and therapeutic value of LA remodeling.
P1570 Evaluation of The Echocardiographic Parameters of Patients Enrolled to The CZECH-ICIT Study
Authors: Poloczkova H , Krejci J , Hude P , Ozabalova E , Godava J , Honek T , Spinarova L , Belaskova S
Published: January 2020

Background

Dilated cardiomyopathy (DCM) is a serious disease leading to heart failure (HF) often in young people. One of the most common causes of DCM is myocarditis.

Aim of the study

To compare the changes of the echocardiographic (ECHO) parameters of patients enrolled to the CZCEH-ICIT study (randomized study comparing the immunosuppression regiment with conventional heart failure therapy in patients with biopsy proven inflammatory cardiomyopathy). The primary outcome was the change of LVEF in 12 months after randomization. Obtained ECHO parameters were analysed at the baseline and in 12 months during the study .

Study population

We enrolled 20 patients (17 men and 2 women), age from 18 to 65 years , with diagnosis of recent onset dilated cardiomyopathy. EF LV < 40% and NYHA class II or worse who underwent EMB with confirmation of inflammatory cells in myocardium (> 14 LCA+ and/or > 7 CD3+ cells/mm2). All patients had negative PCR of infectious cardiotropic agents and were randomized in to two groups – IT – (prednison and azathioprin given on the top of standard HF therapy) and conventional HF therapy (CHT).

Results

Mean value of EF at the baseline clustered by groups were for IT group 22.3% with SD = 4.7 and for CHT group 21.7% with SD = 4. There were no statistically significant differences between two groups at the baseline p = 0.757. The mean value clustered for groups in 12 months were significant different, we found mean EF = 33.7% for IT group with SD = 9.5 and mean EF = 41.3 with SD = 13 for CHT group. The p-value based on t-test in 12 months was p = 0.175 due to huge variability. The results obtained on the basis of linear mixed models show that there is a trend that needs to be considered. At the baseline there is slightly lower level of EF in the group CHT (estimate of difference is -0.63, p = 0.879) the trend is changing in the time in 12 month - there is higher level of EF in CHT (estimate of difference is 11.37, p = 0.008). Total p-value difference based on the F test adjusted obtained for group is p = 0.065, for time p < 0.0001 and for time*group p = 0.537.

Conclusion

In our small study population we haven´t found positive effect of the immunosuppressive therapy on the development of the ECHO parameters.
P1575 Preserved myocardial work efficiency after transcatheter aortic valve implantation-induced left bundle branch block
Authors: Klaeboe L G , Brekke P H , Haugaa K H , Edvardsen T
Published: January 2020

Background

Left bundle branch block (LBBB) frequently complicates transcatheter aortic valve implantation (TAVI), but may not induce classical mechanical dyssynchrony typically observed in heart failure patients with LBBB. Non-invasive estimated myocardial work by pressure strain-loops is a novel method for evaluation of left ventricular (LV) performance including loading conditions and identifies responders to cardiac resynchronization therapy. Assessment of myocardial work in TAVI-induced LBBB has, however, not been performed earlier.

Purpose

We aimed to evaluate myocardial performance in TAVI-induced LBBB by myocardial work.

Methods

Patients with severe aortic stenosis (AS) and normal ventricular conduction undergoing transfemoral TAVI were included. TAVI-induced LBBB was defined according to strict ECG criteria. In addition to standard echocardiographic parameters, we performed speckle tracking echocardiography (STE) within 2 days post procedure. Post-procedural myocardial work was estimated by commercially available software, combining LV strain by STE and a non-invasively estimated LV pressure curve. Peak systolic LV pressure was assumed to be equal to the sum of peak arterial cuff pressure and mean aortic valve pressure gradient. The proportion of constructive work relative to the sum of wasted and constructive work was expressed as myocardial work efficiency (Figure). A global work efficiency < 90 % was considered abnormal according to the recently published EACVI NORRE study.

Results

We included 109 consecutive patients undergoing TAVI (83 ± 7 years old, 54 % women, logistic Euroscore 16 ± 10) with severe AS (valve area 0.7 ± 0.2 cm2, mean transvalvular gradient 54 ± 18 mmHg), QRS duration 94 ± 10 ms, and a relatively preserved LV ejection fraction (54 ± 9%). New-onset LBBB was observed in 28 patients (26 %) after TAVI. Although post-procedural myocardial work efficiency was slightly better in patients who retained normal ventricular conduction than those with TAVI-induced LBBB (93.6 ± 2.5% vs 91.2 ± 3.4%, p = 0.004), both groups of patients had global myocardial work efficiency within the normal reference range.

Conclusions

Patients with TAVI-induced LBBB have preserved work efficiency despite gross electrical block satisfying strict ECG criteria. The reduced myocardial work efficiency in TAVI-induced LBBB was within the reference range of normal in the recently published EACVI NORRE study. The preservation of myocardial work in TAVI-induced LBBB may explain why LBBB as a complication to TAVI does not necessarily imply poor prognosis.

Abstract P1575 Figure.
The Maternal Nutritional Buffering Model: an evolutionary framework for pregnancy nutritional intervention
Authors: Thayer Zaneta M , Rutherford Julienne , Kuzawa Christopher W
Published: January 2020

Evidence that fetal nutrition influences adult health has heightened interest in nutritional interventions targeting pregnancy. However, as is true for other placental mammals, human females have evolved mechanisms that help buffer the fetus against short-term fluctuations in maternal diet and energy status. In this review, we first discuss the evolution of increasingly elaborate vertebrate strategies of buffering offspring from environmental fluctuations during development, including the important innovation of the eutherian placenta. We then present the Maternal Nutritional Buffering Model, which argues that, in contrast to many micronutrients that must be derived from dietary sources, the effects of short-term changes in maternal macronutrient intake during pregnancy, whether due to a deficit or supplementation, will be minimized by internal buffering mechanisms that work to ensure a stable supply of essential resources. In contrast to the minimal effects of brief macronutrient supplementation, there is growing evidence that sustained improvements in early life and adult pre-pregnancy nutrition could improve birth outcomes in offspring. Building on these and other observations, we propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself. Our model leads to the prediction that birth weight will be more strongly influenced by the mother’s chronic pre-pregnancy nutrition than by pregnancy diet, and highlights the need for policy solutions aimed at optimizing future, intergenerational health outcomes.

Lay summary: We propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself.