bluuebunny/crossref_metadata_2025 huggingface dataset:
P1783 Concealed structural abnormalities detected by 2D speckle tracking strain echocardiography persist post ablation in patients with idiopathic ventricular arrhythmias
Authors: Trivedi S , Kumar S , Thomas L
Published: January 2020

Background

Idiopathic ventricular arrhythmias (IVA) occurs in patients without overt heart disease. 2D speckle tracking strain echocardiography parameters, including global longitudinal strain (GLS) and mechanical dispersion (MD), have been shown to predict ventricular arrhythmias. It is unclear if the abnormalities are due to structural substrate abnormality, or substrate abnormality consequent to electrical alterations. Aim: We sought to assess whether patients with IVA have impaired left ventricular (LV) strain indices, and if so, whether these persist following successful treatment with radiofrequency ablation (i.e. correction of electrical alteration). Methods: 2D strain analysis was performed (in sinus rhythm) in 23 consecutive patients with IVA (no structural heart disease by cardiac magnetic resonance imaging (MRI); Group A) prior to electrophysiological mapping/ablation, and compared to 23 age and gender matched healthy controls (Group B). Follow up echocardiography and multiday Holter monitoring was performed 12 months post ablation. Results: Baseline characteristics were similar for indexed LV end diastolic volume (EDV) and ejection fraction (EF) (p = 0.1 for both) (Table 1). LV GLS was lower (p = 0.03) and LV MD was increased (p = 0.002) in the IVA group prior to treatment. At follow up, 18 patients (78%) (Group C) remained free of ventricular arrhythmias – in these patients, LV GLS improved and was similar to controls (p = 0.217); however, LV MD remained significantly increased at 12 months compared to controls (p = 0.009). In the 5 patients (22%) (Group D) that continued to have ventricular arrhythmias at follow up, both LV GLS (p = 0.04) and LV MD (p = 0.008) remained significantly impaired compared to controls. Conclusion: Despite demonstrable absence of structural abnormalities with cardiac MRI, 2D strain can detect subtle alterations in myocardial contraction heterogeneity. Furthermore, 12 months post successful ablation treatment, the increase in MD persists. This suggest the presence of subtle substrate abnormality that results in IVA. In uncured patients, both myocardial deformation parameters remain impaired, suggesting the need for close future surveillance of these patients. Long term follow up with greater number of patients is required to further validate these findings.

Table 1. Echocardiographic parameters Group Indexed LVEDV (ml/m2) LVEF (%) LV GLS (%) LV MD (ms) IVA (Group A) 55 ± 15 61 ± 5 -19.9 ± 3* 44 ± 12* Controls (Group B) 54 ± 14 64 ± 7 -21.2 ± 2 33 ± 9 Group C 12 months follow up -21.7 ± 3 42 ± 11* Group D 12 month follow up -19.8 ± 2* 43 ± 11* * denotes p < 0.05
P253 Patient after correction of Taussig-Bing anomaly with severe neoaortic regurgitation and after sudden cardiac arrest
Authors: Bielecka-Dabrowa A M , Rybak M , Pawliczak F , Lewek J , Banach M , Maciejewski M
Published: January 2020

The Taussig –Bing anomaly is a rare congenital heart malformation that was first described in 1949 by Helen B. Taussig and Richard J. Bing. It is characterized by the presence of a large subpulmonic ventricular septal defect (VSD) and, usually, side-by-side great vessels that arise entirely from the right ventricle. Unlike TGA with VSD, this anomaly is characterized by the presence of a bilateral conus and the absence of aortomitral continuity. Increased pulmonary blood flow leads to early onset of pulmonary vascular disease, hence repair in the early infancy period is recommended. VSD closure combined with arterial switch is currently the preferred procedure. Lecompte introduced a new surgical technique that includes extensive resection of the conal septum and direct reimplantation of the pulmonary trunk on the superior margin of the right ventricular infundibulotomy.

We present case of 18-year-old male patient with Taussig-Bing anomaly after pulmonary artery binding and closure of ductus arteriosus when one year old and after anatomical Jatene correction with modified Lacompte procedure at the age of two years. The patient was admitted to our Department in October 2018 after episode of sudden cardiac arrest in the mechanism of ventricular fibrillation. Echocardiographic examination revealed preserved systolic function of both ventricles (LVEF 62%, TAPSE 25 mm, RV S’ 13cm/s) without contractility disturbances. The enlarged and hypertrophic left ventricle consists of the primary cavity connecting by VSD (size 39 mm) with a fragment of the right ventricle separated from the rest of the right ventricle by a patch with Gore-Tex acting as a ventricular septum - without any leakage features (Figure 1A and 1B). We noticed also enlarged left atrium, increased diameter of neoaorty bulb (50 mm), severe neoaortic regurgitation (AV max: 1,85 m/s, ERO-70, VC-8mm, PHT 327 ms) (Figure 1C), moderate mitral regurgitation (type I according Carpentier) (Figure1D). On 8.01.2019 a subcutaneous ICD Boston Scientific Emblem with a subcutaneous defibrillation electrode was implanted. In performed spiroergometry decreased peak oxygen consumption (2,24 ml/min/kg), the study was stopped because of fatique, assessed expiratory exchange ratio, and episode of nsVT. After decision of Heart Team the patient is qualified for surgical treatment of valve defects.

Abstract P253 Figure 1
P1806 Relation between carotid artery wave intensity compression wave and left ventricular dp/dt
Authors: Antonini-Canterin F , Strazzanti M , Pepe A , Penzo M , Nicolosi E , Pagliani L , Luzza G , Rivaben D
Published: January 2020

Background

Invasive catheter-based studies demonstrated a correlation between left ventricular (LV) dP/dt, a well known index of contractility, and carotid artery wave intensity compression wave.

It is possible to estimate LV dP/dt with ultrasound, evaluating the slope of continuous Doppler wave of mitral regurgitation in early systole. Wave intensity (WI) is achieved merging the echo-tracking of the common carotid artery with the simultaneous pulsed Doppler signal inside the vessel. The first peak (W1) represents the forward compression wave, reflecting theoretically LV contractile function. Nowadays data about the relationship between the two dP/dt methods are scarce.

Purpose

The aim of the study is to compare carotid artery WI and mitral regurgitation wave-derived LV dP/dt in a population of patients with ischemic and not ischemic heart failure.

Methods

We examined 31 consecutive patients with heart failure (7 females, 24 males, mean age 66.7 + 13.9 years, range 29-97 years, 21 ischemic, 10 not ischemic). All patients had at least a mild mitral regurgitation. Two subgroups were created according to the left ventricle ejection fraction values (LVEF ≤ 45% and LVEF > 45%, with 15 and 16 patients respectively). A simultaneous not-invasive brachial blood pressure was obtained.

Results

The W1 was significantly linearly correlated with the echocardiographic LV dP/dt value (r = 0.41, p 0.02). Both W1 and LV dP/dt correlated significantly with LV ejection fraction.

Conclusions

Carotid WI evaluation, and specifically its first peak W1, could be reinterpreted as an alternative method to estimate not invasively LV contractility performance. Larger studies are needed to evaluate the relative prognostic role of carotid artery W1 and LV dP/dt in clinical practice.

Results LVEF ≤ 45 % (n = 15) LVEF > 45 % (n = 16) p value W1 6.19 +- 3.77 9.3 +- 3.43 0.02 dP/dT 789 +- 329 1244 +- 337 0.0007

Abstract P1806 Figure. Common Carotid Artery eTracking
P1816 Cerebral microembolism in low-risk patients with paroxysmal atrial fibrillation before and after pulmonary vein isolationCerebral microembolism in low-risk patients with paroxysmal atrial fibrillation
Authors: Wieczorek J , Cichon M , Wieczorek P , Hoffmann A , Wnuk-Wojnar A , Szydlo K , Lasek-Bal A , Mizia-Stec K
Published: January 2020

BACKGROUND

Invasive treatment of atrial fibrillation (AF) becomes more suitable and effective therapy. There are no consistent data describing the occurrence of potential neurological complications in low-risk patients with paroxysmal AF.

AIM

to determine the occurrence, consequences and risk factors for brain white matter hiperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients before and after pulmonary vein isolation (PVI) treatment.

METHODS

Eighty patients with symptomatic paroxysmal AF (median age: 58 years (IQR 50-63), K/M: 30/50), CHA2DS2-Vasc ≤ 3 (CHA2DS2-Vasc: 2 (IQR 1-2.5)) were included in the study. Before and after a minimum of 6-month period after PVI-RF treatment (med. 9,9 months, IQR 7.6-11.8 months) a clinical evaluation with brain MRI and Mini Mental State Examination (MMSE) test were determined. Severity of brain WMH in MRI was assessed in the Fazekas scale (pic 1). The efficacy of PVI-RF treatment analyzed in a 7-day Holter monitoring was confirmed in 43 (53.8%) patients.

RESULTS

Baseline WMH lesions were found in 55 (68.8%) patients. Patients with baseline WMH lesion obtained similar results in the MMSE test, compared to patients with a normal brain image in the MRI study. There was a statistically significant more frequent occurrence of cerebral WMH lesions among older patients, with a higher CHA2DS2-Vasc score, with left atrial (LA) dilatation and dysfunction. Factors affecting the severity of the WMH were: the co-occurrence of the patent foramen ovale (PFO) and coronary artery disease (CAD).

After PVI-RF treatment there were no significant changes in the presence and severity of WMH lesions. Similarly, there were no significant changes in the cognitive abilities assessed with MMSE test compared to the pre-procedural evaluation. There were also similar factors predisposing to brain WMH changes: older age, higher CHA2DS2-Vasc score and higher BMI. In turn, the degree of the brain WMH severity after observation period was dependent on age, higher CHA2DS2-Vasc score, presence of PFO and CAD and the initial LA function.

CONCLUSIONS Cerebral microembolism assessed in MRI is often found in low-risk patients with paroxysmal AF, and its presence and severity are associated with LA dilatation and dysfunction, age and higher CHA2DS2-Vasc score. Additional factors affecting the severity of WMH lesions are: the co-occurrence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions. In the population of relatively young AF patients with no significant cardiovascular disease burden, cerebral microembolism is not related to cognitive impairment.

Abstract P1816 Figure. pic 1
P256 Takotsubo syndrome early after treatment due to non cardiotoxic chemotheraphy agents
Authors: Ozbay B , Gurses E , Kemal H , Simsek E , Kultursay H
Published: January 2020

Physicians have encountered cardiotoxicity in different situations. The most known scenario is heart failure after especially anthracycline treatment. In this case, immediately after chemotherapy typical Takotsubo syndrome developed and was diagnosed with normal coronary angiography with apical ballooning movement in ventriculography. Acute cardiotoxicity may depend on different pathogenesis than ordinary toxicity mechanism.

Case report

A 65 years old female attended emergency department with epigastric pain after chemotherapy. She had vinorelbine and gemcitabine treatment for malignant urotelial renal carcinoma. The patient was consulted with cardiology department, because of progressive high troponin T levels. She had no prior history except urotelial carsinoma for one year and hypertension for seven years. Her prior chemotherapy protocols included carboplatine and docetaxel. She did not describe typical angina pectoris or shortness of breath.

Electrocardiography (ECG) at admission had symmetrical T wave inversion on precordial derivations (figure 1). Echocardiography (echo) showed typical apical ballooning of the left ventricle (figure 2 and 3). We do not know the patient’s prior cardiac performance and acute coronary syndrome and Takotsubo syndrome were our preliminary diagnosis. Normal coronary arteries were seen on coronary angiography, ventriculography revealed apical ballooning movement of the left ventricle (Figure 4) and this supported our diagnosis as Takotsubo syndrome. She was already on valsartane 160 mg daily for hypertension and we included metoprolol 50 mg daily and enoxoparine 6000 IU s.c twice a day. For several days deep symmetrical T wave inversion persisted on ECG. After third day her ECG changings resolved (Figure 5) and echo images had recovered. The patient was discharged uneventfully and is followed.

Abstract P256 figures
P1825 Myocardial bridging and coronary artery disease in hypertrophic cardiomyopathy: a matched case control study
Authors: Van Der Velde N , Huurman R , Yamasaki Y , Kardys I , Galema T , Budde R , Zijlstra F , Schinkel A , Michels M , Hirsch A
Published: January 2020

Funding Acknowledgements

None.

Introduction

The etiology of chest pain in hypertrophic cardiomyopathy (HCM) is diverse and includes coronary artery disease (CAD) as well as HCM-specific causes. Myocardial bridging (MB) has been associated with HCM, chest pain, and accelerated atherosclerosis. To investigate differences in the presence of MB and CAD, we compared HCM patients with age-, gender- and CAD pre-test probability (PTP)-matched outpatients presenting with chest pain.

Methods

We studied 84 HCM patients who underwent cardiac computed tomography and compared these with 168 matched controls (age 54 ± 11 years, 70% men, PTP 12% [5%–32%]). MB, calcium score, plaque morphology and presence and extent of CAD were assessed for each patient. Linear mixed models were used to assess differences between cases and controls.

Results

Differences between HCM patients and controls are described in the table. In summary, MB was more often seen in HCM patients (50% vs. 25%, p < 0.001), who were also more likely to have >1 segment affected (14% vs. 2%, p < 0.05). In the HCM group, MB was associated with pathogenic mutation status. Calcium score and the presence of obstructive CAD were similar in both groups (9 [0-225] vs. 4 [0-82] and 18% vs. 19%; p > 0.05 for both).

Conclusion

MB was twice as prevalent in the HCM group. However, in a matched analysis, the prevalence and extent of CAD was equal among patients with and without HCM. These finding illustrate that despite a higher prevalence of MB, the prevalence of CAD is similar between groups, also demonstrating satisfactory performance of pre-test risk prediction in HCM patients.

Assessment of CAD by CT HCM group(n = 84) Control group (n = 168) p-value Agatston score 9 [0-225] 4 [0-82] 0.22 No. of pts with score* 0.07 0-399 31 (89%) 149 (91%) >400 8 (11%) 15 (9%) Obstructive CAD 15 (18%) 32 (19%) 0.82 No. of pts with MB 42 (50%) 42 (25%) <0.001 No. of vessels with MB <0.001 1 34 (40%) 39 (23%) 2 8 (10%) 3 (2%) No. of pts with >1 segment with MB 12 (14%) 4 (2%) <0.001 Abbreviations CAD = Coronary artery disease, MB = Myocardial bridging, pts = patients *Only measured in 73/84 HCM patients and in 164/168 control patients
P1838 Defining the Optimal Temporal and Spatial Resolution for Cardiovascular Magnetic Resonance Imaging Feature Tracking
Authors: Backhaus S J , Metschies G , Billing M , Kowallick J T , Gertz R J , Lapinskas T , Pieske-Kraigher E , Pieske B , Bigalke B , Kutty S , Hasenfus G , Kelle S , Schuster A
Published: January 2020

Background

Myocardial deformation analyses using cardiovascular magnetic resonance feature tracking (CMR-FT) have incremental value in the assessment of cardiac function beyond volumetric analyses. Since guidelines do not recommend specific imaging parameters, we aimed to define optimal spatial and temporal resolutions for CMR cine images to enable reliable post-processing.

Methods

Intra- and inter-observer reproducibility was assessed in 12 healthy volunteers. Cine images were acquired with differing temporal (20, 30, 40 and 50 frames/cardiac cycle) and spatial resolutions (high in-plane 1.5x1.5mm through-plane 5mm, standard 1.8x1.8x8mm and low 3.0x3.0x10mm). CMR-FT analyses comprised left ventricular (LV) global longitudinal strain (GLS) and systolic strain rate (SRs) as well as LV circumferential and radial strains (GCS and GRS) and right ventricular (RV) GLS. Intra- and inter-observer reproducibility was assessed in all subjects.

Results

Temporal but not spatial resolution did impact absolute strain and SR. Maximum absolute changes between lowest and highest temporal resolution were as follows: 2.3% LV GLS, 2.2%

GCS, 7.2% GRS, 1.7% RV GLS and 0.32s-1 SRs. Changes of time-integrated (strain) values occurred predominantly comparing 20 and 30 frames/cardiac cycle including LV GLS, GCS and GRS (p = 0.034, p = 0.008 and p = 0.034) in highest spatial resolution settings. In contrast, time-derivatives values (SRs) changed significantly from lower temporal resolutions to 40 frames/cardiac cycle and beyond (20 to 30 p = 0.002; 30 to 40 p = 0.018; 40 to 50 frames/cardiac cycle p = 0.075) in highest spatial resolution settings. Strain reproducibility was not affected by either temporal or spatial resolution. SRs variability as assessed by coefficient of variation decreased with higher temporal resolutions.

Conclusion

Temporal but not spatial resolutions significantly affect strain and SR in CMR-FT deformation analyses. Clinical CMR-FT strain and SR analyses require minimum temporal resolutions of 30 and 40frames/cardiac cycle, respectively to ensure precise quantification of myocardial function.
P1839 Extracardiac findings in cardiac CT and MRI - a Maltese perspective
Authors: Sapiano K , Borg A
Published: January 2020

Background

Cardiac CT and MRI are relatively new, non-invasive modalities of cardiac imaging, obtaining excellent image quality mainly pertaining to the heart. However, both these modalities also obtain diagnostic quality images of extracardiac structures. International studies quote varying rates of positive extracardiac findings (ECF) ranging from 20-30% in cardiac MRI and 30-40% in CT.

Purpose

To evaluate the prevalence of incidental ECF in cardiac imaging in the Maltese Islands and assess for any differences in prevalence between sexes and age groups.

Methods

All patients having performed cardiac CT and cardiac MRI scans performed in the year 2017 in the Maltese Islands (n = 733) were enrolled. Imaging reports of these scans were retrospectively reviewed, making a note of the patient’s age and sex and any positive ECF. ECF were then subdivided according to clinical significance and anatomical site.

Results

Positive ECF were present in 219 (29.9%), whilst 514 (70.1%) had no ECF of note. When subdivided, 14.6% of MRI and 35.0% of CT were positive for ECF, p < 0.001. There was a propensity for older patients to have more positive findings, with these present in 11.9% of patients aged <20, 8.1% of patients aged 20-29, 18.2% of patients aged 30-39, 21.9% of patients aged 40-49, 30.1% of patients aged 50-59 and 40.5% of patients aged ≥60, p= <0.001. Females had a higher proportion of positive findings (38.1%) despite having less total scans (n = 312) when compared to men (23.8%, n = 421), p= <0.001. Of the positive findings, 72.1% were newly discovered. These were classified according to clinical significance with 17.7% of these findings classified as definitely resulting in a change in management, 19.0% most likely resulting in a change in management, 46.8% possibly resulting in a change in management and 16.5% being normal variants or expected post-operative changes. Findings were most commonly lung pathologies (28.8%) followed by gastrointestinal pathologies (21.5%) and liver and gall bladder pathologies (14.6%).

Conclusions

ECF in cardiac imaging are common in the Maltese islands with around a third of all scans having a positive finding. CT was the imaging modality that was more likely to pick up ECF. ECF are increasingly frequent in older patients and also more likely to be found in females, despite less women having been scanned than males. Most findings were newly discovered with a large proportion being of clinical relevance.
410 Early cardiac reverse remodeling in a large cohort of patients with HFrEF treated with Sacubitril/Valsartan
Authors: Sassi V A , Mapelli M , Salvioni E , Mattavelli I , Mantegazza V , Volpato V , Vignati C , De Martino F , Paolillo S , Fusini L , Muratori M , Pepi M , Agostoni P G
Published: January 2020

Background

Despite the widespread use of Sacubitril/valsartan (Sac/Val) in patients with reduced ejection fraction (HFrEF), definite data on cardiac remodeling under treatment are still lacking.

Methods

We conducted a retrospective analysis on a large cohort of 201 consecutive HFrEF ambulatory patients who started Sac/Val in our HF unit between Sept. 2016 and Dec. 2018 on top of optimal medical treatment. Patients with both basal and follow up (at least 3 months) echocardiographic assessment (TTE) were included.

Results

A follow up TTE was performed in 100 patients (male 76%; mean age 67.4 ± 11.1 years; medium follow-up 309 ± 182 days). Baseline characteristics are shown in Tab.1. 34% of the patients reached the maximal dose (97/103 b.i.d.) while 18 interrupted the treatment. We observed an overall significant improvement in ejection fraction (EF), end-diastolic and end-systolic ventricular volumes (EDV/ESV), while just a trend in pulmonary pressures (PAPs) and mitral regurgitation (MR) reduction was noted (p = 0.06 and 0.09 respectively). Non ischemic etiology and high dose of Sac/Val were predictors of better remodeling (Fig.1).

Conclusion

In our study Sac/Val led to an early favorable ventricular remodeling assessed by echocardiography. The observed benefit was greater in patients on higher dose of the drug and non ischemic etiology.

Table 1 n = 100 Clinical characteristics Systolic blood pressure (mmHg) 116 ± 11 Diastolic blood pressure (mmHg) 70 ± 9 Hemoglobin (g/dL) 13 ± 2.0 MDRD (ml/min/1.73 m2) 63 ± 21.4 Potassium (mmol/L) 4.26 ± 0.50 NYHA class II (n;%) 59 (59%) NYHA class III (n;%) 41 (41%) Ischemic etiology (n;%) 58 (58%) ICD (n;%) 41 (41%) CRT (n;%) 32 (32%) Beta-blockers (n;%) 94 (94%) ACEi or ARBs (n;%) 92 (92%) MRA (n;%) 77 (77%) Baseline clinical characteristics

Abstract 410 Figure. Fig. 1
412 Sacubitril/valsartan promotes cardiac reverse remodeling and preserves renal function in a real-world heart failure and reduced ejection fraction (HFrEF) population
Authors: Polito M V , Rispoli A , Vitulano V , D"auria F , Silverio A , De Angelis E , Loria F , Citro R , Galasso G , Iaccarino G , Ciccarelli M
Published: January 2020

Funding Acknowledgements

none

Aims. To evaluate the effects of Sacubitril/Valsartan (S/V) on clinical, laboratory and echocardiographic parameters and outcomes in a real-world population with heart failure with reduced ejection fraction (HFrEF).

Methods and results. Prospective study enrolling consecutive patients with HFrEF treated with S/V.The primary outcome was HF rehospitalization;secondary outcomes were all-cause death, cardiac death and the composite of cardiac death and HF rehospitalization at 12 months follow up.The clinical outcome was compared with a retrospective cohort of 90 HFrEF patients treated with standard medical therapy by using propensity score weighting. At 6 months follow-up, changes in symptoms, echocardiographic parameters, eGFR and furosemide dose were also evaluated. The study population consisted of 90 patients (66.1 ± 11.7 years). At 6 months FU, a significant improvement in NYHA class, LVEF (from 31.0% to 34.0%; p = 0.001), LVESV (from 115.0 to 101.0 mL; p = 0.033) and sPAP (from 31.0 to 25.0 mmHg; p = 0.024) was observed. Moreover, S/V did not affect negatively eGFR and was associated with a significantly lower dose of furosemide prescribed. The propensity score weighting adjusted regression analysis showed a significantly lower risk for HF rehospitalization (HR, 0.131; 95% CI, 0.034-0.503; p = 0.003) and the composite outcome (HR, 0.162; 95% CI, 0.053-0.492; p = 0.001) among patients treated with S/V as compared to the standard therapy group.

Conclusions

In this real-world HFrEF population, S/V reduced HF rehospitalization and cardiac death at 1 year. Moreover, S/V improved significantly NYHA class, LVEF, LVESV and sPAP at 6 months, preserving renal function and reducing the need of furosemide.

Table Study outcomes Unadjusted model HR 95% CI p-value HF rehospitalization 0.273 0.101-0.740 0.011 Cardiac death 0.443 0.137-1.440 0.176 Composite outcome 0.331 0.155-0.710 0.005 All-cause death 0.666 0.272-1.628 0.372 Adjusted model HR 95% CI p-value HF rehospitalization 0.131 0.034-0.503 0.003 Cardiac death 0.259 0.047-1.415 0.119 Composite outcome 0.162 0.053-0.492 0.001 All-cause death 0.713 0.201-2.529 0.601 Adjusted and unadjusted HR for the study outcomes.

Abstract 412 Figure.
P773 Can strain imaging predict viability in ST segment elevation myocardial infarction patient
Authors: Mghaieth Zghal F , Habboubi S , Boudiche S , Ben Halima M , Rekik B , Farhati A , Ouali S , Mourali M S
Published: January 2020

Background

In the acute phase of ST elevation myocardial infarction (STEMI), the main objective is to recanalize the guilty artery, but it is important to know whether myocardium with severely compromised function is permanently injured or reversibly dysfunctional indicating myocardial viability. On the other hand, viability tests such as scintigraphy, magnetic resonance imaging with delayed enhanced (DE-MRI) or dobutamine stress echography are either not validated or unavailable in the acute phase of STEMI. The assessment of myocardial deformation by bidimensional strain (2D) is a technique that has emerged in recent years with good correlation with MRI for viability assessment. An important question remains : Is myocardial viability can be determined by 2D strain parameters at the acute phase of STEMI ?

Aim : To assess myocardial viability in the acute phase of STEMI by 2D strain echocardiographic parameters in comparison with 3 month DE-MRI as a reference method.

Methods

A total of 31 first STEMI patients treated with successful primary or elective percutaneous coronary intervention (PCI) were included with an akinetic area on echocardiography corresponding to the infarct segments. Doppler strain values from left ventricular basal, mid and apical segments (n= 527) were obtained at the acute phase of STEMI and checked up after 3 months. The scar was assessed for viability by DE-MR as reference method, 3 months after the acute phase. Viability was defined by a DE < 50% of wall thickness in the scar zone.

Results

Mean age of the study population was 59,29 ±9,96 years , 27 (87%) being males. Nine patients (29%) showed post-PCI improvement of left ventricule (LV) function. Regional peak systolic strain of the infarct segments and global longitudinal strain (GLS) after 3 months. At the acute phase, wall motion score index (WMSI), regional and global strain values were signficantly better in the viable than in the non viable segments. GLS was -10,92 ± 2,48 in patients with MRI non viable myocardium and -14,45 ±2,91 in patients with MRI viable myocardium . A pre-PCI strain value of -2,9% as a cutt off predicted segmental function recovery after PCI and myocardial viability with a sensitivity 82% of and a specificity 84%.

Conclusion : This monocenter study confirms that 2D strain imaging can be a usueful and accurate method to predict myocardial viability and recovery of segmental and global LV function after PCI in STEMI patients.
P1452 A rare case of embolic blindness in an adult patient with univentricular heart after fontan operation
Authors: Lewek J , Bielecka-Dabrowa A , Banach M , Maciejewski M
Published: January 2020

Background

Thromboembolic complications following Fontan procedure are one of the major causes of mortality and morbidity among patients with univentricular heart. We may classify thromboembolic complications into two groups: systemic- and nonsystemic. We present a case of a patient with a manifestation of both.

Case report

24-year old female, foreign student was admitted to Ophthalmology Department due to sudden blindness of the left eye. Performed studies revealed embolus in the left central retinal artery. Because the patient had the history of congenital heart defect she was referred to our department. Analysis of medical documentation showed that the patient has combined congenital heart defect including right ventricle hypoplasia, tricuspid atresia, pulmonic stenosis, ventricular septal defect, atrial septal defect and persistent ductus arteriosus. She had a history of two surgeries: modified left-side Blalock-Tausing connection (in 4th month of life) and total cavo-pulmonary connection with the closure of Blalock-Tausing and excision of interatrial septum (in 2,5 year of life). On admission she presented with left-eye blindness. She had no dyspnoea or palpitations. However she reported very severe migraines from a few days preceding the admission to hospital. Echocardiography revealed tricuspid atresia, hypoplastic right ventricle, preserved systolic and diastolic function of left ventricle, atrial septal defect with no restriction. We observed enlarged diameter of vena cava inferior with no respirophasic variations and massive thrombus in inside with very low flow. The connection between inferior vena cava and right pulmonary artery was working properly with no visible fenestration. We also observed a winding vessel between ascending aorta and truncus pulmonalis/pulmonary artery with continuous flow of blood from left to right side. Computer tomography confirmed the diagnosis of massive thrombosis of vena cava inferior. Patient had anticoagulation started. Two days later we the flow in inferior vena cava returned – we did not observe any thrombus. Patient was referred to catheterization and had chronic anticoagulation initiated.

Three months follow-up revealed no changes in clinical condition of a patient.

Discussion

The palliative Fontan operation predispose to the increased risk of thromboembolic complication. Despite the risk factors of such complications have been identified, there are no guidelines about prophylactic anticoagulation in that group of patients. As a result, chronic anticoagulation is initiated in patients who have other indications e.g. atrial fibrillation. It seems that it would be beneficial to define the group of patients after Fontan procedure with indications to chronic anticoagulation therapy despite arrhythmias.
P288 Prognostic role of hemoglobin levels in patients with severe tricuspid regurgitation
Authors: Garcia Martin A , Hinojar R , Gonzalez Gomez A , Plaza Martin M , Pascual Izco M , Alonso Salinas G , Monteagudo Ruiz J M , Abellas Sequeiros M , Casas Rojo E , Moya Mur J L , Jimenez Nacher J J , Ruiz Leria S , Barrios Alonso V , Fernandez-Golfin C , Zamorano Gomez J L
Published: January 2020

Background

Patients with severe tricuspid regurgitation (TR) frequently develop heart failure (HF) and their surgical therapeutic options are limited because of very high or prohibitive risk. According to the 2016 ESC guidelines for HF, anaemia and iron deficiency are associated with worse prognosis and intravenous iron therapy should be considered in symptomatic patients with HF reduced ejection fraction (HFrEF) in order to alleviate symptoms, improve exercise capacity and quality of life. The effect of treating iron deficiency in HF preserved ejection fraction (HFpEF) is unknown. The purpose of this study was to analyze the correlation between levels of hemoglobin (Hb) and the prognosis in patients with severe TR and preserve EF.

Methods

Consecutive patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015-2018 were included. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.

Results

A total of 70 patients were included (mean age was 74± 8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean left ventricular ejection fraction was 56,5% ±6,7%. During a median follow up of 18 months [IQR: 4-28], 35% of the patients reached the combined end-point (n = 16 developed right HF, n = 17 underwent tricuspid valve surgery, and n = 3 died). Patients with events showed lower Hb values (p = 0.04). The level of anaemia was a prognostic factor of the combined endpoint (per gr/dl, HR 0.77 [0-61-0.98], p = 0.036).

Conclusion

Hemoglobin is predictive of poor outcomes in patients with significant TR. According to these preliminary results, iron deficiency could be a therapeutic target in this subgroup of patients with limited therapeutic options.
P298 The long-term impact of persistent pulmonary hypertension in patients undergoing TAVR with a self-expanding valve
Authors: Drakopoulou M , Soulaidopoulos S , Oikonomou G , Toskas P , Xanthopoulou M , Stathogiannis K , Toutouzas K , Tousoulis D
Published: January 2020

Background

Persistent severe pulmonary hypertension (PH) is considered to negatively affect early and late outcomes of patients undergoing aortic valve surgery. There is limited data however, cincerning the incidence of persistent PH after transcatheter aortic valve replacement (TAVR) and its impact on outcome is limited.

Purpose

We sought to investigate the impact of persistent PH on clinical outcomes of patients undergoing TAVR with a self-expanding valve.

Methods

Consecutive patients with severe symptomatic aortic stenosis scheduled for TAVR in our tertiary center were included in the study. Prospectively collected data before and after TAVR were retrospectively analyzed in all patients. Severe PH was defined as systolic pulmonary arterial pressure (sPAP) ≥45mmHg as assessed by echocardiography. For analysis purposes, patients with a sPAP decrease after TAVR to below 45mmHg were compared to patients with persistent PH following TAVR. All outcomes were evaluated according to the VARC-2 criteria.

Results

In total, 258 patients were included in this study (mean age 80.06 ± 7.50 years old, logEuroscore 24.50 ± 9.70%, NYHA III/IV Class 98.6%). Of these, 149 (57.8%) had sPAP less than 45mmHg and 109 (42.2%) had sPAP above or equal to 45mmHg at baseline. Patients with severe PH were older (81.1 ± 7.0 vs 79.1 ± 7.7, p = 0.034), presented with higher logEuroscore (26.9 ± 9.3% vs 22.5 ± 9.9%, p< 0.001), lower ejection fraction (47.9 ± 9.3% vs 52.2 ± 8.5%, p< 0.001) and higher rates of at least moderate mitral regurgitation (36.7% vs 16.2%, p = 0.002) compared to the group without PH. After TAVR, 161 (62.4%) patients had sPAP less than 45mmHg and 97 (37.6%) had sPAP above 45mmHg. There was a significant decrease of 2.4 ± 12.2mmHg in sPAP post TAVR (p < 0.01). Multivariable analysis (univariate analysis: age, logEuroscore, pre TAVR mitral regurgitation, pre TAVR ejection fraction below 40%) identified pre TAVR ejection fraction below 40% to be the most powerful predictor for persistent PH after TAVR (odds ratio 2.4, 95% confidence interval 1.0.9 – 5.26, p = 0.028). During a mean follow up period of 26.6 ± 26.8, the presence of pre TAVR severe PH was not found to be predictive of cumulative mortality[Hazard Ratio(HR) : 1.57, 95% Confidence Intervals (CI) 0.92 – 2.66, p = 0.09). However, in the same follow up period, patients with persistent PH after TAVR had higher cumulative risk of death compared to patients with sPAP < 45mmHg after TAVR (Hazard Ratio 0.49, 95% Confidence Intervals 0.29-0.82, p = 0.007) (Figure).

Conclusions

Our data suggest that TAVR is associated with a significant reduction in sPAP. Persistent PH post TAVR seems to be a predictor of higher cumulative mortality post TAVR.

Abstract P298 Figure.
P301 The prognostic value of preoperative left atrial volume after surgical aortic valve replacement in patients with isolated severe aortic stenosis and preserved left ventricular ejection fraction
Authors: Mateescu A D , Calin A , Rosca M , Beladan C C , Enache R , Cadil D , Parasca C A , Botezatu S , Ginghina C , Popescu B A
Published: January 2020

Background

Left atrial (LA) volume is an important cardiovascular prognostic marker. However, data regarding the prognostic value of LA volume in severe AS patients (pts) after surgical aortic valve replacement (AVR) are scarce. Moreover, the predictive role of LA function in AS pts after AVR has not yet been studied. Our study aimed to assess the relationship of LA volume index (LAVi) and function with outcome, in terms of mortality, in severe AS pts who underwent surgical AVR.

Methods

A total of 360 consecutive pts with isolated severe AS (aortic valve area index ≤ 0.6 cm2/m2) referred to our echocardiography laboratory were prospectively screened. Two hundred and seventeen pts with preserved left ventricular (LV) ejection fraction (≥50%) and in sinus rhythm were enrolled. All patients underwent a baseline comprehensive echocardiogram, including speckle tracking analysis of both LV and LA strain. Symptomatic pts (142 pts, 65%) that were subject to AVR were followed for a median period of 4 years (IQR 3-6 years). The endpoint was all-cause mortality after AVR. The last update of the survival status was obtained in January 2019. Outcome data were available in 116 severe AS pts that underwent AVR (mean age 63 ± 10 yrs, 56% men), who formed the final study population.

Results

Seventeen (14%) pts died during follow-up. No significant differences were found between nonsurvivors and survivors after AVR in terms of age and cardiovascular risk factors. Nonsurvivors had higher BNP plasma values (p=.04) at baseline compared with surviving pts. Survivors and nonsurvivors alike exhibited similar preoperative AS severity and LV systolic function parameters (ejection fraction and global longitudinal strain). Moreover, there were no significant differences between the two groups regarding baseline valvuloarterial impedance, average E/e’ ratio, and LA longitudinal deformation parameters. Nonsurvivors had a tendency toward higher LV mass index (p=.08). Nonsurvivors had higher preoperative LA volume index (LAVi)(50 ± 12 vs. 44 ± 10 ml/m2, p=.003). In a multivariable Cox regression analysis adjusted for age, LAVi emerged as the only independent predictor for death in our population study (HR 1.06, 95% CI 1.01-1.11, p=.02). A cut-off value for LAVi derived from ROC curve analysis was used to construct Kaplan-Meier survival curves. A value of 43 ml/m2 for LAVi predicted all-cause mortality after AVR in severe AS pts with 71% sensitivity and 54% specificity.

Conclusions

In our study, preoperative LAVi predicted death in severe AS pts after surgical AVR. LAVi assessment may improve preoperative risk stratiﬁcation in patients with severe AS, however further larger prospective studies are needed.

Abstract P301 Figure.
P312 Early changes of left ventricular myocardial work performance in patients undergoing coronary artery bypass surgery: off-pump vs. on-pump
Authors: Hatam N , Spetsostaki K , Musetti G , Steffen H , Autschbach R , Zayat R
Published: January 2020

Background

Coronary-artery bypass grafting (CABG) without the use of cardio-pulmonary bypass (CPB) was introduced to avoid the potential damaging effects of fpreign surfaces. Nevertheless, the value of off-pump CABG (OPCAB) remains controversial. Regional myocardial work has been shown to reflect regional metabolic demand and provide a more comprehensive assessment of myocardial function. Recently a novel non-invasive method for assessing regional MW by LV pressure–strain loop analysis has been described.

Purpose

To detect changes of MW after CABG comparing off- and on-pump techniques.

Methods

We prospectively evaluated 93 patients undergoing CABG (50 on- vs. 43 off-pump). Patients underwent transthoracic echocardiography exams prior to and one week after surgery as well as concurrently systolic arterial blood pressure measurements at rest. Besides conventional echocardiography parameters, wemeasured global longitudinal strain (GLS), global work index (GWI) and global work efficiency (GWE).

Results

All patients survived surgery. Patients in the OPCAB group had significantly higher EuroSCORE II (3.3% vs. 1.1%, p < 0.001). Preoperatively, OPCABgroup had significantly lower EF (50.1 vs. 55.7%, p = 0.004), lower GWI (1411 vs. 1650mmHg%, p = 0.039) and lower GWE (86.7 vs. 91.6%, p = 0.017). GLS did not differ significantly between off- and on-pump groupspreoperatively. However, postoperatively GLS, MWI, MWE and EF decreased significantly within the on-pump group (p < 0.001, p < 0.001, p < 0.001 and p = 0.002, respectively). In the OPCAB group only GWI and GLSdecreased significantly (p = 0.028 and p = 0.017, respectively). Due to the fact, that mean differences between all pre- and postoperative values were higher in the on-pump group, no significant differences in systolic LV-function (sLVF) could be detected between on- and off-pump patients postoperatively. During the early postoperative phase, no correlation between GWI and GWE and clinical outcomes could be detected, onlylower preoperative-GWI values showed a weak correlation with the incidence of postoperative cardiogenic shock (r= -0.27, p = 0.029).

Conclusion

Despite having worse preoperative sLVF in the off-pump group determined by EF, GLS, GWI and GWE, the decrease in sLVF parameters was significantly higher in the on-pump group, leading to an equal distribution of LV-function parameters between off- and on-pump patients postoperatively. Our results suggest that off-pump CABG provides a better preservation of LV-function.
P314 The functional effects of intramural course of coronary arteries by two-dimensional speckle-tracking dobutamine stress
Authors: Ballo H , Uusitalo V , Luotolahti M , Pietila M , Saarenhovi M W , Hartiala J , Saraste M , Knuuti J , Saraste A
Published: January 2020

Background

Intramural course of a coronary artery is a common anatomic variant, especially in the left anterior descending coronary artery (LAD). However, its effect on the myocardial function during stress remains still unclear.

Purpose

We compared regional myocardial strain measured by speckle tracking during dobutamine stress echocardiography (DSE) in patients with or without intramural course of the LAD.

Methods

Fifty patients (63 ±7 years) were prospectively enrolled and underwent DSE, computed tomography angiography (CTA), quantitative 15-Oxygen water positron emission tomographic perfusion imaging (PET), and invasive angiography. Patients with superficial (>1 mm) or deep (>2 mm) intramural course in the LAD were identified using CTA. Regional longitudinal strain and strain rate (LS, LSr), circumferential strain and strain rate (CS, CSr), as well as radial strain and strain rate (RS, RSr) were measured at rest, at a dobutamine dose of 20 mg/kg/min, at peak stress, and at early recovery (1 min after stress). Obstructive coronary artery disease (CAD) was defined as >75% stenosis or 40% to 75% stenosis combined with either fractional flow reserve < 0.80 or ischemia on PET.

Results

Intramural course of the LAD was detected in 17 patients. Of these, 8 patients had obstructive CAD and were excluded. Thus, 9 patients with intramural course and 11 controls without intramural course or obstructive CAD in the LAD were included. Myocardial strain and strain rate in the myocardial territory distal to intramural segment were similar to those in controls at rest, dobutamine stress and early recovery (Figure). Furthermore, there were no significant differences, at all time points, between the regional strain values of the myocardial segments those distal to the superficial and deep intramural course. In the myocardium distal to an intramural coronary segment, regional myocardial flow measured by PET during adenosine stress correlated with the regional LS (r = 0.80, p = 0.004), LSr (r = 0.66, p = 0.03), and CS (r = 0.69, p = 0.02) and RS (r = 0.53, p = 0.07) at the peak dobutamine stress. However, there was no correlation between flow and strain at rest.

Conclusions

Myocardial strain is not consistently affected in patients with intramural course of the LAD during dobutamine stress as assessed by speckle tracking echocardiography. Larger studies are warranted to evaluate whether certain anatomical variants cause abnormalities in systolic myocardial strain.

Abstract P314 Figure.
P321 Cardiotoxicity related to cancer therapy. is the study of mechanical dispersion an additional value?
Authors: Privitera F , Losi V , Monte I P
Published: January 2020

Myocardial dysfunction are the most concerning cardiovascular complications of cancer therapies with a poor prognosis, so it’s critical to detect subclinical cardiac abnormalities in order to start cardioprotective therapy early or increased surveillance frequency. Global longitudinal strain (GLS) by echocardiography is an excellent tool for assessing regional and global left ventricular (LV) function. Mechanical dispersion (MD) reflects heterogeneous myocardial contraction, evaluated in many cardiopathies.

We evaluated subclinical myocardial dysfunction by GLS and MD using 2D Speckle-tracking Echo, in order to established if MD could be a predictor of ventricular dysfunction in the field of Cardiotoxicity (CTX).

Were enrolled 42 women with breast cancer chemotherapy-treated and underwent to Echo evaluation during 3- and 6-months follow-up, compared to evaluation performed before starting chemotherapy (T0). Depending on chemotherapy type were identified 2 groups: Anthracyclines ± Taxol treated (group 1) and Anti-HER2 treated (group 2). CTX diagnosis was made according ESC criteria: LVEF < 50%, LVEF decrease >10% or GLS decrease >15% compared to previous check.

At three months, 28% patients (p < 0,009) developed CTX and, in this group, MD was significantly increased compared to T0 (64,4ms ± 18,6 vs 43,48ms ± 7.88 p < 0,001). This finding was consistent regardless treatment group: 65,2 ms ± 5,30 (p < 0.0001) in group 1 and 63,14 ms ± 36,40 (p 0.02) in group 2. Also, GLS was significantly changed: in CTX patients decreased of 9% compared to T0 (p 0.02), but this finding was consistent in group 1 in which GLS decreased of 18% (p 0,01), while in group 2 decrease only of 5% and wasn’t statistically significant compared to T0 (p = 0,3). These patients were treated by beta-blockers or ACE-inhibitors. At six months there was a normalization of MD value (47.7 ± 15.97 ms in CTX group) that was not statistically significant compared to T0 (p = 0,2) and we have interpreted as consequence of positive effect induced by cardioprotective therapy.

We believe that MD is a predictor of ventricular dysfunction earlier than GLS during Anti-HER2 treatment, so in this field MD could integrates information obtained from GLS about subclinical dysfunction.