bluuebunny/crossref_metadata_2025 huggingface dataset:
P372 Aortic stiffness in Loeys-Dietz syndrome: a comparison with Marfan syndrome patients and healthy volunteers
Authors: Ruiz Munoz A , Guala A , Rodriguez-Palomares J F , Lopez-Sainz A , Granato C , Valente F , Gutierrez L , Galian L , La Mura L , Gonzalez-Alujas T , Servato L , Sao-Aviles A , Ferreira I , Evangelista A , Teixido-Tura G
Published: January 2020

Funding Acknowledgements

ISCIII PI14/0106 and PI17/00381, La Marató de TV3 (20151330), Eur FP7/People 267128 and CIBERCV

BACKGROUND

Genetic syndromic aortic diseases are rare, with Marfan syndrome (MFS) being the most common. However, less is known of Loeys-Dietz syndrome (LDS) which has much lower prevalence and presumed worse prognosis. Increased aortic stiffness in MFS has been previously described but no studies have evaluated aortic biomechanics in LDS. Pulse wave velocity (PWV) is the gold standard measure for arterial stiffness and can be quantified by 4D flow MRI. We aim to evaluate regional aortic PWV by 4D flow MRI in LDS compared to MFS and healthy volunteers.

METHODS

Sixteen LDS patients with a pathogenic mutation, 76 MFS and 49 healthy volunteers were prospectively and consecutively included. No patient had previous aortic dissection or surgery. All underwent a 4D flow MRI study in a 1.5 T clinical scanner. Ascending (AAo) and descending (DAo) aorta PWV were computed using wavelet analysis of the systolic upslope for transit time calculation (Figure). Statistical comparison was made with non-parametric analysis to account for the non-normality of data and multivariate analysis was evaluated separately for AAo and DAo PWV.

RESULTS

Ascending and descending aortic PWV revealed stiffer aortas in LDS patients than in healthy volunteers, even after adjustment for diameter of sinus of Valsalva (SoV) and sex. Conversely, no differences in aortic stiffness were found between LDS and MFS patients (Table).

CONCLUSIONS

Abnormally high regional aortic stiffness was observed in LDS patients when compared with controls. The severity of increased regional aortic stiffness was found similar to the one affecting MFS patients.

Table Controls (N = 49) LDS (N = 16) MFS (N = 76) LDS vs. HV LDS vs. MFN Parameter Unadjusted p-value Adjusted p-value Unadjusted p-value Adjusted p-value Age [years] 39 ± 12 39 ± 16 36 ± 12 0.903 0.599 Men 32 (65%) 6 (37%) 34 (45%) 0.079 0.782 Weight [kg] 72 ± 11 69 ± 13 74 ± 16 0.288 0.194 Height [cm] 172 ± 8 172 ±12 181 ± 11 0.834 0.008 Systolic BP [mmHg] 126 ± 18 125 ± 14 127 ± 17 0.957 0.523 Diastolic BP [mmHg] 70 ± 11 77 ± 6 75 ± 12 0.011 0.318 SoV diameter [mm] 30.6 ± 3.9 35.4 ± 4.6 38.1 ± 5.9 0.001 0.060 AAo diameter [mm] 27.7 ± 3.8 29,0 ± 5.0 29.7 ± 5.4 0.458 0.579 DAo diameter [mm] 20.0 ± 2.0 21.3 ± 3.6 22.9 ± 3.8 0.546 0.124 AAo PWV [m/s] 5.2 ± 1.9 7.6 ± 2.4 7.3 ± 2.8 0.001 0.050* 0.534 NS DAo PWV [m/s] 7.1 ± 2.2 9.4 ± 2.6 10.7 ± 4.6 0.003 0.025** 0.493 NS

Abstract P372 Figure
P373 Left atrial mechanics and aortic stiffness following high intensity interval training: a randomised controlled study
Authors: Jalaludeen N , Bull S , Taylor K , Wiles J , Coleman D , Mukhtar O , Cheriyan J , Wilkinson I , Sharma R , O"driscoll J
Published: January 2020

Background

Physical inactivity is associated with an increased risk of cardiovascular disease. High intensity interval training (HIIT) has been shown to improve important health parameters, including aerobic capacity, arterial blood pressure, cardiac autonomic modulation and left ventricular mechanics. However, adaptations in left atrial (LA) mechanics and aortic stiffness remain unclear. Therefore, the aim of the present study was to assess any left atrial and aortic adaptations to HIIT.

Methods

Forty-one physically inactive males and females (aged 23 ± 2.7 years) volunteered for the study. Participants were randomised to either a 4-week HIIT intervention (n = 21) or 4-week control period (n = 20). The HIIT protocol consisted of 3 x 30-second maximal cycle ergometer sprints with a resistance of 7.5% body weight, interspersed with 2-minutes of active unloaded recovery. Speckle tracking imaging of the left atrium and M-Mode tracing of the aorta was performed pre and post HIIT and control period using commercially available software (EchoPac; GE Medical Systems). Analysis of covariance, with baseline measures as the covariate, was used to explore any differences in left atrial mechanics and aortic stiffness between the intervention and control groups. Stepwise linear regression analysis using LA stiffness as the dependent variable was conducted.

Results

Following 4-weeks of HIIT, there was significant improvement in LA mechanics, including LA reservoir (13.9 ± 13.4%, p = 0.033) and LA stiffness (-0.05 ± 0.04%-1, p = 0.032) compared to the control condition. In addition, improvements were observed in aortic distensibility (2.1 ± 2.7 cm2 × dyn×-1 × 103, p = 0.031) and aortic stiffness index (-2.6 ± 4.6, p = 0.041) compared to the control condition. In stepwise linear regression analysis, aortic distensibility change was significantly associated with LA stiffness change (p = 0.002), with an R2 of 0.613.

Conclusion

A short-term programme of HIIT was associated with a significant improvement in LA mechanics and aortic stiffness. These adaptations may have important health implications and contribute to the improved left ventricular diastolic and systolic mechanics, aerobic capacity and reduced arterial blood pressure previously documented following HIIT.
P374 Prediction of an adverse cardiovascular response to physical exercise from resting echocardiography imaging in young adults with suboptimal blood pressure
Authors: Alsharqi M , Huckstep O J , Williamson W , Mohamed A , Tan C , Lapidaire W , Telles F , Arnold L , Monteiro C , Dawes H , Foster C , Lewandowski A J , Leeson P
Published: January 2020

Funding Acknowledgements

British Heart Foundation (BHF) grants (PG/13/58/30397)

Background

Young adults with mildly elevated blood pressure are less likely to engage with physical activity. This may be because early hypertension alters myocardial response to moderate exercise, leading to greater perceived exertion and lower levels of enjoyment. As atrial and ventricular function are closely coupled we investigated whether subclinical atrial changes at rest may identify this myocardial response.

Purpose

To identify whether subclinical changes in left atrial function at rest predict response to exercise by performing left atrial deep-phenotyping in a cohort of young adults with a range of blood pressures.

Methods

Seventy-one full-term born young adults (25.25 ± 5.13 years) were enrolled in the Young Adult Cardiovascular Health sTudy (YACHT) to undergo baseline clinical and cardiovascular phenotyping including detailed blood pressure measurement. Cardiopulmonary exercise testing combined with echocardiography imaging was performed to assess the myocardial response to physical exercise at 40%, 60% and 80% of peak exercise load for all participants. Left ventricular ejection fraction and global longitudinal strain were measured from an apical four chamber view at each exercise load, and resting left atrial phasic function was assessed by conventional and speckle tracking echocardiography from apical four and two chamber views (figure 1).

Results

In this young cohort with a range of blood pressure (120.9 ± 12.96/70.85 ± 9.78 mmHg), resting left atrial reservoir and conduit function, but not left atrial structural measures, showed good correlation with left ventricular ejection fraction and global longitudinal strain during 40%, 60% and 80% of peak exercise. The association between resting left atrial conduit with left ventricular deformation at 60% of peak exercise intensity remained significant when adjusted for age, sex and mean arterial pressure (P = 0.007).

Conclusion

Left atrial phasic function at rest predicts left ventricular responses to physical exercise in this cohort of young adults, which may relate to early subclinical left atrial remodelling in early hypertension. These findings require validation in other cohorts and investigation of whether this exercise limitation can be overcome in young hypertensives.

Abstract P374 Figure 1
409 Left atrial pump function assessed by speckle tracking echocardiography adds important value for the diagnosis of heart failure with preserved ejection fraction
Authors: Rimbas R C , Mihalcea D J , Luchian L M , Mihaila Baldea S , Magda L S , Visoiu S I , Andronic A A , Velcea A , Lungeanu Juravle L , Balinisteanu A , Nicula A , Vinereanu D
Published: January 2020

Funding Acknowledgements

“This work was supported by a grant of Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1-TE-2016-0669, within PNCDI III”

Background

Differentiation between heart failure with preserved ejection fraction (HFpEF) and isolated diastolic dysfunction (DD) at rest is crucial, since the prognosis is different. Symptoms are often non-specific, while NTproBNP might not be available. Increased NTproBNP is predicted by none of the currently used transthoracic echocardiographic (TTE) parameters. However, assessment of left atrial (LA) function by speckle tracking echocardiography (STE) might be a potential new marker of increased LV filling pressure.

Aim. To assess LA function by STE in HFpEF and DD, on top of the currently used TTE parameters, in order to establish the added value of LA deformation in the diagnosis of HFpEF.

Methods

70 patients were enrolled prospectively: 40 with HFpEF (68 ± 9 yrs) and 30 with DD (60 ± 10 yrs). TTE was used to assess LV ejection fraction (LVEF), E/E’ ratio, left atrial volume index (LAVi), and systolic pulmonary arterial pressure (sPAP). STE was used to assess LA functions: reservoir function by strain from MVC to MVO (LASr) and positive strain rate (LASRr), conduit function by strain from MVO to onset of atrial contraction (LAScd) and early negative strain rate during conduit phase (LASRcd), and LA pump function by negative strain at MVC (LASct) and late negative strain rate during atrial contraction phase (LASRct). NTproBNP was measured in all patients.

Results

HFpEF patients had significantly higher LVEF, NTproBNP, E/E’ ratio, and sPAP, but similar LAVi compared to DD, suggesting higher LV filling pressure (Table). LA reservoir and conduit function were similar. However, LA pump function was significantly lower in HFpEF, expressed by LASRct (Tabel). NTproBNP correlated with E/E’ ratio, sPAP, and LASRct (all r = 0.44, p < 0.001), but not with LAVi. By multiple regression analysis, best predictor for NTproBNP > 125pg/ml was LASRct (r = 0.60, r2 =0.30, p < 0.001). LASRct < -1.29 (AUC = 0.82, sensitivity 75%, specificity 81%) was the only predictor of NTproBNP > 125pg/ml (Figure).

Conclusion

LA pump function is the only predictor of NTproBNP > 125pg/ml. This parameter should be incorporated in the current protocols for the diagnosis of HFpEF.

Group (N) NTproBNP ng/ml LVEF (%) E/E’ sPAP (mmHg) LAVi (ml/m2) LASr (%) LASRr LAScd (%) LASRcd LASRct HFpEF (40) 329 ± 383 62 ± 6 10.4 ± 2.7 34 ± 11 40 ± 9 25 ± 4 1.28 ± 0.3 11.6 ± 5.5 -1.37 ± 0.5 -1.07 ± 0.6 DD (30) 37 ± 26 57 ± 8 7.5 ± 1.8 23 ± 7 39 ± 11 26 ± 6 1.26 ± 0.3 11.2 ± 3.6 -1.5 ± 0.6 -1.76 ± 0.7 P value 0.001 0.008 <0.001 <0.001 0.7 0.4 0.8 0.7 0.4 <0.001

Abstract 409 Figure.
416 LV only fusion pacing CRT without RV lead induces size and shape LA reverse remodelling
Authors: Vacarescu C , Petrescu L , Luca C T , Mornos C , Gurgu A , Goanta E V , Crisan S , Lazar M A , Cozlac R A , Cozma D
Published: January 2020

Background

Adaptive CRT pacing induces significant left atrium (LA) reverse remodelling comparing to biventricular (BiV) pacing, although the algorithm delivers compulsory BiV pacing in heart rate over 100/min! Purpose: to assess LA remodelling in LV only pacing without RV lead in a real-life situation of permanent CRT fusion pacing.

Methods

Prospective data were analysed from a cohort of patients with CRT-P indication implanted with right atrium/left ventricle (RA/LV) DDD pacing system. Complete follow-up at every 6 months included device interrogation, exercise test, transthoracic echocardiography (TE) and individualised drug optimisation. LA evaluation included: parasternal dimension (LAd), 4 chambers view: mid-LA transverse diameter (LAt), basal LA maximal transverse diameter (LAb); volume (LA vol) and shape assessment: trapezoidal LA shape was defined by LAt less than Lab, the reverse situation was considered ellipsoidal shape.

Results

55 pts (30 males) with idiopathic DCM aged 62 ± 11 y.o. were included. Baseline characteristic: QRS 164 ± 18 ms; EF 27 ± 5.2%; mitral regurgitation was severe in 22 pts, moderate in 27 pts and mild in 6 pts; 15 pts had type III diastolic dysfunction, 37 pts with type II diastolic dysfunction, 3 pts with type I diastolic dysfunction. Average follow-up was 42 ± 18 months: all patients were responders, EF increased at 37 ± 7.9%; mitral regurgitation decreased in 38 pts (69%), diastolic profile improved in 36 pts (65%). Trapezoidal LA shape was documented in 31 (56%) patients. Atrial fibrillation was noted in 4 pts (7%) and cardioversion was needed. Non-sudden cardiac death occurred in 5 patients (9%), all deaths were noted in pts with severe LA vol, trapezoidal shape and type III diastolic dysfunction. Statistically significative LA reverse remodelling was noted regarding LA volume, but not shape.

Conclusions

RA/LV fusion CRT pacing was associated with important LA reverse remodelling and a low incidence of AF. Larger randomised studies are needed to validate these results and assess the role of LA shape remodelling in CRT.

before RA/LV CRT-P Follow-up 42 ± 18 months p LV EF, %, mean ± SD 27 ± 5.2 37 ± 7.9 <0.0001 LA diameter (mm), mean ± SD 50 ± 4.9 44 ± 2.8 <0.0001 LA area (cm2), mean ± SD 24 ± 5.6 22 ± 0.7 0.0138 LA volume (ml), mean ± SD 104.9 ± 34 80 ± 28.2 0.0001

Abstract 416 Figure.
422 Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve
Authors: Ozturk C , Frederich M , Werner N , Nickenig G , Hammerstingl C , Schueler R
Published: January 2020

The MitraClip procedure is established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, we aimed to evaluate five-year outcomes after MitraClip.

265 patients (Age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60,5% secondary MR: sMR) undergoing MitraClip were included. Despite procedural success of 91.3%, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04).

Five years after MitraClip, the majority of patients presented with reduced symptoms, sustained MR reduction (≤ grade 2) and improved functional capacity (Functional NYHA class: p = 0.0001; six minutes walking test: p = 0.04) and right ventricular (RV) function.

Systolic pulmonary artery pressure (sPAP) was significantly reduced during FU only in sMR patients, (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, five-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality.

MitraClip showed low complication rates and sustained MR reduction with improved RV function and sPAP five years after the procedure, which was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher five-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and five-year mortality.
425 Alterations in left atrial structure and function in chronic heart failure patients with functional mitral regurgitation after MitraClip
Authors: Ozturk C , Fasell T , Sinning J M , Werner N , Nickenig G , Hammerstingl C , Schueler R
Published: January 2020

Backround

The MitraClip procedure has been increasingly performed as an established treatment alternative for symptomatic patients with moderate to severe mitral regurgitation (MR) at prohibitive surgical risk. Left ventricular (LV) reverse remodelling following MitraClip has been shown in different studies. Left atrial (LA) volumes are believed to decrease following interventional reduction of MR. However, effects of MitraClip on LA function are not well understood.

Objectives

In this study we aimed to evaluate the effect of MitraClip on LA structure, volumes and function in chronic heart failure patients with functional MR.

Methods

All patients underwent 3D transthoracic echocardiography prior to the MitraClip procedure and at follow-up (FU) with offline evaluation of LA function and geometry using dedicated software (TomTec Image Arena, 4D LV-Analysis, Munich, Germany). FU examinations were performed 10 ± 3.4 months after the procedure.

Results

We prospectively included 75 consecutive surgical high risk (Logistic EuroScore: 17.2 ± 13.9%) patients (Age: 77 ± 9years, 22% female) with symptomatic moderate to severe MR without atrial fibrillation. All patients underwent MitraClip following heart team decision without periinterventional major complications.

Baseline echocardiography showed impaired left ventricular function (Ejection fraction (EF): 32,6 ± 11.2%), moderate to severe MR , increased systolic right ventricle pressure (RVSP: 46.1 ± 10.5 mmHg) and elevation in estimated left ventricle enddiastolic pressure (E/E´ ratio: 15.6 ± 7.3) in the patient cohort.

There was no relevant mitral stenosis after the procedure (MPG: 3.3 ± 0.5 mmHg), however the MPG increased significantly after the procedure (p = 0.05). The E/E´ ratio significantly increased at FU (15.6 ± 7.3, 24.1 ± 13.2, p = 0.05) as well. The left atrial (LA) volumes and LA-muscular mass (End-diastolic volume [LA-EDV] and end-systolic volume [LA-ESV]) significantly increased at FU (LA-EDV: 83.1 ± 39.5ml, 115.1 ± 55.3ml, p = 0.012; LA-ESV: 58.4 ± 33.4ml, 80.1 ± 43.9ml, p = 0.031; 105.1 ± 49.3gr, 145.4 ± 70.6gr, p = 0.013). LA stroke volume significantly increased after the procedure (24.6 ± 12.5ml, 34.9 ± 19.1ml, p = 0.016). LA-EF and atrial global longitudinal strain (LA-GLS) showed no significant changes at FU (LA-EF: 31.7 ± 12.8%, 31.1 ± 12.3%, p= 0.8; LA-GLS: -10.8 ± 5.4%, -9.7 ± 4.45%, p = 0.4).

Despite no relevant changes during FU, baseline E/E´ ratio (AUC: 0.652) and baseline aGLS (AUC: 0.694) were found to be independent predictors for mortality.

Conclusion

Transcatheter MV repair (TMVR) with the MitraClip procedure improves atrial stroke volume, increases atrial volumes and muscular mass acutely after the procedure. It might be explained by the acutely increased MPG and LVEDP after the MitraClip procedure. Baseline aGLS and E/E´ ratio were found to be independent predictors for mortality.
435 Left ventricular reverse remodeling and angiotensin ii receptor blocker neprilysin inhibitor - a real-world data
Authors: Martinho A , Almeida J , Freitas A , Ferreira C , Franco F , Costa S , Baptista R , Pinho A , Robalo M , Goncalves L
Published: January 2020

BACKGROUND

Although sacubitril/valsartan (ARNI) improves the NYHA functional class and prognosis in patients with heart failure with reduced ejection fraction (HFrEF), its impact on reverse remodelling is uncertain. We assessed left ventricular reverse remodeling in a cohort of HFrEF patients treated with ARNI.

METHODS

We conducted a single-centre, retrospective, observational study of 200 HFrEF patients started on ARNI during 2018. Of these, we analysed 100 patients treated with the maximum, target dose (97/103 mg bid). Baseline clinical, laboratory and demographic characteristics were evaluated and a clinical and echocardiographic follow-up, including left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and mitral valve regurgitation (MR), were conducted from ARNI initiation to a 3-month landmark.

RESULTS

Mean age was 59 ± 13 years and 85% were male. At baseline, 63% were on NYHA II, 34% in NYHA III and 3% in NYHA IV functional class. Mean systolic blood pressure was 125 ± 16 mmHg, median NT-proBNP was 773 pg/dL (IQR 386-1569) and mean LVEF 27 ± 7%. Median time between initiation of the drug and reaching the target dose was 10 weeks. Functional class significantly improved; at baseline, 37% of patients were in NYHA III-IV; 3 months after target dose, only 6% remained in NYHA III-IV (p = 0.005). Half of patients (48.6%) improved LVEF (from 27 ± 7% to 31 ± 10%, mean increase 4.2 ± 8.8%; 95%CI 2.1 to 6.3, p < 0.001) and in one quarter (24.6%) LVEF improved over 35% (p < 0.001). In a echocardiographic subgroup analysis, including a random sample of 35 patients, we found a significant improvement in GLS 1.5 ± 2.9 (95%CI 0.4 to 2.6%, p = 0.009), a significant decrease in LVESV and LVEDV 29 ± 3 mL (95%CI -42.6mL to -15.4mL, p < 0.001) and 31 ± 47ml (95% CI -48 to -15, p < 0.001), respectively, and a significant improvement in MR severity (p = 0.001).

CONCLUSIONS

We observed that in an HFrEF patient population treated with ARNI there was a significant clinical improvement, who may be explained by a robust impact on reverse remodelling, even on a short-time of follow-up. An interesting finding was that 24.6% improved LVEF above the 35% cut-off, and therefore lost an indication for a prophylactic implantable cardioverter defibrillator.
436 Prognostic value of calcium scoring in changes of echogenicity in carotid plaques
Authors: Perea Gabriel G P , Corneli M , Daquarti G , Meretta A , Rosa D , Masoli O
Published: January 2020

Background

Atherosclerosis is a dynamic process, in which the characteristics of the plaques evaluated by imaging methods could represent the degree of inflamatory activity of the disease.

Purpose

Assess the value of the coronary calcium score in the changes of echogenicity of carotid plaques in a population with low-intermediate cardiovascular risk.

Methods

Patients with no cardiovascular history and low and intermediate Framingham risk score were evaluated. Patients attended at our institute for a preventive cardiovascular control between January 2012 and April 2013, and then a subsequent follow-up was made until January 2019.

They were screened for coronary calcium scoring (CCS) and carotid plaque by ultrasound at first visit. Then the changes of carotid atherosclerotic disease were evaluated through new carotid ultrasound exam at follow up.

A carotid artery plaque was defined as a localized protrusion of the vessel wall, which 1) extended into the lumen ≥ 1.5 mm, or 2) had a thickness exceeding the intima-media thickness (IMT) of the adjacent portion of the vessel wall by >50%. Plaque morphology was defined in terms of its echogenicity.

Results

121 patients that have carotid atherosclerotic disease at first carotid ultrasound exam were included. The mean age was 61 ± 9 years, 72 (59%) male patients. Cardiovascular risk factors: hypertension: 68 (56%), dyslipidemia: 46 (38%), sedentary lifestyle: 24 (20%), overweight: 17 (14%), smoking: 29 (24%) and diabetes: 15 (12%).

Median distribution of CCS was 192 (percentile distribution 25-75%: 8 – 224) Agatston units. Medium follow-up: 5 ± 1 year. At first ultrasonography study, 47 patients (39%) presented hypoechoic plaques, 61 patients (50%) isoechoic plaques and hyperechoic plaques in 13 patients (11%).

After the follow-up, the distribution of the plates according to their sonographic characteristics was: hypoechoic plaques in 23 patients (19%), isoechoic plaques in 55 patients (45%) and hyperechoic plaques in 42 patients (36%).

The incidence of the progression of sonographic changes of the carotid plaques varies according to CCS: 0-100:29%, 101-400: 54%, >401:53% (p < 0,001) Figure 1.

The value of CCS was associated with the progression of carotid atherosclerotic plaque regardless of the use of statins and angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers (Cox model p <0.001).

Conclusions

This study shows that there is an association between coronary calcium score and progression of carotid disease. Even in populations with low and intermediate cardiovascular risk, the higher the severity of the calcium score, the greater changes in the structure of the carotid plaque manifested in our work as changes in the echogenicity; regardless of the use of statins. These findings could be useful to assess the progression of atherosclerotic disease at a median follow up.

Abstract 436 Figure. folow up
474 Isolated pulmonary endocarditis
Authors: Fernandez Valledor A , Cepas Guillen P , Izquierdo M , Vidal P , Pereda D , Prat S , Vidal B ,   Infective Endocarditis Team
Published: January 2020

INTRODUCTION

Isolated pulmonary endocarditis is a rare entity, especially in patients without predisposing factors, being its current incidence less than 1% of the total cases of infectious endocarditis. This is due to the lower right heart pressures and a decrease of intravenous drug-consum, being most of the cases nowadays, related to congenital right-heart diseases or pacemakers and defibrillators implants.

CLINICAL CASE

A 35 year-old man, tobacco smoker and intravenous cocaine consumer since he was 25, was admitted to our Emergency Department for fever up to 40ºC, cough and dyspnea started three days before admission. In the anamnesis he refereed intravenous consum of cocaine and sharing of syringes the last week. On physical examination he was tachycardic and signs of heart right failure were present such as jugular ingurgitation and peripheral edema. No murmurs were heard. No respiratory failure was detected at any time. Blood test analysis showed high levels of protein C reactive and leukocytosis. Blood cultures were positive for S. aureus (OXA-S) in the first 24h. Chest X-ray (image 1) showed a necrotizing bilateral pneumonia that was confirmed with the presence of cavitated images in the pulmonary CT (image 2). Antibiotic treatment was started with daptomicine + cloxaciline. With the suspicion of right endocarditis a transthoracic echocardiography was performed, showing the presence of a big vegetation (4x1cm) on the pulmonary valve that caused moderate pulmonary insufficiency (images 3, 4). Neither tricuspid nor left side valves were involved. Biventricular function was conserved and hyperdynamic. Endocarditis diagnosis was definitive and due to the presence of multiple right embolisms and the big size of the vegetation, the patient underwent cardiac surgery. Intra-surgical finding demonstrated a big vegetation of almost 5 cm (image 5) depending of the posterior pulmonary valve that was removed; the posterior valve needed to be repaired. Posterior clinical evolution was correct without complications, completing 17 days of i.v. antibiotics (cloxaciline) before discharge.

CONCLUSIONS

Right endocarditis is a rapidly progressive disease due to the fact that staphylococcus are the most frequent microorganisms involved. Valvular destruction and secondary embolic phenomena are the rule. Tricuspid valve is involved most of the times being the isolated pulmonary valve affection very uncommon.

Abstract 474 Figure. CT, Echo and surgical images
478 A rare case of right ventricular ischaemia and ventricular tachycardia in neonate caused by intermittent occlusion of origin of the right coronary artery by an echogenic mass
Authors: Padmanabhan S
Published: January 2020

OnBehalf

Cornwall

A term neonate with poor condition at birth was noted to be markedly bradycardic when crying. ECG showed first degree heart block. Echocardiogram demonstrated poor bi-ventricular function. He was treated for Hypoxic ischemic encephalopathy (HIE).

In the next few hours he developed short episodes of ventricular tachycardia with left bundle branch block and non-conducted P waves suggesting an origin of tachycardia from the right ventricle.

His repeat ECHO suggested that he had right ventricular infarction due to a very rare finding of intermittent occlusion of the origin of the right coronary artery by an echogenic mass.

He was transferred for emergency cardiac surgery to remove a clot of 1.6cm, occluding the right coronary artery. Histology findings were in keeping with a thrombus. Thrombophilia screen for both parents and infant were negative. MRI Brain did not show evidence of HIE suggesting his poor condition at birth was secondary to intermittent coronary ischemia. Discussion: Myocardial infarction (MI) in neonates is a rarely encountered and potentially life-threatening condition, with mortality rate as high as 90%. We present one of the first reported cases of successful surgical management of an acute right coronary artery thrombosis after an early diagnosis. The cause of thrombosis remains unclear in our patient. They were born in poor condition with initial pH 6.9 and lactate of 10, but with a structurally normal heart and negative thrombophilia screen. Perinatal asphyxia is a potential cause; however there is doubt that this may be a symptom rather than cause of the right coronary artery occlusion. Early diagnosis was key in management after a high level of clinical suspicion. He made significant recovery with near normal RV function, and is currently on captopril and carvedilol post-surgery. This is one of the first cases to document near full return of cardiac function following ischaemia to the right ventricle

Abstract 478 Figure. 5
479 When 2 rights make a wrong
Authors: Tong J , Joseph Francis P , Lee E
Published: January 2020

Background

The presence of an intra-cardiac mass is always a cause for concern, with regards to not only aetiology, but also treatment of complications. We describe a case series of 2 right sided cardiac myxomas, where the first case described an unusual location for tumour occurrence, while the second case provided insights into complications of a cardiac myxoma.

Methods

The first case involved a 70 year old asymptomatic lady who was referred for an additional heart sound. A transthoracic echocardiogram (TTE) showed a large, mobile 1.5 X 1.2 cm mass, attached to the atrial surface of septal tricuspid valve leaflet, prolapsing in and out of the right sided chambers. This was confirmed on transoesophageal echocardiogram (TEE). Cardiac MRI (magnetic resonance imaging) showed a similar mass attached to the septal tricuspid leaflet with features consistent with a myxoma. She was referred to cardiothoracic surgery, and 2 lobulated tumours arising the septal tricuspid valve and adjacent posterior leaflet were seen. The tumours were resected and a bio-prosthetic tricuspid valve replacement implanted. Histology of the tumours showed myxomatous degeneration of tricuspid valve, consistent with cardiac myxoma.

The second case was a 56 year old lady who had dyspnoea, pedal oedema and an elevated jugular venous pulse on examination. A TTE done showed a large 7 X 4 cm mass extending from the right atrium (RA) into the right ventricle (RV). The left ventricular ejection fraction was 35%. Cardiac MRI confirmed the presence of a large mass in the right ventricle that exerted pressure effects on the ventricular septum and RV anterior free wall. Intra-operatively, a large RA mass attached by a stalk to the fossa ovalis was seen. The mass was excised and histology was consistent with cardiac myxoma. A repeat transthoracic echocardiogram done 2 weeks later showed normalisation of the LVEF.

See images below for more information.

Conclusion

While myxomas are the most common benign cardiac tumours, they occur less commonly in the right atrium, and much less so on the tricuspid valve. Clinical manifestations range from being completely asymptomatic, as in the 1st case, to non-specific constitutional symptoms such as fever or general malaise, and to life-threatening complications. These include embolism to the pulmonary circulation, causing sudden death, or to the systemic circulation through an intra-cardiac shunt, causing strokes. This risk is increased if the tumour is large, polypoidal and friable. Large tumours can also cause obstructive symptoms and heart failure. Thus timely diagnosis with multi-modality imaging tools, and definitive treatment with complete resection of the tumour are essential. Continued monitoring for recurrences of the tumour, which can occur in 1-5% of all cases, should be performed as well.

Abstract 479 Figure. Right sided cardiac masses
503 Unlocking the mystery of haemolytic anaemia after mitral valve repair
Authors: Sotananusak T , Yingchoncharoen T , Chaiyaroj S , Limpijankit T
Published: January 2020

Hemolytic anemia is an uncommon complication after mitral valve repair. All possible causes should be excluded before making a diagnosis. Echocardiography is an important tool. Transthoracic echocardiography may underestimate the severity and direction of regurgitation jets. Transesophageal echocardiography is the helpful imaging modality helping identify an accurate mechanism.

A 55-year-old female with a history of mitral valve repair 5 years earlier presented with shortness of breath for 2 months. She noticed that she had intermittent jaundice and dark urine for 5 months but these symptoms were worsening and persistent for 2 months. She had no fever and abdominal pain. She did not take any medication. The physical examination revealed mark pale conjunctiva and icteric sclera. The apex of heart was palpated at 6th intercostal space lateral to the midclavicular line. The pan-systolic murmur was audible along the mitral valve area. The lung was clear and no pedal edema. Her complete blood count showed hematocrit of 13% with fragmented red blood cell and polychromasia in a blood smear. The level of aspartate transaminase, direct bilirubin, and lactate dehydrogenase was elevated with low haptoglobin level. A chest X-ray showed cardiomegaly without pulmonary edema. The diagnosis of autoimmune hemolytic anemia was made but her symptom was not improved after corticosteroid treatment. Transthoracic echocardiography cannot explain the cause of hemolytic anemia, so the transesophageal echocardiography was performed. The echocardiography revealed severe mitral regurgitation and paravalvular leak. The turbulent flow was seen across the mitral annuloplasty ring. She underwent mitral valve replacement to treat her symptoms. After an operation, her symptoms were significantly improved without any jaundice. The hemolytic anemia was resolved.

This case demonstrated an important role of transesophageal echocardiography, especially in post heart valve surgery patient. Although hemolytic anemia after mitral valve surgery is rare, it should be considered in every hemolytic anemia patient without other explainable causes. An accurate diagnosis is a crucial role in treatment.

Abstract 503 Figure.
542 Non-invasive risk assessment of the left atrial appendage thrombosis using deep learning methods
Authors: Suvorov A , Melik - Ogandzhanyan G , Dmitrieva E , Voskresenskaya N , Kruglov A
Published: January 2020

INTRODUCTION

patients undergoing planned cardioversion have high risk of left atrial appendage (LAA) trombosis. Transesophageal echocardiography (TEE) is usually performed to rule out LAA thrombosis.

PURPOSE

building a model for predicting the risk of thrombosis of LAA prior to TEE in patients with atrial fibrillation (AF) planned to cardioversion based anamnesis, clinic and transthoracic echocardiography (echo) using deep learning algorithms.

METHODS

From 12.2018, 100 patients with AF included in the hospital registry or planned cardioversion. All patients underwent echo and TEE . Other clinical data was collected from medical records, echo and TEE results. Deep learning neural network was constructed in R v. 3.5.3 for risk assessment of the LAA trombosis prior to TEE. The model was trained / verified for 70% / 30% included patients.

RESULTS

Among included, 47.0% were women, mean age was 67.8 ± 11.9 years. LAA thrombosis rate was 37.0%. The paroxysmal form of AF diagnosed in 22.0%, the rest had persistent form. Arterial hypertension was observed in 77.0%, diabetes mellitus - in 14.0%. Previous stroke was diagnosed in 5.0% of patients, previous myocardial infarction — in 3.0%, heart failure - in 51.0% of patients. Median of CHA2DS2VASc score was 3 (2; 4) points. The mean indexed volume of left atrium was 50.1 ± 13.7 ml/m2, for LAA - 4.0 ± 1.8 ml/m2. Mean ejection velocity in the LAA is 3.5 ± 1.3 cm/s. Before admission 24.0% of patients did not receive any anticoagulant therapy. The group was divided into «training» and «test» parts in the proportion of 70%/30%. Both groups were statistically comparable by cardiovascular deseases, risk factors, demography, age and treatment before admission. Neural network was trained on the following factors of the «training» group: gender, previous infarction, heart failure, score for CHA2DS2VASc, creatinine level, left atrial indexed volume and linear dimensions, transmitral E and mitral annulus e`, peak and mean pressures and square of mitral regurgitation, pulmonary veins systolic and diastolic flows, anamnestic anticoagulation and duration of its intake. 10-fold cross-validation was performed. Verification (comparison of the real results with the predicted by model) was made for the «test» group: the Cohen’s kappa was 0.68, 95%CI for positive predictive value was 65.3 - 98.6%, for negative predictive value - 35.9 - 99.6%, for model accuracy 67.6 - 97.3% , ROC analysis showed 91.7% for area under curve (95%CI 79.3 - 99.9%).

CONCLUSION

deep learning neural net for assessing the risk of thrombosis of LAA using only anamnestic and echo data can be used for experimentally prediction for pretest probability of thrombosis prior to TEE. Further verification of the model with more data is required.
544 Deep learning in segmentation and function evaluation of right ventricle in 2D echocardiography
Authors: Karuzas A , Sablauskas K , Verikas D , Teleisyte E , Skrodenis L , Matuliauskas D , Balciunas J , Mileris J , Rumbinaite E , Zaliaduonyte-Peksiene D , Vaskelyte J J , Jurkevicius R , Plisiene J
Published: January 2020

INTRODUCTION

Deep learning (DL) has been of increasing use in the field of echocardiographic cardiology. The importance of segmentation and recognition of different heart chambers was already presented in different studies. However, there are no studies made regarding the functional heart measurements. Even though, functional measurements of right ventricle (RV) remains "dark side of the moon", no doubtfully severity of RV dysfunction influences the worse outcomes.

PURPOSE

To evaluate DL for recognition of geometrical features of RV and measurement of RV fractional area change (FAC).

METHODS

A total of 896 end-systolic and end-diastolic frames from 129 patients (with various indications for the study) were used to train and validate the neural networks. Raw pixel data was extracted from EPIQ 7G (Philips) imaging platform. All of the images were from 2D echocardiography apical four chamber views. RV was annotated in each image, with 1716 images used for training and 180 for validation.

We used the state of art mask regional convolutional neural network (MR-CNN) and attention U-net convolutional neural network models for the RV segmentation task. Intersection over Union (IoU) was used as the primary metric for model evaluation. IoU measures the number of pixels common between the target and the prediction masks divided by the total number of pixels present across both masks. Additionally FAC was calculated using frames with minimal and maximal segmented area by the network.

RESULTS

U-Net architecture demonstrated considerably faster training compared to MR-CNN with time per training step of 85 ms and 750 ms for U-Net and MR-CNN, respectively (p < 0.001). MR-CNN and U-Net had an IoU of 0.91 and 0.89 respectively on validation dataset which corresponds to good performance of the model and there was no significant difference between the different neural networks (p = 0.876). Comparing the evaluation of FAC by physician and U-Net the mean squared difference was 12% when using minimum and maximum right ventricle area detected by the network.

CONCLUSION

With small dataset deep learning give us ability to recognize RV and measure RV FAC in apical four chamber view with high accuracy. This method offers assessment of RV to become daily used in the cardiologist practice, moreover, in the near future automated measurements will allow to reduce the need of observer manual evaluation. Improvements can be made in FAC calculation by also improving techniques for end-systolic and end-diastolic frame detection.
558 Prevalence of diastolic dysfunction according to EACVI/ASE guidelines from 2009 and 2016 in a 63-65 years old general population cohort-Data from the ACE 1950 study
Authors: Sveen K A , Aagaard E , Berge T , Enger S , Orstad Bjoerkan E , Roesjoe H , Omland T , Tveit A , Steine K
Published: January 2020

Funding Acknowledgements

Akershus University Hospital and Vestre Viken Hospital Trust

OnBehalf

ACE 1950

Background

Large surveys have previously reported a prevalence of left ventricular diastolic dysfunction (DD) between 20- and 30 % in individuals above 60 years of age. The new DD guidelines from 2016, however, have emphasized the presence of increased left ventricular filling pressure, and may result in a stricter definition of DD.

Purpose

The aim of the present study was to compare the prevalence of DD using 2009 and 2016 EACVI/ASE criteria and to identify clinical correlates of DD.

Methods

The present cross-sectional substudy consisted of 3706 indivuduals born in 1950 included in the Akershus Cardiac Examination (ACE1950) 1950 study. Comprehensive baseline cardiovascular examination was performed, including ultrasound imaging utilizing echocardiographic indices for diagnosing DD according to both the 2009 and 2016 criteria.

Results

Complete echocardiographic data were available in 3464 (93.5%) individuals. Mean age was 63.9 ± 0.7 years, and 49% were women. 11% had diabetes mellitus and 23% were obese (BMI >30). In the total cohort, 19.8% (685/3464) fulfilled the 2009 criteria for diastolic dysfunction. Of these, 7.9% (n = 273) had grade 1; 8.7% (n = 303) grade 2 and 3.1% (n = 109) grade 3 diastolic dysfunction. Only 2.0% (71/3464) of the total cohort were classified with DD according to the 2016 criteria. In individuals with known diabetes the prevalence of DD was 22% and in obese this number was 28.9% using the 2009 criteria.

Conclusions

Diastolic dysfunction is present in 1 in 5 of 63-65 years old norwegians, and higher in the obese and those with diabetes, according to the 2009 criteria. However, the prevalence was dramatically lower by applying the 2016 criteria. LV filling pressure can be looked upon as dynamic and be normalized by unloading, and therefore possibly mask DD in some individuals.
561 Targeting septal work and viability identifies responders to cardiac resynchronization therapy
Authors: Aalen J , Donal E , Larsen C K , Duchenne J , Cvijic M , Leclercq C , Bogaert J , Hopp E , Fjeld J G , Penicka M , Linde C , Kongsgaard E , Galli E , Voigt J U , Smiseth O A
Published: January 2020

Funding Acknowledgements

The study was supported by Center for Cardiological Innovation.

Introduction

Septal dysfunction is the dominant mechanism of left ventricular (LV) failure in left bundle branch block (LBBB). We hypothesize that, provided septum is viable, septal function can recover and hence LV function improve after cardiac resynchronization therapy (CRT).

Purpose

To determine if combined assessment of septal function and viability identifies responders to CRT.

Methods

In a prospective multicenter study of 200 unselected patients referred for CRT, we measured myocardial strain by speckle-tracking echocardiography and regional work by pressure-strain analysis before and 7 ± 1 months after CRT. Viability was assessed by late gadolinium enhancement cardiac magnetic resonance imaging (n = 123). CRT response was defined as ≥15% reduction in LV end-systolic volume.

Results

Before CRT, septal work was 258 ± 463 and LV lateral wall work 1469 ± 674 mmHg·% (p < 0.0001). In CRT responders, septal work was restored to 1243 ± 495 mmHg·%, whereas non-responders showed less marked improvement (p < 0.0001). The figure illustrates a typical CRT responder with negative septal work and a large difference between work in the LV lateral wall and septum (panel A). There was no septal scar (panel B) and, after 6 months with CRT, septal work was recovered (panel C). Pressure-strain loops illustrate that CRT converted inefficient septal contractions with substantial negative (wasted) work to positive work throughout systole. For the entire study population, the difference between work in the LV lateral wall and septum predicted CRT response with area under the curve (AUC) 0.75 (95% CI: 0.68-0.83) and was feasible in 98% of patients. Furthermore, septal scar predicted non-response to CRT with AUC 0.76 (95% CI: 0.65-0.86). Combining work difference and septal viability improved AUC for CRT response to 0.85 (95% CI: 0.76-0.94) (figure panel D). The AUC was similar for QRS 120-150 and >150 ms.

Conclusions

The proposed combined approach with assessment of septal work and viability identified CRT responders with high precision.

Abstract 561 Figure.
570 Myocardial deformation imaging after STEMI: can we better predict one-year mortality and heart failure development?
Authors: Trifunovic D , Krljanac G , Asanin M , Savic-Spasic L , Aleksandric S , Dudic J , Cucic L , Sulovic V , Mrdovic I
Published: January 2020

Prognosis after STEMI is still challenging. One-year mortality ranges between 10-12% and the incidence of heart failure (HF) is between 4% and 28%. Early and accurate identification of high-risk patients necessitates therapy intensification.

Aim

this study is a part of PREDICT-VT study (NCT03263949). The aim was to test whether deformation imaging based on spackle tracking echocardiography predict MACE (total mortality, HF hospitalization and NYHA class ≥3 development) better than conventional echocardiography and clinical parameters.

Methods

in 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec). LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strain were calculated as average of PSS over 18 LV segments.

Results

198 patients completed 1-year follow-up and 22 patients (11.1%) experienced MACE. Significant echo, clinical and laboratory predictors with the ROC analysis are listed in the table according to AUC .

Conclusion

peak systolic longitudinal and to a lesser degree peak systolic circumferential deformation predict mortality and HF development after pPCI better than conventional echo and even clinical parameters. From diastolic parameters only radial SR during atrial contraction was better MACE predictor compared to conventional echocardiography.

AUC p Cut-off Senz Spec Peak systolic LS epicardial layer 0.757 <0.001 -11 75 63 Radial SR during atrial contraction 0.754 <0.001 -0.63 65 80 Peak systolic LS mid-wall layer 0.750 <0.001 -12.58 80 60 PSS LS endocardial layer 0.744 <0.001 0.1409 70 61 Peak systolic CS endocardial layer 0.744 <0.001 -18.08 70 67 Wall Motion Score Index 0.740 0.001 1.53 70 70 Peak systolic CS mid-wall layer 0.730 0.001 -13.66 80 60 Peak radial LV strain 0.722 0.001 14.08 80 60 Creatine kinase peak level 0.698 0.003 2155 64 73 LV EF 0.692 0.004 47.5 67 60 TAPSE 0.685 0.015 1.95 75 60 LA strain 0.676 0.012 18.33 63 64 Killip class 0.644 0.028