bluuebunny/crossref_metadata_2025 huggingface dataset:
P1782 Left ventricular deformation proprieties in aortic coarctation: insights from multilayer strain imaging
Authors: Sorrentino R , Fiorillo L , Canonico M E , Lembo M , Luciano F , Santoro C , Esposito R , Borgia F , Galderisi M
Published: January 2020

Background

Patients with coarctation of the aorta (CoA) have proven impaired left ventricular (LV) myocardial deformation that will persist even after successful transcatheter intervention compared to normal controls. However, little is known about layer specific contraction in this clinical setting.

Purpose

To investigate multi-layer longitudinal strain in patients with repaired CoA, compared with a control group of healthy subjects.

Methods

In a case-control study, 13 CoA patients (F/M = 9/4, age = 15.1 ± 4.4 years) and 13 healthy age- and sex-matched controls, underwent a complete echocardiogram, including speckle tracking assessment for quantification of LV transmural global longitudinal strain (GLS), subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and myocardial longitudinal strain gradient (LSsubendo - LSsubpepi).

Results

CoA patients had similar blood pressure, heart rate, and body surface area in comparison with healthy controls. The two groups did not differ for ejection fraction and LV diastolic indices. Increased maximal gradient (>20 mmHg) in descending aorta was found in 9 (69.2%) CoA patients. In CoA population, 5 (38.5%) had LV concentric remodeling (RWT > 0.42) and 2 (15.4%) LV hypertrophy (Z score >2.0). LV mass index (92.4 ± 31.1 vs. 60.9 ± 12.5 g/m^2.7, p = 0.002), septal wall thickness (8.7 ± 2.0 vs 6.6 ± 0.9 mm p = 0.002), posterior wall thickness (8.2 ± 1.7 vs. 6.6 ± 1.4 mm, p = 0.02) and RWT (0.38 ± 0.06 vs. 0.27 ± 0.08, p < 0.001) were greater in CoA patients. By multi-layer deformation analysis, GLS (21.2 ± 1.9 vs. 22.9 ± 1.4%, p < 0.01), LSsubepi (19.3 ± 1.6 vs. 21.0 ± 1.6%, p < 0.01), LSsubendo (22.9 ± 1.8 vs. 25.4 ± 1.9%, p = 0.003) and longitudinal strain gradient (3.6 ± 1.1 vs. 4.7 ± 1.1, p < 0.02) were lower in CoA patients than in healthy controls. Separate sub-analyses in patients without LV hypertrophy, substantially confirmed the same results: GLS 20.9 ± 1.6 vs. 22.8 ± 0.9%, p = 0.004; LSsubepi 19.0 ± 1.4 vs. 21.1 ± 1.3%, p = 0.004; and LSsubendo 22.4 ± 1.2 vs. 25.3 ± 1.4%, p < 0.0001; strain gradient 3.4 ± 1.0 vs. 4.6 ± 1.1, p = 0.02. Notably, LSsubepi (18.6 ± 1.4 vs. 20.6 ± 1.0%, p = 0.03) and, with greater significance, LSsubendo (22.1 ± 1.1 vs. 24.7 ± 1.8%, p < 0.0001) were lower in CoA patients with increased aortic gradient versus those without significant gradient increase.

Conclusions

In CoA patients, layer specific strain imaging highlights an impairment of LV longitudinal deformation, which mainly involves LSsubendo and causes reduction of longitudinal strain gradient. This preferential impairment of subendocardium is particularly evident in patients with residual aortic gradient and is independent of LV hypertrophy.

Abstract P1782 Figure. Multilayer strain in CoA vs. controls
P1787 Pharmacologic stress test: still an important prognostic factor? a follow-up study
Authors: Ferreira V , Moura Branco L , Galrinho A , Rio P , Aguiar Rosa S , Gameiro F , Cacela D , Castelo A , Garcia Bras P , Branco Mano T , Reis J , Cruz Ferreira R
Published: January 2020

Introduction

Dobutamine stress echocardiography (DSE) is an established exam for evaluation of extent and severity of coronary artery disease.

Purpose

To analyse the results and complications of DSE and identify prognostic predictors in patients (P) who underwent DSE for myocardial ischemia detection.

Methods

220P who underwent consecutive DSE from 2013 to 2017. P with significant valvular disease were excluded. Clinical data, echocardiographic parameters and data from follow up (FU) regarding all-cause mortality and MACEs were analysed. Mean age 64.8 ± 12.0 years(Y), 143 men (65%).

Results

88P (40%) had positive, 102 had negative and 30 had inconclusive DSE; complications rate of 15%. Prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, prior MI, percutaneous coronary interventionc (PCI), coronary arterial bypass graft (CABG) and HF was 82.7%, 42.3%, 67.7%, 35.9%, 31.8%, 10.9% and 9.5%, respectively. Mean left ventricular endsystolic (LVSD) and enddiastolic dimensions were 33.7 ± 8.9 and 52.8 ± 7.1 mm. Mean resting wall motion score index (rWMSI) and peak (pWMSI) were 1.16 ± 0.28 and 1.24 ± 0.34. Mean resting GLS (rGLS) and peak GLS (pGLS) were -16.3 ± 4.3 and -16.6 ± 4.3. Mean no. of ischemic segments was 1.7 ± 2.4 and 16.8% had ischemia >3 segments. There was ischemia in left anterior descending (LAD) coronary in 53P and in circumflex and right coronary territories in 18 and 68P. 22.6% had more than one ischemic territory. 43P (49.4%) underwent intervention, 38 with PCI and 5 with CABG. During a mean FU of 38.8 ± 16.8 months, 47 MACEs were observed, including 32 deaths (14.5%). Positive DSE (p = 0.012), no. of ischemic segments (p = 0.019), ischemia in the LAD (p = 0.003), rGLS (p = 0.038) and pGLS (p = 0.038) were related to the occurrence of MACEs. In Cox regression analysis, age (p = 0.005), DM (p = 0.005), HF (p = 0.006), prior CABG (p = 0.015), LVSD (p = 0.026), rWMSI (p = 0.029), pWMSI (p = 0.013) and pGLS (p = 0.038) were associated with increased all-cause mortality. Kaplan–Meier survival analysis showed that survival was significantly worse for ischemia > 3 segments (log rank 0.005), ischemia of more than one territory (log rank 0.025) and pWMSI >1.5 (log rank < 0.0005). With multivariate Cox regression analysis, age >65Y (HR 4.22, p = 0.004), DM (HR 2.49,p = 0.038) and pWMSI > 1.5 (HR 9.73,p = 0.007) were independently associated with all-cause mortality.

Conclusion

In patients who underwent DSE there were some baseline and DSE-related independent predictors of long-term prognosis: age, DM and peak WMSI.

Abstract P1787 Figure. Kaplan–Meier curves
P1792 Coronary flow velocity reserve and prognosis during stress echocardiography
Authors: Ciampi Q , Zanella H , Borguezan Daros C , Cortigiani L , Gaibazzi N , Zagatina A , Wierzbowska-Drabik K , De Castro E Silva Pretto J L , Djordjevic-Dikic A , Amor M , Merlo P M , Lowenstein J , De Nes M , Carpeggiani C , Picano E
Published: January 2020

OnBehalf

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

Background

Stress echocardiography (SE) based on regional wall motion abnormalities (RWMA) has established risk stratification capabilities, further enhanced by assessment of coronary flow velocity reserve (CFVR) on mid-distal left anterior descending coronary artery which assesses not only epicardial coronary artery stenosis but also coronary microcirculation.

Aim

To assess the value of CFVR in predicting outcome

Methods

From September 2016 to December 2018, we enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 631, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. CFVR was measured from pulsed wave Doppler as peak/rest ratio of peak diastolic flow. All patients were followed-up for a median of 16 months.

Results CFV was 28 ± 10 cm/s at rest and 62 ± 19 cm/s at peak stress (p<.001) with a CFVR of 2.25 ± 0.58. At individual patient analysis, CFVR was abnormal (≤2.0) in 528 (28%) patients: 265 (42%) with exercise, 254 (21%) with vasodilator and 9 (21%) with dobutamine stress. At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 acute heart failures, and 112 late (> 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced RWMA (Hazard Ratio 3.883, 95% Confidence Intervals: 2.379-6.336, p<.0.001) and CFVR (Hazard Ratio 1.590, 95% Confidence Intervals: 1.123-2.275, p<.009) were independent predictors. Kaplan-Meier curves showed progressively worsening event-free survival with progressively lower values of CFVR: see figure

Conclusion In patients referred to SE, CFVR assessing coronary microvascular dysfunction allows a more accurate prediction of outcome than RWMA which only detect epicardial coronary artery stenoses.

Abstract P1792 Figure. CFVR and event-free survival curves
P1793 Blunted heart rate reserve during exercise or vasodilator stress echo is a predictor of outcome
Authors: Prota C , Cortigiani L , Gaibazzi N , Borguezan Daros C , Zagatina A , Djordjevic-Dikic A , Wierzbowska-Drabik K , Kasprszak J D , Torres M A T , Boshchenko A , De Nes M , Paterni M , Carpeggiani C , Ciampi Q , Picano E
Published: January 2020

OnBehalf

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

Background

A blunted heart rate reserve (HRR) during exercise or vasodilator stress echo (SE) has been associated with a poor outcome in retrospective studies.

Aim. To assess the prognostic value of HRR in patients undergoing SE in prospective study.

Methods

We prospectively recruited a sample of 1825 patients (none with pacemakers or atrial fibrillation; mean age 63 ± 11 years; 1099 male, 60%; 1125, 62% on beta-blockers at the time of testing). All underwent SE with either exercise (n= 631, 543 with semi-supine bicycle and 88 with post-treadmill) or vasodilator (n = 1194, 1184 with accelerated high dose dipyridamole and 10 with adenosine) SE for evaluation of known or suspected coronary artery disease and/or heart failure in 7 accredited laboratories of 5 countries. HRR was calculated by ECG as the peak/rest HR ratio. All patients were followed-up.

Results

During a median follow-up time of 480 days, 211 events occurred: 20 deaths, 22 non-fatal myocardial infarctions, 58 hospital admissions for acute decompensated heart failure and 111 late (> 3 months from SE) myocardial revascularizations. Positivity cutoff for HRR identified by ROC analysis was ≤1.67 (sensitivity 51.0, specificity 63.4) in the exercise group and ≤1.32 (sensitivity 65.0, specificity 48.9) in the vasodilator group. The separation was present both in the exercise (left panel) and the vasodilator (right panel) subsets : see figure. At multivariable analysis, blunted HRR was an independent predictor of event-free survival in the overall group (Hazard Ratio 1.422, 95 % Confidence Intervals: 1.055-1.917, p=.021), independent of beta-blocker therapy.

Conclusion

A blunted HRR is a useful non-imaging predictor of adverse events during both vasodilator and exercise SE, independent of inducible ischemia and beta-blocker therapy.

Abstract P1793 Figure. HRR and event-free survival curves
P1796 Three dimensional echocardiograhy navigation of mitral valve in patients with left ventricular dysfunction and functional mitral regurgiation
Authors: Darweesh R , Farrag AZZA , Hassan A M R , Mesak JULIET
Published: January 2020

OnBehalf

cairo university

Background

Mitral valve MV apparatus is a dynamic three-dimensional system that allows a unidirectional heart pump function. Functional mitral regurgitation (FMR) is a common complication that adversely affects the prognosis in patients with congestive heart failure. Accurate assessment of the interaction of the LV and MV apparatus is crucial for surgical correction of FMR.

Purpose

Evaluation of MV deformity indices in patients with Left ventricle (LV) dysfunction and varying severity FMR using 3D transoesophageal echocardiography and MV navigation (MVN) software

Methods

96 patients were selected with echocardiographic evidence of dilated LV dimensions, EF ≤ 45%,and at least mild MR . A standard comprehensive transthoracic echocardiographic assessment of : 1. LV diameters and volumes with calculation of LVEF , LV shape, sphericity index, 2. Mitral leaflets morphology including anterior mitral leaflet length ,Mitral annular (MA) diameter , mid-systolic mitral annular area (MAA) , The coaptation height (CH) or distance , MV tenting area, leaflet-tethering distance for anterolateral papillary muscle (Tethering-AL) and posteromedial papillary muscle (Tethering-PM), 3.Quantification of MR : MR jet area , vena contracta (VC) width, effective regurgitant orifice area (EROA), , regurgitant volume, 4. 2D speckle-tracking imaging for LV strain analysis,5.MV morphology and dynamics were analysed using MVN for assessment of : Annular geometry including diameters, circumference ,height , annular ellipticity .

Results

MV deformation (AML and PML tethering distance) was negatively correlated with GLS (r= -0.408, p = 0.009),and (r= -0.428, p = 0.006) as well as 2D and 3D MAA were negatively correlated with the GLS (r= -0.469, p = 0.002) and (r= -0.477, p = 0.002). MR severity parameters as MR volume and EROA were associated with increased MAA (r = 0.38, p = 0.015), (r = 0.469, p = 0.002) respectively. Severity of MR was strongly correlated with MVA indices including AP diameter, 3D MA circumference, MAA, MV tenting height and volume and annular ellipsicity.

Conclusion

Mitral annular enlargement appears to be more closely linked to occurrence of FMR in patients with LV dysfunction. 3D imaging modalities will help assessment of complicated, dynamic, three-dimensional and non-planar mitral annulus
P1798 Determinants of increased mitral mean diastolic gradient after transcatheter edge-to-edge mitral valve repair
Authors: Oguz D , Padang R , Pislaru S V , Nkomo V T , Mankad S V , Malouf J F , Guerrero M , Reeder G S , Eleid M F , Rihal C S , Thaden J J
Published: January 2020

Background

Transcatheter edge-to-edge mitral valve repair (TMVR; MitraClip, Abbott Vascular) is clinically approved for treatment of severe, symptomatic mitral regurgitation (MR) in high or prohibitive surgical risk patients. Iatrogenic mitral stenosis is a known complication of TMVR, but determinants of increased post-procedure mean diastolic gradient are not well defined.

Purpose

We aimed to investigate the determinants of increased mitral mean diastolic gradient after TMVR.

Methods

We retrospectively reviewed 59 patients. 2D and 3D TEE data sets acquired before and immediately after procedure were analyzed. 4D Cardio-View and 4D MV-Assessment (TomTec, Germany) were used for the analysis of the 3D volume data set. Quantitative mitral valve analysis was done at the end of systole. Increased mitral mean diastolic gradient after TMVR was correlated with pre-procedure 2D and 3D echocardiographic data.

Results

34 patients had primary MR, 25 patients had mixed/secondary MR. Baseline mean mitral diastolic gradient was 2.0 ± 0.9mmHg and increased to 3.9 ± 1.8mmHg post-TMVR and the mean 3D planimetric mitral valve area decreased from 5.3 ± 1.5cm2 to 2.6 ± 1.0cm2. Implantation of multiple clips was performed less frequently in patients with smaller baseline mitral valve area; 8% vs 47% in the lowest quartile vs all others (p = 0.006). 12(20%) of patients had a mean diastolic gradient >5mmHg post-TMVR and 15(25%) of patients had a post-TMVR mitral valve area <2.0 cm2. There was no significant difference in post-procedure heart rate between patients with mean diastolic gradient ≤5mmHg vs >5mmHg (p = 0.08). Patient characteristics according to post-TMVR mean diastolic gradient are shown in the Table. Post-TMVR mean diastolic gradient >5mmHg was more common in patients with increased pre-procedure mean diastolic gradient(p = 0.006), post-TMVR mitral valve area <2.0 cm2(40% vs 14%, p = 0.03), and ≥moderate residual mitral regurgitation(38% vs 11%, p = 0.02). Post-TMVR mitral valve area <2.0cm2 was present in 50% vs 19% of patients with vs without a mean gradient >5mmHg(p = 0.04).

Conclusions

Elevated post-TMVR mean diastolic gradient is multifactorial and related to mitral stenosis, but residual mitral regurgitation also appears to be an important contributor to increased gradients in some patients. Larger cohorts are likely needed to assess the concurrent impact of mitral annular calcification, leaflet calcification, and other variables on post-TMVR mean gradient.

Abstract P1798 Figure. 2D and 3D Echocardiographic Parameters
P1804 Phenotypic overlap between Brugada syndrome and arrhythmogenic cardiomyopathy
Authors: Scheirlynck E , Droogmans S , Sieira J , De Asmundis C , Motov A , Edvarsen T , Koulalis J , Lie ØH , Chivulescu M , Chierchia G B , Brugada P , Cosyns B , Haugaa K H
Published: January 2020

Background

Brugada syndrome (BrS) and arrhythmogenic cardiomyopathy (AC) are genetic cardiac diseases characterized by high risk for sudden cardiac death. Although BrS and AC are different clinical entities, experimental research and clinical cases suggest a phenotypic overlap.

Purpose

We aimed to assess the prevalence of structural and electrical AC diagnostic criteria in BrS patients.

Methods

In this multicentre study we acquired electrocardiograms (ECG) and transthoracic echocardiography in BrS patients between May and September 2018. We assessed the right ventricular outflow tract (RVOT) diameter, fractional area change (FAC) from echocardiography, and depolarization and repolarization criteria from ECG using parameter cut offs and definitions according to 2010 AC Task Force criteria.

Results

We included 123 BrS patients [54 (40-62) years old, 63 (51%) women]. Although, by definition, no akinesia, dyskinesia or aneurisms were present, 61 (50%) BrS patients had major criteria for dilated RVOT and/or reduced FAC, and 39 (32%) had at least one minor RVOT or FAC criterion (Figure). ECG showed minor repolarization and/or depolarization criteria in 30 (24%) BrS patients. No epsilon waves or major T-wave inversions were observed.

Conclusion

Half of BrS patients had evident major RVOT dilation and/or reduced FAC and one quarter had minor electrical features of AC. These findings suggest a significant phenotypical continuum between BrS and AC.

Abstract P1804 Figure.
P1824 Feature tracking strain values of noncompaction cardiomyopathy patients: differences in the light of ejection fraction
Authors: Kiss A , Szucs A , Gregor Z S , Toth A , Furak A , Horvath M , Czimbalmos C S , Dohy Z S , Szabo L , Suhai F I , Merkely B , Vago H
Published: January 2020

Feature tracking (FT) is a new cardiac magnetic resonance (CMR) technique for strain measurement which may give additional information about the progression of noncompaction cardiomyopathy (NCMP).

First in the literature, we compared the strain and functional parameters of NCMP patients with reduced (R) and good (G) ejection fraction (EF) using CMR-FT.

From the total of 164 CMR proven R NCMP patients, who were examined between 2009 and 2018 at the Heart and Vascular Center of Semmelweis University, we selected 26 non-ischaemic, contrast agent-free examinations (age: 56 ± 10.6 years; EF: 32.7 ± 10.0%; male = 19). According to their EF they were divided into medium (M; EF: 35-50%; n = 10) and significantly reduced EF (SR; EF <35%; n = 16) subgroups. We searched 25 NCMP patients with good EF (age: 37 ± 14.4 years; EF: 65.9 ± 5.3%; male = 16) and 26 control persons (age: 52 ± 10.7 years; EF: 70.8 ± 5.1%; male = 16) to the above mentioned groups.

The Medis Suite program was used for analysis and the MedCalc software for statistics, (p < 0.05).

Significant differences were found between the functional parameters of R and G patients. The global longitudinal strain (GLS) and global circumferential strain (GCS) values of the R group were decreased significantly compared to G and C groups. (R vs G; GLS: -9.5 ± 4.3 vs -20.9 + 3.2%; GCS: -12.5 ± 6.1 vs -30.5 ± 5.0%, p < 0.0001; R vs C; GLS: -9.5 ± 4.3 vs -23.3 ± 4.4%; GCS: -12.5 ± 6.1 vs -35.6 ± 5.1%, p < 0.0001).

All the segmental strain values of R group were decreased compared to G and C groups, moreover this significancy was observed between the M and SR subgroups as well.

The strain values of the R group in all the basal, mid and apical part of the left ventricle (LV) were reduced equally.

The average longitudinal strain values of the apical part of the LV in the SR subgroup were significantly reduced compared to the average strains of the basal part (apical vs basal: -8.9 ± 3.0 vs -11.9 ± 4.4 %, p < 0.05). In addition, we found positive correlation in the R subgroup between the GCS and the mass of trabeculated muscle (r = 0.58, p = 0.002) .

Our study shows that the global and segmental strain values decreased significantly in proportion to the reduction of the EF which describes well the progression of heart failure in NCMP. However, the decreased strain values of the hypertrabeculated apical part might be specific to NCMP.
P286 Inverse relation between systolic blood pressure variability and global longitudinal strain in patients with Parkinson"s disease and autonomic dysfunction
Authors: Caminiti G , D"antoni V , Morsella V , Torti M , Grassini P , Vacca L , Selli S , Volterrani M
Published: January 2020

Background

Parkinson"s disease (PD) patients often present cardiac blood pressure (BP) derangement as a result of autonomic dysfunction. However their echocardiography pattern have been poorly investigated yet . Study aim: to evaluate the correlation between indices of left ventricular function ad 24/h blood pressure pattern in patients with PD

Methods We evaluated 20 patients with diagnosed PD and autonomic dysfunction and 15 hypertensive age-matched subjects. All patients performed 24/h blood pressure monitoring (ABPM) and echocardiography. Left ventricular systolic function was evaluated through ejection fraction (EF), tissue doppler S wave and global longitudinal strain (GLS). BP variability (BPV) was evaluated through average real variability.

Results

GLS (17.6 vs 22.8; p = 0.04) was reduced in the PD group compared to hypertensive patients. Conversely EF and S wave was similar between the two groups. Patients with PD had an inverse significant correlation between GLS and 24/h systolic BPV (r= -0.64; p = 0.003) and a trend through significance between S wave and systolic BPV (r= -0.31; p = 0.07). sNocturnal diastolic BP was inversely related to GLS (r= -0.44; p = 0.001) . There were no correlation between GLS and BPV and values in hypertensive patients.

Conclusions

In PD patients GLS is related to indices of poor BP control. GLS appears to be an early detector of LV dysfunction in patients with PD and autonomic dysfunction.
P287 Assessment of mitral regurgitation and mitral geometry in patients after transcatheter aortic valve implantation
Authors: Sorysz D , Krawczyk-Ozog A , Tokarek T , Zawislak B , Stapor M , Dudek D
Published: January 2020

Introduction

Mitral regurgitation is often found in conjunction with aortic stenosis and the prevalence of both valvular lesions increases with age.

Purpose

The aim of this study was to evaluate mitral regurgitation, left ventricle and left atrium in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Methods

A total of 31 patients (29% males) with severe aortic stenosis and moderate or severe mitral regurgitation, who underwent TAVI were included in this study. Clinical and echocardiographic characteristics were performed at baseline and in 6, 12 months observation.

Results

After TAVI, decrease of vena contracta width of mitral regurgitation (p = 0.00002, p = 0.00004), aorto-mural mitral annulus diameter (p = 0.00008, p = 0.02), increase mitral annular plane systolic excursion (p = 0.0004, p = 0.0003), left ventricular stroke volume (p = 0.0003, p = 0.0004), ejection fraction (p = 0.0004, p = 0.01) and decrease major dimension of left ventricle in three chamber view (p = 0.05, p = 0.002) was observed in patient in both time points, respectively. Additionally, we observed decrease of distance between head of papillary muscles (p = 0.003) at 6 months and decrease of left atrium indexed volume (p = 0.01) and grade of tricuspid regurgitation (p = 0.03) at 12 months follow up.

Conclusions

Patients with moderate or severe mitral regurgitation after TAVI procedure achieved significant reductions of mitral regurgitation and improvement of some parameters assessing mitral annulus, left ventricle and left atrium geometry.
P292 The risk of adverse outcome with ischemic mitral regurgitation at 6-month after myocardial infarction: possible benefit of early intervention by transcatheter mitral-valve repair
Authors: Kimura T , Watanabe N , Nishino S , Kuriyama N , Ashikaga K , Nishihira K , Furugen M , Shibata Y
Published: January 2020

Background

The latest study has demonstrated the better outcomes of transcatheter mitral-valve repair in patients with decompensated heart failure (HF) and left ventricular (LV) dysfunction. However, it is unknown whether earlier intervention for mitral regurgitation (MR) can improve the outcome of myocardial infarction (MI).

Purpose

The aim of this study was to investigate the prognostic value of ischemic MR (IMR) at 6-month after MI for the later incidence of HF and death.

Methods

We retrospectively examined 723 MI patients who were admitted to our hospital. 95.5% of the patients were treated by primary coronary intervention. Patients were clinically followed-up at 6-month after the onset of MI, and divided into 3 groups according to the degree of IMR, i.e. No/Trivial IMR group (n = 528), Mild IMR group (n= 154) and ≥Moderate IMR group (n= 41). We compared the later incidence of hospitalization for HF and all-cause death at 3-year for each group.

Results

The studied population had preserved ejection fraction (EF) (56.9 ± 10.7%, average) and mostly asymptomatic at 6-month after MI. All-cause mortality within 3-year was higher in patients with ≥Moderate IMR (p < 0.001), and the incidence of hospitalization for HF was significantly higher depends on the degree of IMR at 6-month (p < 0.001). Multivariate analysis showed EF and the degree of IMR were the independent predictor for the hospitalization for HF.

Conclusions

IMR at 6-month after MI was associated with the later adverse events despite relatively preserved LV contraction without heart failure symptoms at the index examination. Early intervention for IMR potentially benefit for the better outcome.

Abstract P292 Figure. Caplan-Meier estimates on adverse events
P296 The effect of ideal BSA in patients with moderate aortic stenosis?
Authors: Cases M , Zhu T , Jurt U , Brouillard D , Matangi M
Published: January 2020

INTRODUCTION

The current obesity epidemic has an impact on calculated BSA. Obesity significantly increases the calculated BSA from what the ideal BSA would be if based on a patient’s ideal body weight.

PURPOSE

To determine the effect of ideal BSA on AV area index in patients with moderate aortic stenosis and normal left ventricular function.

METHODS

Our ECHO database was searched for all patients with an LVEF >50% and moderate aortic stenosis based on a mean aortic gradient of 20-39 mmHg and an AV area >1.00 cm2. Patients with more than mild aortic regurgitation, previous valvular repair or replacement, significant mitral valve disease or any LV wall motion abnormalities were excluded. Ideal weight was calculated using the Devine formula = Constant + 2.3 x [height in inches-60], where constant= 50Kg in males and 45.5Kg in females). Body surface area in m2 was calculated using the formula = [√ (height in cm x weight in Kg)/3600]. The paired t-test was used to determine differences between means and the Fisher’s exact test was used to determine differences between proportions. A p value of <0.05 was considered significant.

RESULTS

There were 210 females (mean age 75.4 ± 11.9 years, mean AV gradient 25.3 ± 4.8 mmHg, mean AVA 1.28 ± 0.27 cm2) and 385 males (mean age 72.7 ± 11.3 years, mean AV gradient 25.9 ± 5.2 mmHg, mean AVA 1.32 ± 0.28 cm2). Other important variables are seen in table 1. There were highly significant differences between actual and ideal measurements of weight, BSA and AV area index. Based on the actual BSA there were 151 of 385 male patients (39.2%) with severe aortic stenosis (<0.60 cm2/m2), which dropped to 66 of 385 patients (17.1%) when the ideal BSA was used in the calculation (P < 0.0001, Fisher’s exact test). For females there were 44 of 210 patients with severe aortic stenosis (21.0%) which dropped to 3 (1.4%) when the ideal BSA was used in the calculation (P < 0.0001, Fisher’s exact test).

CONCLUSIONS

Use of the ideal BSA, based on ideal weight, significantly reclassifies women in terms of AS severity and will be consistent throughout time. All mean aortic gradients and AV areas, by definition, and 98.6% of the ideal AV area indices being in the moderate AS range. The data is less compelling in males but is still significantly improved with 82.9% of AV area indices being correctly assigned.

Table 1. Weight/kg (Females) Weight/kg (Males) BSA/m2 (Females) BSA/m2 (Males) AVAI (Females) AVAI (Males) Actual. 77.5 ± 21.4 90.1 ± 16.9 1.79 ± 0.23 2.04 ± 0.20 0.72 ± 0.16 0.65 ± 0.14 Ideal. 51.6 ± 6.2 69.3 ± 7.1 1.51 ± 0.12 1.83 ± 0.14 0.85 ± 0.17 0.73 ± 0.16 P value. <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 AVAI = Aortic valve area index (cm2/m2). BSA = Body surface area (m2).
P307 Trajectories of Myocardial Strain Across the Spectrum of Aortic Stenosis
Authors: Alfuhied A , Alfarih M , Kumar M P , Captur G , Nihoyannopoulos P
Published: January 2020

Introduction

Optimal timing of intervention in aortic stenosis (AS) is key. Left ventricular deformation parameters are sensitive markers of myocardial wellbeing in AS, but data is sparse so strain does not currently feature in the clinical decision-making process governing timing of AS intervention. We explore the trajectory of myocardial strain in AS of varying severity to potentially identify the most sensitive periods for valve intervention.

Methods

50 patients from across the spectrum of isolated AS were prospectively recruited: mild AS n = 10; moderate AS n = 10; and severe AS n = 30 of which n = 10 in each of 3 ejection fraction (EF) groups: EF > 50%, EF = 40-49% and EF < 35%. Longitudinal, circumferential, and radial strain were measured by speckle tracking echocardiography (STE) using TomTec software.

Results

Strain parameters and EF were not significantly different between mild and moderate AS groups but almost all parameters (except for global circumferential strain (GCS)) showed significant deterioration with progression to severe AS, even in spite of preserved EF (>50%; Table1). In patients with severe AS, strain parameters showed no significant differences between hearts with EF > 50% and EF 40-49%, but they continued to deteriorate significantly (p < 0.05) as hearts transitioned from 40-49% to <35% (Figure 1, a&b).

Conclusion

The heart can maintain its deformation and global systolic function throughout mild and moderate AS but strain deteriorates significantly in severe AS, irrespective of EF. Tracking the precise timings of strain deterioration in severe AS could help refine optimal timings of AS intervention.

LVEF and strain in varying AS severity Left ventricle ejection fraction and strain values in varying severity of AS Mild (n = 10) Moderate (n = 10) Severe (n = 10) P-value Mean (SD) Mean (SD) Mean (SD) EF (%) 65.4 (6.1) 65.8 (9.0) 60.4 (3.6)*§ 0.15 GLS (%) -14.2 (2.1) -13.6 (2.3) -11.8 (2.9)* 0.09 GCS (%) -30.3 (9.1) -31.0 (11.4) -26.5 (8.2) 0.55 GRS (%) 55.9 (15.5) 52.6 (24.0) 35.9 (13.5)*§ 0.05 EF: ejection fraction; GLS: global longitudinal strain; GCS: global circumferential strain; GRS: global radial strain; SD: standard deviation. Severe (n = 10): Severe AS with preserved EF >50%. P-value: ANOVA-single factor; comparison in-between groups was performed using unpaired t-test (parametric) and Mann Whitney test (non-parametric). *significant difference P < 0.05 mild vs severe. §significant difference P < 0.05 moderate vs severe.

Abstract P307 Figure.
P325 Inadequate inhibition of platelet function after exercise in patients with ischemic mitral regurgitation qualified for cardiosurgery treatment
Authors: Piatkowski R , Kochanowski J , Budnik M , Huczek Z , Scislo P , Kosior D A , Opolski G
Published: January 2020

Purpose

Human platelets play a major role in the pathophysiology of cardiovascular diseases. The aim of our study was to determine the relationship between exercise and level of platelet inhibition in patients (pts) after myocardial infarction (MI) with at least moderate ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABG) or CABG with mitral reconstruction (CABGmr).

Methods

We collected venous blood samples from 70 pts (M 41, 66 ± 9 years) with at least moderate IMR, 3-24 weeks after MI. Platelet reactivity was estimated with the use of rapid, point-of-care platelet analyzer as the time for flowing whole blood to occlude a collagen-epinephrine ring, with shorter closure times (CEPI-CT), indicating greater activity. CEPI-CT was evaluated before (CEPI-CT rest) and 20 min after ExE (CEPI-CT ExE). Inadequate inhibition of the TXA2-dependent activation pathway was defined as CEPI-CT < 193 seconds. All the patients received 75-100 mg of aspirin daily (without clopidogrel treatment). Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (moderate ≥10-20, severe ≥ 20 mm²). In all pts symptom-limited echocardiography (echo) semi-supine exercise test (ExE) was performed with Schiller system. All the pts were referred for CABG (multivessel coronary disease, ejection fraction (EF) 42,6 ± 10,1%, wall motion score index (WMSI) 1.65 ± 0.36).

Results

We observed inadequate platelet in 26 (37%) pts at rest (CEPI-CT < 193 sec., despite regular aspirin therapy) and in 48 (68%) pts in 20 min. after exercise. We observed a significant decrease in CEPI–CT in all analyzed group (rest vs exe: 202 sec. vs 124 sec., respectively; p < 0,0001) and also in pts with moderate IMR as well as with severe IMR. We didn’t observe a significant change in platelet count and mean platelet volume (MPV) between rest and exercise. Conclusions:

1. Inadequate antiplatelet effect of aspirin at rest was observed in 37% pts after MI with IMR.

2. Symptoms limited exercise test has revealed inadequate platelet inhibition (TXA2 –dependent activation pathway) in 68% of patients after MI with IMR.

3. Aspirin may have a limited antithrombotic effect after physical exercise in patients after MI with significant IMR.
P329 Outcome prediction with force-based left ventricular contractile reserve during stress echocardiography
Authors: Morrone D , Zagatina A , Ciampi Q , Cortigiani L , Gaibazzi N , Djordjevic-Dikic A , Borguezan Daros C , Wierzbowska-Drabik K , Kasprzak J D , Boshchenko A , Ryabova T , Zhuravskaya N , Torres M A R , Carpeggiani C , Picano E
Published: January 2020

OnBehalf

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

Background

Stress echo (SE) risk stratification is based on regional wall motion abnormalities (RWMA). The assessment of global left ventricular contractile reserve (LVCR) based on load-independent Force may refine prognosis.

Aim

To assess the value of LVCR during SE in predicting outcome

Methods

From September 2016 to December 2018, we prospectively enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 543, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. Force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/end-systolic volume by 2D and biplane Simpson method of disks. When Simpson method was not feasible, apical single plane or linear parasternal methods were used to calculate volumes. Abnormal values of LVCR (peak/ rest) based on force were ≤1.10 for dipyridamole and adenosine; ≤1.61 for exercise or dobutamine. All patients were followed-up for a median of 16 months.

Results RWMA and Force-based LVCR were obtained in all pts. Force was 4.24 ± 1.88 mmHg/ml at rest and increased during stress (7.07 ± 4.60 mmHg/ml, p<.001). At individual patient analysis, LVCR was abnormal in 495 (26%) and normal in 1373 (74%) patients. At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 hospital admissions for acute heart failures, and 112 late (> 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced RWMA (Hazard Ratio, HR, 2.899, 95% Confidence Intervals, CI: 2.032-4.137, p<.0.001), force-based LVCR (HR 1.747, 95% CI: 1.245-2.470, p=.002) were independent predictors. Kaplan-Meier curves showed worse event-free survival for pts with abnormal LVCR: see figure.

Conclusion LVCR based on Force is a useful adjunct to RWMA for risk stratification with SE.

Abstract P329 Figure. Survival curves and LVCR
P331 Application of 3-dimensional transthoracic echocardiography in the evaluation of implantable cardioverter defibrillator lead position
Authors: Kaminska M , Lopatowska P , Sobkowicz B
Published: January 2020

Over the last decade there has been a significant increase in the number of implantable cardiac defibrillators (ICD) in patients with heart failure with reduced ejection fraction (HFrEF). These leads have been reported to cause or to increase tricuspid regurgitation (TR). Echocardiography is not routinely used to elucidate the mechanisms of lead interference with tricuspid valve leaflets in individual patients.

AIM

To evaluate of usefulness of 3-dimensional transthoracic echocardiography (3D TTE) in the assessment of ICD lead position and its relations to tricuspid valve.

METHODS

A population consisting of 44 consecutive patients with ICD was evaluated (43 – patients with HFrEF, 1 – patient with hypertrophic cardiomyopathy). 3D TTE full-volume images of the right ventricle and/or zoomed images of the tricuspid valve were obtained. Images were analysed off-line to determine the position of the device-lead in relation to the tricuspid valve leaflets. Severity of TR was estimated as not important (+, ++) and important (+++, ++++).

RESULTS

An evaluation of the device-lead position was impossible due to poor diagnostic quality of echocardiographic images in 4 patients (9%). Among 40 remaining subjects in 12 (30%) lead was in central position, without interfering with leaflet motion, in 14 (35%) - impinging on the posterior leaflet, 6 (15%) - impinging on the septal leaflet, 8 (20%) – lead was positioned near the posteroseptal commissure. Among 15 patients (38%) TR was assessed as important. There was no correlation between device-lead position and severity of TR.

CONCLUSIONS

3D TTE enables to determinate ICD-lead position and its relation to tricuspid valve. 3D TTE can explain a mechanism of associated TR in individual patients. Further studies are necessary to investigate possible relationship between lead position and TR severity.
P338 The road to zero-fluoroscopy catheter ablation in recurrent paroxysmal atrial fibrillation using ICE: training, learning, getting closer
Authors: Minciuna I A , Puiu M , Cismaru G , Istratoaie S , Simu G , Florea C , Gusetu G , Zdrenghea D , Pop D , Rosu R
Published: January 2020

INTRODUCTION

Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure.

PURPOSE

The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation.

METHODS

Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters.

RESULTS

Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded.

CONCLUSIONS

This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation.

Abstract P338 Figure. ICE-guided transseptal puncture
P340 New tools for the assesment of diastolic function in attr cardiac amyloidosis
Authors: Gonzalez Ferrero T , Abou Jokh Casas C A J C , Cacho Antonio C C A , Abou Jokh Casas E A J C , Antunez Muinos P A M , Perez Dominguez M P D , Torrelles Fortuny A T F , Pubul Nunez V P N , Martinez Monzonis A M M , Gonzalez Juanatey J R G J
Published: January 2020

INTRODUCCION

Cardiac amyloidosis (CA) is a cardiomyopathy where the main disturbances are due to diastolic dysfunction. This requires a meticulous clinical and echocardiograpic evaluation.

METHODS

The aim of this study was to analyse the association between previously described parameters of diastolic dysfunction and others less known such as left atrial peak strain.

RESULTS

Thirty-six patients with suspicion of cardiac amyloidosis were submitted to DPD scintigraphyand transthoracic echocardiography, and were divided into two groups.

Of these patients, eleven had no visual gammagraphic catchment whereas twenty-four, (68%) did. Median peak of atrial strain was 16.8 in sinus rhythm and 6.8% in atrial fibrillation (p < 0.0001) with no differences in the proportion of AF.

Median value of the velocity of E wave in patients with no catchment was 1.17 m/s whereas in those with ATTR-CA 0.77 m/s (p= 0.004). No differences were observed in other parameters such as A wave, E/A ratio or deceleration slope of E wave.

We found that the strongest predictor of high filling pressures (E/e’> 14) was systolic strain left atrial peak (p = 0,004 IC 95% 0.8-0.9) with an accurate predictive ability, AUC (76%).

CONCLUSIONS

Left atrial strain peak could be an interesting parameter for the assessment of diastolic dysfunction and a protective value for elevated filling pressures in CA-ATTR patients.

Basal features ABSENCE OF CATCHMENT POSITIVE CATCHMENT P-value E (m/s) 0.77 1.17 0.04 A (m/s) 0.76 0.9 0.64 E/A 195 181 0.91 E/e’ 14 0.9 0.73 Atrial strain peak 8.5 11.8 0.78 35% AF 45% AF Fractional shortening (%) 34.34 31.80 0.81 Differences between both groups

Abstract P340 Figure. Relationship: E/e" and atrial strain
P359 Dipyridamole stress cardiac magnetic resonance in the assessment of utility of coronary revascularization in patients with stable angina
Authors: Igual Munoz B , Maryem Ezzitouny M E , Elena Sanchez Lacuesta E S L C , Jose Luis Diez Gil J L D G , Vicente Miro Palau V M P , Francisco Ten Morro F T P , Maria Ferre Valverdu M F V , Alberto Berenguer Jofesa A B J , Jose Leandro Perez Bosca J L P B , Rafael Paya Serrano R P S
Published: January 2020

The prognostic impact of coronary revascularization in patients with stable angina is limited being reserved nowadays for patients with symptoms or severe ischemia in imaging tests. We propose to study the usefulness of stress CMR to assess the utility of coronary revascularization in patients with stable angina.

Methods

A retrospective cohort study was conducted including consecutive patients with inducible ischemia in dypiridamol stress CMR. Patients with acute coronary syndrome or severe valvular disease were excluded. The decision to revascularize after MRI was made by the responsible medical team following the guidelines of clinical practice. The presence of cardiovascular events (death, admission or need for new revascularization) was analyzed during follow-up. The stress cardiac MR imaging protocol included a baseline functional study (b-SSFP sequences) and after administration of 0.84 mg / kg IV dipyridamole, perfusion sequences (b-SSFP) obtained during the administration of IV gadolinium contrast and F-GRE viability sequences. Clinical data such as the severity of coronary involvement, the type of coronary revascularization and if it was complete as well as data derived from the baseline functional study of ventricular volumes, segmental contractility score, transmurality and extension of necrosis, extension of hypoperfusion and also number of segments with severe ischemia considering as such those segments with transmural hypoperfusion or stress-induced systolic dysfunction.

Results

We included 424 patients of mean age of 65+ 10 years, 182 (43%) of them had known coronary artery disease and 93 (20%) of them had pevious percutaneous revascularization. Thirty-five (8%) had left main disease and 176 (41%) multivessel disease. Twenty five patients had normal stroke volume (SV) and depressed left ventricle ejection fraction (LVEF) and 60p had normal LVEF and low SV . One hundred and seven patients of the total group were revascularized (2.5% surgically). Coronary revascularization showed a significant increase in survival only if it was complete (p <0.004). All analized data were introduced in a multivariate Cox model showing SV as the most powerfull predictor of events (OR:0.9, p = 0.04, CI: 0.96-0.99) and also that patients with indexed SV <40ml / m2 significantly improved their survival after coronary complete revascularization (p = 0.003).

Conclusions

1. SV is the most powerful predictor of events in patients with stable angina and ischemia in CRM dypiridamol stress test.

2. Patients with an SVi <40ml / m2 significantly improve their survival after coronary complete revascularization.

Abstract P359 Figure. Survival curves regarding SV