bluuebunny/crossref_metadata_2025 huggingface dataset:
P1367 Prevalence of left ventricular hypertrophy, diastolic dysfunction and pulmonary hypertension in patients with severe aortic valve stenosis
Authors: Stoebe S , Kandels J , Tayal B , Laufs U , Sogaard P , Hagendorff A
Published: January 2020

Background

The prognostic and therapeutic consequences of aortic valve stenosis (AS) are incompletely described by the effective orifice area (EOA) and transvalvular flow velocities (AV-Vmax) in echocardiography. The aim of the study was to evaluate parameters of left ventricular hypertrophy (LVH), diastolic dysfunction and pulmonary artery hypertension (PAH) in severe AS.

Methods

Patients (n = 320) with severe AS (mean age 78 ± 9.5 years) defined by EOA < 1cm2 and/or a AV-Vmax > 4m/s were included. Left ventricular (LV) volumes and ejection fraction (EF), relative wall thickness (RWT), LV mass index (LVmassi), several parameters of diastolic function, e.g. E/A-ratio, e/e", indexed left atrial (LA) volumes (LAVI min. and max.) and systolic pulmonary artery pressure were assessed. Patients were grouped in four subgroups according to their mean pressure gradient (mPGAV) and indexed stroke volume (Low-Flow/Low-Gradient (LFLG), Normal-Flow/Low-Gradient (NFLG), Low-Flow/High-Gradient (LFHG) and Normal-Flow/High-Gradient (NFHG)).

Results

LVH was documented in 83%, diastolic dysfunction in 75% and PAH in 79% of all patients, whereas > 50% exhibited pathological values for all three and 82% for at least two of these cardiac alterations. Further, in no patient normal ranges of all three cardiac alterations were observed. EOA (0.74 ± 0.18 vs 0.78 ± 0.17, p = 0.047) was lower and mPGAV (34.0 ± 16.6 vs 29.3 ± 14.1, p = 0.009) was higher in patients presenting all three cardiac alterations vs. patients presenting less than three cardiac alterations. Prevalences of diastolic dysfunction and LVH did not differ among AS subgroups (Fig.1/Tab. 1, p > 0.05). In contrast, higher prevalence of PAH was observed in HG-AS (89%) compared to LG-AS (76%) (p = 0.02).

Conclusion

Severe AS is highly associated with LVH, diastolic dysfunction and PAH. This analysis sets the stage to determine the prognostic importance of the analyzed cardiac alterations in patients with severe AS.

Tab.1-Prevalence of cardiac alterations Parameters LFLG-AS (n = 135) NFLG-AS (n = 97) LFHG-AS (n = 21) NFHG-AS (n = 67) Relative wall thickness > 0.42 121 (89%) 90 (92%) 19 (90%) 67 (100%) LVmass index > 115 g/m2 (men), > 95 g/m2 (women) 120 (88%) 84 (86%) 17 (81%) 62 (93%) e/e" > 14 94 (70%) 56 (59%) 15 (71%) 41 (61%) Tricuspid regurgitation > 2.8 m/s 95 (70%) 71 (75%) 16 (76%) 47 (70%) Increased LAP and diastolic dysfunction grade 2 or 3 103 (76%) 69 (73%) 17 (81%) 50 (75%)

Abstract P1367 Figure. Fig.1-Prevalence of cardiac alterations
P1371 The effect of ideal BSA in patients with low-flow, low-gradient severe aortic stenosis
Authors: Matangi M , Cases M , Zhu T , Jurt U , Brouillard D
Published: January 2020

INTRODUCTION

The current obesity epidemic has an impact on calculated BSA, significantly increasing 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 low-flow, low-gradient severe aortic stenosis and normal left ventricular function.

METHODS

Our ECHO database was searched for all patients with an LVEF >50%, a mean aortic gradient of <40 mmHg, an AV area <1.00cm2, AVA index <0.60cm2/m2 and SV index <35ml/m2. Patients with atrial fibrillation, mechanical and bioprosthetic valves, any valve repair, HOCM, Amyloidosis, more than mild aortic regurgitation, moderate mitral regurgitation, any wall motion abnormality despite normal LVEF, Pacemaker or ICD or a moderate pericardial effusion 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 73 females (mean age 76.2 ± 11.3 years, mean AV gradient 27.2 ± 7.4 mmHg, mean AVA 0.82 ± 0.11 cm2 and mean LVEF of 64.9 ± 5.4%) and 55 males (mean age 76.1 ± 9.8 years, mean AV gradient 29.9 ± 7.2 mmHg, mean AVA 0.85 ± 0.11 cm2and mean LVEF of 62.2 ± 5.7%). Other important variables are seen in table 1. Based on the corrected ideal BSA there were 0 of 55 male patients who were re-assigned to the moderate AS category, compared to 25 of 73 (34.2%) female patients (P < 0.0001, Fisher’s exact test).

CONCLUSIONS

Use of the corrected ideal BSA has no effect on the hemodynamic diagnosis of low-flow, low gradient, normal LVEF severe aortic stenosis in males, but has a significant effect of the same diagnosis in females. It is therefore recommended that ideal body weight and ideal BSA be used when calculating AVA index in female patients suspected of low-flow, low-gradient severe aortic stenosis with normal ventricular function.

Weight(M) Weight(F) BSA(M) BSA(F) AVAI(M) AVAI(F) SVI(M) SVI(F) Actual 82.6 ± 12.5 70.1 ± 13.5 1.95 ± 0.15 1.71 ± 0.16 0.44 ± 0.06 0.48 ± 0.07 25.9 ± 4.9 23.9 ± 5.1 Ideal 67.5 ± 6.8 49.7 ± 5.4 1.79 ± 0.13 1.47 ± 0.11 0.48 ± 0.07 0.56 ± 0.08 28.3 ± 5.5 27.7 ± 6.3 P value <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 (M)=male, (F)=female, weight in kg, BSA in m2, AVAI in cm2/m2, SVI in ml/m2.
P1390 Myocardial work indices in the assessment of the systolic function of the left ventricle in amateur half marathon runners
Authors: Dankowski R , Szalek A , Tschurl J , Sacharczuk W , Baszko A , Woznicka-Leskiewicz L , Posadzy-Malaczynska A , Szyszka A
Published: January 2020

Background

Myocardial work (MW) has been recently introduced as a tool for non-invasive assessment of left ventricular (LV) systolic function. It is based on myocardial strain analysis but incorporates also data regarding loading conditions, which is potential advantage of this technique.

Purpose

We south to evaluate the impact of a three-month training before the half-marathon on cardiac function using indices of MW.

Methods

The study included 28 young amateur runners (11 women, mean age 32 years). None of the participants had a prior history of cardiovascular disease. The group was assessed at the beginning of training period, after three month (within 48 hours before half-marathon), and within 72 hours after the run. We collected clinical, laboratory and echocardiographic data. All participants underwent echocardiography to assess myocardial mechanics and MW indices using speckle-tracking technique.

Results

23 participants completed the training and all of them finished the race. After the training period we observed significant increase in LV end-diastolic diameter only (49,9 ± 0,94 mm vs 51,6 ± 0,9 mm, p= 0,007) with no significant change after the run. There were no changes in global longitudinal strain (GLS), global work index (GWI) global wasted work (GWW) neither after the training period nor after the run. We observed significant changes suggesting myocardial injury after the race, including slight increase of NT-proBNP and troponin levels, increase in left atrial volume index, and reduction of tissue Doppler lateral e` wave. Global constructive work (GCW) decreased significantly after the training period, with no change after the run (2122,0 ± 299,4 vs 1929,0 ± 227 vs 1986,5 ± 295,7 mmHg%; start of the training vs before the run assessment vs after the run assessment, respectively; p = 0,005). GCW was correlated significantly with systolic blood pressure, which decreased also significantly after the training period.

Conclusion

Three-months training before the participation in half-marathon run was not associated with significant changes in myocardial work indices except the global constructive work, which could be related to decrease of loading conditions. Despite the signs of myocardial injury there was no deterioration in myocardial mechanics parameters, which may indicate the beneficial effects of training before the half-marathon run.
P1397 Rehabilitation in pulmonary arterial hypertension: REHAB-HTP
Authors: Missana A , Azzolini Jacquin M , Baudouy D , Sanfiorenzo C , Leroy S , Sermesant M , Ferrari E , Moceri P
Published: January 2020

BACKGROUND

Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients.

PURPOSE

To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio-pulmonary exercise test.

METHODS

We prospectively included 12 clinically stable PAH patients over a 6 months period. Exercise stress echocardiography (ESE), cardio-pulmonary exercise test (CPET), SF-12 quality of life health survey, 6 minute walking test distance (6MWD), BNP and clinical assessment were performed before and after cardio-pulmonary rehabilitation. Patients underwent 8 weeks of exercise training (3 times a week of aerobic training and at home daily prescribed exercises).

RESULTS

All patients underwent ESE and CPET without any complication. 6 patients experienced a reduction in WHO functional class whereas 6 remained stable. Patients significantly improved their physical quality of life (p = 0.006). They also improved their exercise capacity according to maximum workload during CPET (p = 0.008) and CPET duration (p = 0.001) whereas a trend toward an improved 6MWD was observed (+58m, p = 0.10). Anaerobic threshold and peak VO2 (+1.7 ± 2.7 mL/kg/min) improved significantly (p = 0.01 and 0.03). Regarding imaging data, at rest peak strain improved after rehabilitation (p = 0.05) whereas the RV became more dilated. RV contractile reserve, defined by the change in peak systolic longitudinal RV strain between rest and maximum exercise, significantly improved (-3.9 ± 4.7%, p = 0.03)

CONCLUSION

In this preliminary study, cardio-pulmonary rehabilitation led to an improved quality of life and exercise capacity in PAH. The increased in RV contractile reserve post-rehabilitation might explain, in association with the peripheral muscular effects of exercise training, the clinical benefits of rehabilitation in PAH.

Abstract P1397 Figure. echography peak/rest in a PAH patient
P1403 Prognostic value of B-lines during stress lung ultrasound
Authors: Coviello K , Scali M C , Zagatina A , Zhuravskaya N , Cortigiani L , Gaibazzi N , Borguezan Daros C , Wierzbowska-Drabik K , Kasprzak J D , Djordjevic-Dikic A , Simova I , Morrone D , Lattanzi F , Ciampi Q , Picano E
Published: January 2020

OnBehalf

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

Background

B-lines (also known as comets) by lung ultrasound (LUS) are a marker of pulmonary congestion and interstitial pulmonary edema during stress echocardiography (SE).

Aim

To assess the prognostic value of B-lines during SE.

Methods

We prospectively performed transthoracic echocardiography (TTE) and LUS (4-site simplified scan) evaluation at rest and peak stress in 1437 patients (age 63 ± 11 years; 874 males, 61%) referred for exercise (n = 581), vasodilator (n = 819: dipyridamole, n= 809 and adenosine, n= 10) or dobutamine (n = 37) SE for known or suspected coronary artery disease or heart failure. B-lines were assessed by LUS with a 4-site simplified scan (total score from 0-1, dry lung, to 40, alveolar pulmonary edema). Follow-up (median 16 months) was completed in all.

Results

B-lines were 1.14 [0-35] at rest and increased during stress (2.10 [0-40], p<.001). At individual patient analysis, B-lines appeared de novo/increased (≥2 points) during stress in 306 (21.3%), remained absent or fixed in 1097 (76.3%) and decreased/disappeared in 34 (2.4%). At follow-up, there were 174 events: 17 deaths, 14 non-fatal myocardial infarctions, 51 hospital admissions for acute heart failures, and 92 late (> 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced regional wall motion abnormalities (Hazard Ratio, HR, 2.842, 95% Confidence Intervals, CI: 2.016-4.005, p<.0.001) and B-lines change during stress (HR 1.471, 95% CI: 1.054-2.052, p=.022) were independent predictors. Kaplan-Meier curves showed progressively worsening event-free survival for 943 pts with absent (score 0-1), 333 with mild (2-5), 90 with moderate (6-10) and 71 with severe (>10) B-lines at peak stress: see figure.

Conclusion

B-lines by LUS are a useful adjunct to regional wall motion abnormalities for risk stratification during SE. The presence and number of B-lines during stress allow a titration of risk. The outcome is darker with more comets in the SE sky.

Abstract P1403 Figure. Survival curves and peak stress B-lines
P1408 Age and gender dependency of left ventricular and left atrial volume ratio assessed by three-dimensional echocardiography
Authors: Takeuchi M , Otani K , Kitano T , Nabeshima Y
Published: January 2020

Funding Acknowledgements

Dr. Takeuchi was supported by a Grant-in-aid for Scientific Research (19K12853) from the Japanese Society of Promotion of Science.

Background

Left ventricular (LV) and left atrial (LA) volumes may change according to advanced aging. Since both chambers affect each other, their ratio, LV and LA volume ratio (LVLAVR) may sensitively detect age- and gender-related change in left chamber volume and function.

Purpose

We aimed to (1) investigate age and gender dependency of LVLAVR and (2) determine reference values.

Methods

We simultaneously obtained both LV and LA volume curves using 3D echocardiography with novel speckle tracking software (4D LV analysis v.3 LA, TomTec Imaging systems), and generated LVLAVR curve throughout one cardiac cycle, from which we measured LVLAVR at end-diastole (ED) and at end-systole (ES) in 313 healthy subjects (age, 20-85 years; 51% men).

Results

The mean values of LVLAVR at ED and ES in male subjects were 5.74 ± 1.54 and 1.37 ± 0.35, respectively. Corresponding values in female subjects were significantly lower (5.20 ± 1.47, p = 0.003 and 1.13 ± 0.29, p < 0.001) than those in male subjects. Their age and gender dependency are shown in table. LVLAVR at ED step wisely decreased to advanced aging, and had a highest F ratio compared with other left chamber volumetric parameters in both gender.

Conclusions

We proposed new index, LVLAVR which is a sensitive parameter to reflect age- and gender-related change in LV and LA volumes. Further studies should be required to validate clinical utility of this index over traditional volumetric parameters.

Male subjects (n = 160) 3rd decade (n = 35) 4th decade (n = 34) 5th decade (n = 34) 6th decade (n = 21) 7th decade (n = 24) F ratio p-value LVEDVI (ml/m2) 81 ± 12 72 ± 11 75 ± 14 71 ± 11 68 ± 12 4.22 0.003 LVESVI 38 ± 7 33 ± 6 35 ± 8 34 ± 5 32 ± 6 2.93 0.023 Maximum LAVI 25 ± 5 25 ± 4 27 ± 5 26 ± 6 30 ± 8 4.07 0.004 Minimum LAVI 12 ± 3 12 ± 3 14 ± 3 14 ± 3 18 ± 6 12.23 <0.001 LVLAVR at ED 6.80 ± 1.54 6.36 ± 1.31 5.42 ± 1.00 5.23 ± 1.37 3.97 ± 0.85 19.72 <0.001 LVLAVR at es 1.53 ± 0.42 1.39 ± 0.29 1.36 ± 0.31 1.35 ± 0.32 1.09 ± 0.26 5.85 <0.001 Female subjects (n = 153) 3rd decade (n = 31) 4th decade (n = 23) 5th decade (n = 30) 6th decade (n = 22) 7th decade (n = 47) F ratio p-value LVEDVI 69 ± 11 68 ± 10 62 ± 8 60 ± 9 63 ± 9 4.29 0.003 LVESVI 29 ± 6 29 ± 6 27 ± 5 26 ± 7 28 ± 6 1.45 0.220 Maximum LAVI 24 ± 5 24 ± 5 24 ± 5 25 ± 5 27 ± 5 1.73 0.147 Minimum LAVI 11 ± 2 11 ± 2 12 ± 3 13 ± 4 16 ± 4 16.59 <0.001 LVLAVR at ED 6.51 ± 1.36 6.20 ± 1.26 5.43 ± 1.28 4.67 ± 0.96 4.03 ± 0.81 25.46 <0.001 LVLAVR at ES 1.22 ± 0.22 1.22 ± 0.32 1.14 ± 0.33 1.06 ± 0.29 1.06 ± 0.25 2.08 0.087 LVED(S)VI, left ventricular end-diastolic (end-systolic) volume index; LAVI, left atrial volume index; LVLAVR, left ventricular left atrial volume ratio
P1411 Ultrasound-guided transseptal access in catheter ablation of left-sided tachyarrhythmias - single centre experience
Authors: Zizek D , Antolic B , Kajdic N , Zorz N , Breskvar U , Zupan Meznar A , Jan M
Published: January 2020

Background

Transseptal puncture (TSP) for catheter ablation (CA) of left-sided tachycardias is traditionally performed with the aid of fluoroscopy. Compared to fluoroscopy, intracardiac echocardiography (ICE) can provide better orientation and imaging of soft tissue structures that are relevant to TSP.

Objective

Our aim was to evaluate feasibility and safety of ICE-guided TSP in CA treatment of left-sided tachyarrhythmias.

Methods

Consecutive fluoroless CA procedures with combined use of three-dimensional electroanatomic mapping system and ICE requiring TSP were evaluated in 357 patients (269 male, mean age 54 ± 18 years) referred to our hospital from July 2014 to November 2018. Among CA treated left-sided tachyarrhythmias 55 patients had accessory pathway, 16 had focal atrial tachycardia, 276 had atrial fibrillation or atypical atrial flutter and 10 had ventricular tachycardia. Success of transseptal access and complications related to TSP were analyzed. Adverse event requiring additional intervention was defined as major complication.

Results

Double TSPs were performed in 253 patients and single in 104 patients. Additional ablation procedures were needed in 26 patients and the rest had a single CA procedure. Altogether, 661 TSPs (274 double and 111 single) were attempted and 659 were successful (99.7%). Both TSPs failed due to severely thickened interatrial septum after previous cardiac surgery. In 14 patients (21 TSPs, 3.2%) a cardiac implantable electronic device (CEID) was present. ICE provided excellent lead visualisation and no lead dislodgements were recorded. Additional radiofrequency energy application to the transseptal needle was used for 3 challenging TSPs. Minor complications (pericardial effusions managed conservatively) occurred after 7 double TSP procedures (12/661, 1.8%). Major complication with pericardial tamponade (requiring pericardiocentesis) occurred during one double TSP (2/661, 0.3%). No TSP-related embolic complications were observed.

Conclusion

ICE-guided TSP in CA of left-sided tachyarrhythmias is safe with excellent success rates. In addition, ICE could provide additional reassurance in difficult cases and in patients with CEIDs.
P1431 Safety of thoracentesis in patients with refractory heart failure: lung ultrasound guidance is obligatory and blind procedures are not justified
Authors: Lazarevic A , Dobric M , Kantar M , Goronja B , Krivokuca S , Jovanic J , Lazarevic N , Duronjic M , Picano E
Published: January 2020

Background

Pleural effusion refractory to diuretic treatment is frequent in advanced heart failure. Therapeutic thoracentesis (TT) is a time-honored practice, recently made simpler and safer by guidance with lung ultrasound.

Purpose

In order to elucidate safety of lung ultrasound-driven TT in refractory heart failure, we compared incidence of pneumothorax requiring surgical drainage in patients undergoing TT with or without lung ultrasound.

Methods and results

In a single-centre retrospective analysis we recruited 373 patients with heart failure with reduced ejection fraction (26 ± 12%), New York Heart Association class ≥3, and pleural effusion ≥ moderate at lung ultrasound. They underwent overall 493 TT. Evacuated pleural fluid by passive drainage was 1030 ± 534 mL. The maximal interpleural space was 73.6 ± 15.6 mm before, and 12.4 ± 3.1 mm after TT (p < .001). Two groups of TT were identified ex-post: 462 guided by lung ultrasound (Group 1); 31 without ultrasound guidance (Group 2), performed by cardiologist/pneumologist lacking access to ultrasound machine or expertise in lung ultrasound). The rate of complications (pneumothorax) was 0/462 in Group 1 and 3/31 in Group 2 (0 vs 10%, p < 0.001)

Conclusion

Lung ultrasound-driven TT of pleural effusion in decompensated heart failure patients is feasible and safe when performed by cardiologists guided by lung ultrasound. A blind TT without ultrasound guidance is associated with higher rate of pneumothorax, and should be avoided.
P1453 Unfortunate association between obstructive hypertrophic cardiomyopathy and infective endocarditis
Authors: Balauca N , Ianos R , Ulici B , Beyer R , Rosianu H
Published: January 2020

Bacterial endocarditis is an uncommon, but potentially severe complication of hypertrophic cardiomyopathy (prevalence < 1%).

We report the case of a 27-year-old woman, with low socioeconomic status, with hypertrophic cardiomyopathy, presenting with chest pain, dyspnoea at moderate effort, fever and chills. The transthoracic and transoesophageal echocardiography showed obstructive septal hypertrophic cardiomyopathy (interventricular septum of 38 mm, systolic anterior motion of the mitral valve, maximum gradient in the left ventricular outflow tract of 80 mmHg), vegetations of 10 mm, on the atrial and ventricular mitral leaflets sides, mitral valvular abcess, severe mitral regurgitation, flail of the noncoronarian aortic cusp (with a 10 mm vegetation), severe aortic regurgitation, basal SIV vegetation, pericardial effusion. The blood cultures were positive for Streptococcus mitis. The thoracic, abdominal, pelvin CT scan confirmed the diagnosis of mitral-aortic infective endocarditis , revealing also an abcess of the aortic root and multiple embolisations (spleen and right external iliac artery). The cranial CT scan was normal. At the evaluation of the foci sites, multiple dental foci were discovered and treated by multiple extractions. The endocarditis team recommended antibiotic treatment (with ampicillin), urgent bivalvular replacement (aortic and mitral valve) and septal myectomy. The surgical procedure was denied by the patient, which was after that voluntarily discharged from the hospital. The patient died from cardiac arrest (asystole) 11 days after the initial diagnosis.

A severe association between obstructive hypertrophic cardiomyopathy and infective endocarditis with multiple complications can have an initial paucisymptomatic clinical presentation.

The low socioeconomic status of the patient was correlated with inadequate oral hygiene, that was a negative prognostic factor in the outcome of the patient. It is possible that the integration of oral health in our national general health programs for people with low socioeconomic status, will decrease morbidity and improve the quality of life.

Abstract P1453 Figure. picture clinical case
P1474 Right or left; which sided the infective endocarditis is?
Authors: Baskurt A A , Ozpelit E , Kumral Z , Akdeniz B
Published: January 2020

ABSTRACT

Treatment and management of infective endocarditis (IE) depends on the side of involvement. Involvement of both sides of heart is rarely encountered. We describe one case of both sided infective endocarditis caused by staphylococcus auerus. In this case, the vegetation is thought to be on the right side of the heart at first examination by transthrorasic echocardiography (TTE). However; when examined more carefully with transoesophageal echocardiography (TEE), nothing was as it seemed.

CASE PRESENTATİON

A 86-year-old woman, who underwent mechanic aortic valve replacement surgery 11 years before, was admitted to emergency room with fever, dispnea and cough. Physical examination showed a temperature of 38.6. Electrocardiography showed a atrial fibrillation of 112 beats/min. Laboratory tests revealed an elevated C reactive protein of 211 mg/l. The patient was empirically treated with intravenous piperacillin-tazobactam and teicoplanin, by the recommendation of infection disease unit. Staphylococcus aureus grew in both bottles of blood cultures.

A TTE showed severe tricuspid regurgitation with vegetation, mild aortic regurgitation and moderate mitral regurgitation with no clear vegetation. We decided perform TEE and realised the vegetation in the right atrium was originated from the right atrial wall not from the tricuspid valve. Then we also noticed a thickening in the walls of aortic root with systolic expansion. This finding was consistent with paraaortic abscess formation. The 3D TEE examination helped us to understand the origin of the vegetation in the right atrium. Because the wall of the right atrium which the vegetation arised from was in direct continuity with the infected aortic root. We conclude that the paraortic abscess was spread to the right atrium by neighborhood. After one week of IV antibiotics treatment, the patient undergone open heart surgery. The surgical inspection confirmed the echocardiographic diagnosis.

DISCUSSION

Echocardiography helps us in diagnosis, determination of side of involvement, and complications of infective endocarditis. Usually the endocarditis invole only one side of the heart: left or right. We have found only four cases of double-sided endocarditis in literature. Our case is the first one , in which we describe a direct extension of aortic root abscess to the right atrium.

Abstract P1474 figure 1
P1501 Huge lateral wall ventricular pseudoaneurysm complicating a silent myocardial infarction
Authors: Almaghraby A , Abdelnabi M , Shehata H , Saleh Y , Ozden Tok O , Laymouna R , Elsharkawy E
Published: January 2020

Introduction

Mechanical complications of acute myocardial infarction (AMI) are mainly ventricular septal rupture (VSR), free wall rupture, and ischemic mitral regurgitation. If the patient survives the acute phase, negative remodeling starts to occur leading to aneurysm or pseudoaneurysm formation.

Case report

A 44-year-old male patient, smoker with a past medical history of hypertension, diabetes mellitus and no past cardiac history except for recurrent pericardiocentesis of hemorrhagic pericardial effusion in another hospital since 3 months with no available data, presented to our medical facility complaining of dyspnea grade III with no orthopnea or paroxysmal nocturnal dyspnea that started 4 months ago and progressed gradually with no history of any acute events. He was hemodynamically stable with no audible murmurs and clear chest auscultation. Transthoracic echocardiography (TTE) showed reduced left ventricular (LV) systolic function (ejection fraction 40%) with accidentally discovered large lateral wall ventricular pseudoaneurysm containing a large mural thrombus (Panels A and B) and a small pericardial effusion with no evidence of constriction or tamponade. Cardiac Computed tomography (CT) confirmed the presence of large ventricular pseudoaneurysm with mural thrombus lining the wall of the aneurysm (Panels C and D). Invasive coronary angiography (CA) revealed a total occlusion of the left circumflex artery (LCx) and non significant lesions in the remaining coronaries. The patient refused to have surgery and he was discharged on anti-ischemic, anti-failure measures and anti-coagulation with close follow-up.

Conclusion

Bedside echocardiography is still the mainstay procedure for diagnosis of mechanical complications following AMI and other imaging modalities such as cardiac CT and cardiac magnetic resonance (CMR) are new diagnostic tools for confirming the diagnosis and planning for further interventions. Although rare, mechanical complications of AMI should always be considered in every ischemic patient.

Abstract P1501 Figure. Echo and CT images
P1520 Aortic flow reversal caused by aortic regurgitation deteriorates renal function
Authors: Yamaguchi K , Yoshitomi H , Nakamura T , Okazaki K , Morita Y , Kawahara Y , Kagawa Y , Ouchi T , Sato H , Watanabe N , Endo A , Tanabe K
Published: January 2020

Background

Chronic kidney disease is a growing public health problem. Renal dysfunction is known as a strong risk factor for cardiovascular disease and end-stage renal failure. The presence of pan-diastolic flow reversal in the abdominal aorta is a very specific sign of severe aortic regurgitation (AR). A higher aortic reverse/forward flow ratio is associated with lower intrarenal forward flow. However, the influence of AR on renal function has been poorly understood. We hypothesized that the aortic flow reversal reduces the renal artery forward flow and accordingly leads to renal dysfunction in patients with severe AR.

Methods

The study consisted of 21 consecutive patients (mean age 69 ± 11 years) with severe AR who underwent aortic valve replacement (AVR). We compared echocardiographic indices and the glomerular filtration rate (GFR) before and 603 ± 541 days after AVR.

Results

Blood pressure was 122 ± 16/54 ± 8 mmHg before AVR and 123 ± 16/76 ± 11 mmHg after AVR. After AVR, left ventricular (LV) end-diastolic dimension decreased from 57 ± 9 to 44 ± 5 mm and LV ejection fraction increased from 58 ± 12 to 60 ± 11 %. Estimated GFR significantly increased from 62.9 ± 18.9 to 71.8 ± 18.1 mL/min per 1.73 m2 after AVR (p = 0.003).

Conclusions An increase in aortic flow reversal caused by severe AR reduces forward flow into the kidney and thereby deteriorates renal function. This study demonstrated a key mediating role of central hemodynamic factors, particularly an exaggerated aortic flow reversal in renal dysfunction and severe AR.
P1523 Impact of different techniques for mitral valve repair on left ventricular function: a 2D/3D echocardiographic analysis
Authors: Cimino S , Birtolo L I , Maestrini V , De Leo F , Vinciguerra M , Filomena D , Monosilio S , Luongo F , Neccia M , Petronilli V , Cantisani D , Greco E , Miraldi F , Fedele F , Agati L
Published: January 2020

Funding Acknowledgements

None

Aim

Different surgical techniques are available for mitral valve (MV) repair in patients with degenerative severe mitral regurgitation (MR). Leaflet resection (LR) and neochordoplasty (NP), both including ring annuloplasty (RA), are the most frequently performed techniques for posterior mitral leaflet prolapse/flail repair. Despite NP technique is supposed to preserve LV physiology more than LR, it is unclear which technique provides the best haemodynamic pattern. In the present study, the results of the two different surgical techniques in terms of left ventricular (LV) dimension and function are investigated.

Methods

23 consecutive patients who underwent MV surgical repair were enrolled. All patients underwent, before surgery and after 8 ± 2 months, 2D and 3D echocardiography with automatic (Heart Model, Philips) assessment of LV volumes and ejection fraction (EF), left atrial (LA) volume, right ventricular (RV) dimension and function, pulmonary artery systolic pressure (PASP), MR, tricuspid regurgitation (TR) and MVPG quantification. MR was corrected using 1) NP with polytetrafluoroethylene sutures and 2) triangular LR, both with RA. Patients were divided in 2 groups according to the surgical technique. Results: techniques were able to successfully correct MR. There were no significant differences in baseline echocardiogram and demographic characteristics between the two groups. There were no significant differences in terms of post-surgical MVPG between the two groups. In all patients a trend in reduction in LV dimension at follow-up was observed, but it was statistically significant only in NP patients (pre-surgical EDV 150 ± 41 VS post-surgical EDV 100 ± 27 ml, p = 0.03).

Conclusions

Both MV repair techniques showed a successful MV repair and an improvement in LV volumes at follow-up, especially in NP group. Further perspective studies are necessary to demonstrate the hypothesis of more physiological haemodynamic pattern associated with NP techniques.

Echo parameters pre VS post MV Repair Parameter pre post p value LVEDV RN (ml) 150 ± 41 100 ± 27 0.03 LVESV RN (ml) 58 ± 20 46 ± 14 NS LVEF RN (%) 58 ± 8 55 ± 7 NS LVEDV RR (ml) 160 ± 58 118 ± 31 NS LVESV RR (ml) 62 ±11 51 ±13 NS LVEF RR (%) 59 ± 8 57 ± 4 NS EDV: end-diastolic volume, ESV: end-systolic volume, EF: ejection fraction, RN = Ring + Neochordae; RR= Ring + Resect.
P1529 Impact of the new PH guidelines on echocardiographic definition leading to double demand of right heart catheterization
Authors: Fauvel C , Raitiere O , Burdeau J , Si Belkacem N , Bauer F
Published: January 2020

Background

Doppler echocardiography is the most widespread and well-recognized technique for the screening of patients with pulmonary hypertension (PH). When tricuspid regurgitation peak velocity (TRPV) ≥3.4 m/s, right heart catheterization is requested to confirm mean pulmonary artery pressure >25 mm Hg. In the proceedings from the 6th world symposium on pulmonary arterial hypertension recently released, the new definition of PH has been lowered to mean pulmonary artery pressure > 20 mm Hg.

Purpose

The purpose of our work was twofold : i) to determine a new cut-off value for TRPV to accommodate the new hemodynamic definition of PH, ii) to investigate the impact on the demand of right heart catheterization (RHC) from our echo CORE lab.

Methods

We extracted and analyzed both the haemodynamic and echocardiographic records of 130 patients who underwent investigations the same day. Tricuspid regurgitation peak velocity was measured in apical-4 chamber view using continuous-wave doppler modality and compared to mean pulmonary artery pressure recorded from fluid-filled catheter.

Results

Tricuspid regurgitation peak velocity has a weak correlation with mean pulmonary pressure (y = 9.2x-2.2, r² = 0.22, p < 0.01). Targeting a mean pulmonary pressure on right heart catheterization of 20 mm Hg for the definition of PH, receiver operating characteristic curve analysis demonstrated a good association between TRPV and PH diagnosis (area under the curve, 0.78 ; p < 0.001). The cut-off value obtained for TRPV was 3.0 m/s (Se = 0.78, Sp = 0.37). From 01/01/18 to 31/12/18, 2539 out of 6215 had TRPV recorded from which 283 had TRPV ≥ 3.0 m/s (24,1%) and 615 had TRPV ≥ 3.4 m/s (11,1%). When applied to a community population the new TRPV cutoff > 3m/s used as surrogate for mean pulmonary artery pressure > 20 mm Hg may produce a 111% increase of right heart catheterization demand.

Conclusions

The new definition of pulmonary hypertension (invasive mean pulmonary artery pressure > 20mm Hg) necessitates revisiting tricuspid regurgitation peak velocity > 3 m/s as a screening test leading to more than twice RHC demand.
P1532 Segmental assessment of left ventricle in patients with Fabry"s disease
Authors: Losi V , Rodolico M S , Faro D C , Licciardi S , Tamburino C , Monte I P
Published: January 2020

Anderson-Fabry disease (AFD) is a rare X-linked metabolic disorder due to deficiency in lysosomal enzyme activity of a-galactosidase A, resulting in pathological accumulation of glycosphingolipids in several tissues and a progressive multi-organ dysfunction.

The Global Longitudinal Strain (GLS) of the left ventricle (LV) by Speckle-tracking echocardiography (STE) has been show to detect subclinical cardiac involvement in many cardiomyopathies. The Mechanical Dispersion (MD), derived from STE is considered able to reflect a heterogeneous myocardial contraction, evaluated in many cardiopathies. A reduction in GLS was associated with myocardial fibrosis in the subclinical stages of AFD cardiomyopathy, but there is no MD data in AFD.

The aim of the study was to evaluate the distribution of GLS and MD of LV in patients with AFD.

47 consecutive AFD adult patients treated (37F, 12 M, age 45 + 17 years) were examined by a complete echocardiographic examination from a Vivid E95 ultrasound scanner (Horten, Norway). The STE post-processing was performed by Echopac 2.02, in apical long-axis, 4-chambers, and 2-chambers views to determine GLS and MD. Data were expressed as mean± standard deviation. The comparison between the AFD group and 20 normal subjects (N) was performed with unpaired T-test.

Compared to N, the AFD group showed higher values of LVMi, LAVi, E/E’, and MD, but a lower value of GLS (Table). GLS was significantly lower in the basal (sept p<.002; post p<.0001) and mid segments (ant-sept p<.008; post p<.0001; ant p<.001). MD was significantly higher in the inferior (basal p<.003; mid p<.01; apical p<.005) and lateral segments (mid p<.004; apical p<.001).

In patients with AFD, MD added to GLS seems to be a promising tool for the early diagnosis of segmental dysfunction .

Table1: Results AFD N p< m SD m SD LVMi g/sqm 77.1 29.8 62.3 14.1 0.008 LVEF % 65.7 5 63.6 3.5 0.04 LAVi ml/sqm 25.5 11 18.2 4.5 0.000 E/E" 8.3 3 5.4 1.1 0.000 TV vmax m/s 2.2 0.4 2.1 0.3 - LV GLS % -17 4 -20 2 0.003 LV MD ms 52 38 29 8 0.000
P1559 3D echocardiography improves the agreement between left ventricular and right ventricular stroke volumes in healthy individuals
Authors: Pilalidou A P , Kantartzi V K , Adamopoulos C A , Zitiridou L Z , Dimtsa M D , Sotiriou S S , Karakanas A K , Stamatiadis N S , Moschovidis V M , Koutavas N K , Zaravalis I Z , Konstantinidou M K , Gogos C G , Styliadis I S , Sachpekidis V S
Published: January 2020

Funding Acknowledgements

None

Background/Introduction: Calculation of the LV and RV stroke volumes (SV) with the volumetric method can be useful for assessment of valvular regurgitant volumes and intracardiac shunt ratios. However, this method often yields significant differences between the estimated LV and RV SV even in healthy subjects. We hypothesized that this discrepancy can be largely due to the assumption of LV and RV outflow tract circularity which forms the basis of 2D derived areas.

Purpose

To assess if the use of 3D transoesophageal (TOE) derived LVOT and RVOT areas can improve the agreement between LV and RV stroke volumes using the volumetric approach in healthy subjects with no valvular abnormality or intracardiac shunt.

Methods

We studied 20 patients (9 Males, age: 51 ± 19 y) submitted to TOE for various reasons, who had normal cardiac anatomy and function and good quality 3D TOE LVOT and RVOT data. Two dimensional TOE measurements of the LVOT and RVOT diameters were made in a zoomed mid oesophageal long axis and short axis view respectively; using these measurements 2D TOE LVOT and RVOT derived areas were calculated assuming circularity. In a similar way, we calculated the 2D LVOT and RVOT areas using data from transthoracic echo (TTE) for each patient. Offline analysis of the 3D TOE data allowed direct planimetry of the LVOT and RVOT areas devoid of any geometric assumptions. Finally, calculation of the 2D TTE, 2D TOE and 3D TOE LV and RV stroke volumes were performed for each patient based on the acquired data. The difference between LV and RV stroke volume (which theoretically should be around zero) for each technique and for each patient was also calculated.

Results

The mean LV and RV SV for the whole cohort, did not differ significantly within each method: 2D-TTE. However, the mean absolute difference between LV and RV stoke volumes for each technique was significantly lower with the use of 3D TOE compared to both 2D TTE and 2D TOE. Mean values and dispersion of absolute differences for each method are shown in Figure 1.

Conclusions

Compared to 2D, use of direct 3D TOE RVOT and LVOT planimetry yielded significantly less difference between RV and LV stroke volumes in healthy individuals. This finding can have potential clinical implications for more accurate assessment of valvular regurgitant volumes or intracardiac shunts.

The mean absolute difference LV-RV Absolute mean defference between LV and RV 95%ΔΕ F(2.38) p-value TTE 2D 18,65 ± 11,72 (13,2-24,1) 8.63 0.001 TOE 2D 13,45 ± 12,44 (7,6-19.3) 8.63 0.001 TOE 3D 6,45 ± 3,62 (4,8-8,1) 8.63 0.001

Abstract P1559 Figure. Bland Altaman Analysis
P1564 Changes in coronary flow velocity measuring during coronary bypass grafting can predict elevation of cardiac troponin
Authors: Zagatina A , Novikov M , Zhuravskaya N , Balakhonov V , Shmatov D
Published: January 2020

Background

Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to a hemodynamic law. The range of decreased velocity can hypothetically reflect the effectiveness of a graft. Grafting effect insufficiencies often cause elevations in periprocedural cardiac troponin (cTn) elevation. The aim of the study is to determine, if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict further cTn elevation.

Methods and results

Consecutive 68 patients (48 men, 64 ± 9 years old), who were referred for CABG, were included into the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries’ proximal segments. Measurements of coronary flow velocities was performed before and after grafting in the same sites of the arteries. The maximal value of cTnI within 48 hours after CABG was accounted for in the analysis. All patients had arterial hypertension, 15 patients (22%) had diabetes mellitus, 12 patients (18%) was current smokers. Forty-one patients (60%) had prior myocardial infarctions, 18 persons (26%) had previous coronary stenting. The ejection fraction before the operation was 56 ± 13%. Before grafting the mean velocity in the left main artery was 79 cm/s (25th-75th quartile, 42-111), in LAD 98 cm/s (25th-75th quartile, 71-125), and in LCx 116 cm/s (25th-75th quartile, 68-156).

There was a strong significant correlation between changes in coronary flow velocities and the value of cTnI (R = 0.56, p < 0.0004). The patients with and without significant elevations in cTnI had differences in coronary velocity changes before and after grafting (p < 0.009). Patients with elevated cTnI in more than 5 times, had, on average, an increase in the velocities for native arteries of 21 ± 19 cm/s.

Conclusion

Coronary flow velocity assessment during CABG could predict an elevation of cardiac troponins after cardiac surgery.

Abstract P1564 Figure.
Practical guidance for P2Y12 inhibitors in acute myocardial infarction undergoing percutaneous coronary intervention
Authors: Lee Seung Hun , Kim Hyun Kuk , Jeong Myung Ho , Yasuda Satoshi , Honda Satoshi , Jeong Young-Hoon , Lee Joo Myung , Hahn Joo-Yong , Kang Jeehoon , Chae Shung Chull , Seong In-Whan , Park Jong-Seon , Chae Jei Keon , Hur Seung-Ho , Cha Kwang Soo , Kim Hyo-Soo , Seung Ki-Bae , Rha Seung-Woon , Hwang Jin-Yong , Choi Dong-Ju , Oh Seok Kyu , Kim Sung Soo , Park Taek Kyu , Yang Jeong Hoon , Song Young Bin , Choi Seung-Hyuk , Gwon Hyeon-Cheol ,   KAMIR, JAMIR, and SMART-DATE Investigators
Published: January 2020

Aims

Potent P2Y12 inhibitors for dual antiplatelet therapy (DAPT) is crucial for managing acute myocardial infarction; however, the selection of drugs is based on limited clinical information such as age and body weight. The current study sought to develop and validate a new risk scoring system that can be used to guide the selection of potent P2Y12 inhibitors by balancing ischaemic benefit and bleeding risk.

Methods and results

Derivation cohort of 10 687 patients who participated in the Korea Acute Myocardial Infarction Registry-National Institutes of Health study was used to construct a new scoring system. We combined the ischaemic and bleeding models to establish a simple clinical prediction score. Among the low score group (n = 1764), the observed bleeding risk (8.7% vs. 4.4%, P < 0.001) due to potent P2Y12 inhibitors exceeded ischaemic benefit (1.3% vs. 2.2%, P = 0.185) during 12 months. Conversely, the high score group (n = 1898) showed an overall benefit from taking potent P2Y12 inhibitors from the standpoint of observed ischaemic (17.1% vs. 8.6%, P < 0.001) and bleeding events (10.1% vs. 6.8%, P = 0.073). The performance of ischaemic [integrated area under the curve (iAUC) = 0.809] and bleeding model (iAUC = 0.655) was deemed to be acceptable.

Conclusion

The new scoring system is a useful clinical tool for guiding DAPT by balancing ischaemic benefit and bleeding risk, especially among Asian populations. Further validation studies with other cohorts will be required to verify that the new system meets the needs of real clinical practice.
Maturity evaluation of orthodontically important anatomic structures with computed tomography
Authors: Ok Gokcen , Sen Yilmaz Berza , Aksoy Direnc Ozlem , Kucukkeles Nazan
Published: January 2020

Background/objectives

The success of the orthopaedic treatment is closely related to the patient’s skeletal maturation. This study aimed to evaluate the midpalatal suture (MPS), the zygomaticomaxillary suture (ZMS) maturation, and the closure degree of the spheno-occipital synchondrosis (SOS) in patients of different age groups. The presence of a correlation between these parameters and the palatal dimensions was also verified.

Subjects/methods

The study was based on computed tomography images of 314 patients between 7 and 30 years of age with no orthodontic treatment history. The images were retrieved from the archive of the Radiology Department of Bezmialem Vakif University Hospital and divided into six groups according to the patient’s age: 7–10, 11–13, 14–16, 17–20, 21–25, and 26–30 years. The maturation scores of ZMS, SOS, and MPS were determined, and palatal thickness and length were recorded. The data were analysed by using Statistical Package for Social Sciences for Windows 22.0.

Results

A positive relationship was found between SOS closure degree and MPS/ZMS maturation (MPS–ZMS: r = 0.816, MPS–SOS: r = 0.736, ZMS–SOS: r = 0.868, P = 0.000). The degrees of ZMS and MPS maturation were significantly increased as the SOS closure degree increased. The MPS maturation score was significantly lower in patients with a short and thick palate (MPS–palatal thickness: r = 0.405, MPS–palatal length: r = 0.387, P = 0.000).

Conclusions

A positive correlation indicated the simultaneous progress in the maturation of the SOS, MPS, and ZMS. Moreover, the ANS–PNS length increase was found to be correlated with the increase of the MPS, ZMS, and SOS maturation scores. In contrast, a negative correlation was observed between the palatal thickness and the maturation stage of these structures.
Genomic Analysis of Mycobacterium tuberculosis Isolates and Construction of a Beijing Lineage Reference Genome
Authors: Wang Woei-Fuh , Lu Mei-Yeh Jade , Cheng Ting-Jen Rachel , Tang Yi-Ching , Teng Yu-Chuan , Hwa Teh-Yang , Chen Yi-Hua , Li Meng-Yun , Wu Mei-Hua , Chuang Pei-Chun , Jou Ruwen , Wong Chi-Huey , Li Wen-Hsiung
Published: January 2020

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, kills over 1 million people worldwide annually. Development of drug resistance (DR) in the pathogen is a major challenge for TB control. We conducted whole-genome analysis of seven Taiwan M. tuberculosis isolates: One drug susceptible (DS) and five DR Beijing lineage isolates and one DR Euro-American lineage isolate. Developing a new method for DR mutation identification and applying it to the next-generation sequencing (NGS) data from the 6 Beijing lineage isolates, we identified 13 known and 6 candidate DR mutations and provided experimental support for 4 of them. We assembled the genomes of one DS and two DR Beijing lineage isolates and the Euro-American lineage isolate using NGS data. Moreover, using both PacBio and NGS sequencing data, we obtained a high-quality assembly of an extensive DR Beijing lineage isolate. Comparative analysis of these five newly assembled genomes and two published complete genomes revealed a large number of genetic changes, including gene gains and losses, indels and translocations, suggesting rapid evolution of M. tuberculosis. We found the MazEF toxin–antitoxin system in all the seven isolates studied and several interesting mutations in MazEF proteins. Finally, we used the four assembled Beijing lineage genomes to construct a high-quality Beijing lineage reference genome that is DS and contains all the genes in the four genomes. It contains 212 genes not found in the standard reference H37Rv, which is Euro-American. It is therefore a better reference than H37Rv for the Beijing lineage, the predominant lineage in Asia.