bluuebunny/crossref_metadata_2025 huggingface dataset:
P289 Aortic valve resistance risk-stratifies low-gradient aortic stenosis
Authors: Cho J , Uejima T , Nishikawa H , Yajima J , Yamashita T
Published: January 2020

Background

Grading the severity of aortic stenosis (AS) is challenging, since there is a discrepancy between aortic valve area (AVA) and mean pressure gradient (mPG). Arotic valve resistance (RES) has been proposed as a usuful descriptor of AS severity, but it is not commonly used for clinical decision-making, because its robust validation of clinical-outcome efficacy is lacking. This study aimed to investigate whether RES holds an incremental value for risk-stratifying AS.

Methods

This study recuited 565 AS patients (AVA < 1.5cm²) referred to echocardiography for valve assessment. The patients were divided into three different groups, according to the guidelines: high-gradient AS (HG-AS, mPG≥40mmHg, n = 157), low-gradient AS (LG-AS, mPG < 40mmHg + AVA ≤ 1.0cm², n = 155) and moderate AS (Mod-AS, mPG < 40mmHg + AVA > 1.0cm², n = 253). RES was calculated from Doppler measurement of mPG and stoke volume. The diagnositic cutoff point for RES was determined at 190 dynes × s×cm-5 by substituting AVA = 1.0cm² and mPG = 40mmHg into the definition formula of RES and Gorlin formula. The patients were followed up for 2 years. The endpoint was a composite of cardiac death, hospitalization for heart failure and aortic valve replacement necessitated by the development of AS-related symptoms.

Result

Kaplan-Meier analyses showed that LG-AS exhibited an intermediate outcome between HG-AS and Mod-AS (event-free survival at 2 years = 20.9% for HG-AS, 59.7% for LG-AS, 89.9% for Mod-AS, p < 0.001, figure A). When LG-AS was stratified by RES, the survival curves showed a significant separation (event-free survival at 2 years = 35.3% for high RES, 70.7% for low RES, p < 0.001, figure B). This trend persisted even when analysed separately for norml (stroke volume index > 35ml/m²) and low (stroke volume index ≤ 35ml/m²) flow state ((normal flow) event-free survival at 2 years = 38.7% for high RES, 70.4% for low RES, p = 0.023, figure C; (low flow) event-free survival at 2 years = 26.7% for high RES, 74.6% for low RES, p < 0.001, figure D).

Conclusion

This study confirmed the clinical efficacy of RES for risk-stratifying LG-AS patients.

Abstract P289 Figure.
P290 Differences in cardiac dimensions in mitral valve prolapse with or without Barlow phenotype
Authors: Kamoen V , Calle S , De Backer T , Timmermans F
Published: January 2020

Background

Mitral valve prolapse (MVP) is a common cause of chronic mitral regurgitation (MR). Barlow’s disease (BD) and fibro-elastic deficiency (FED) are two major entities of MVP affecting the connective tissue of the mitral valve, but both have a different underlying pathophysiology and phenotype. In some connective tissue diseases (CTD), it has been suggested that ventricular dysfunction occurs despite absence of MR, suggesting that CTD directly involve the myocardium. We therefore investigated whether patients with BD have different cardiac dimensions compared to FED, after correcting for MR severity grade.

Methods

134 patients with MVP and chronic MR were prospectively included. MR was graded carefully by echocardiography using a multi-parametric approach. The morphology of the mitral valve prolapse was specified as definite Barlow (n = 45) or non-Barlow (n = 89; FED, flail leaflet or unspecified etiology) by two experienced echocardiographers.

Results

In our cohort, MR was significantly more severe in the non-Barlow group compared to typical BD group (regurgitant volume (RV) 51 vs 33 ml, p = 0.021; right ventricular systolic pressure, 40 vs 34 mmHg, p= 0.05, left atrial volume index, 51 vs 42 ml/m², p = 0.07, respectively).

However, there was a trend towards higher left ventricular end-diastolic diameter index (LVEDDi, 27.7 vs 29 mm, p = 0.07) and a significantly higher end-diastolic volume index (LVEDVi, 62 vs 71 ml/m², p= 0.02) in the Barlow group, despite similar ejection fractions and much less MR in the Barlow group. This resulted in a significantly higher RV/LVEDV ratio in the non-Barlow group compared to the Barlow group (42% vs 23%, p = 0.001). Similarly, the LA volume/LVEDV ratio was significantly lower in the Barlow cohort (63 vs 79%, p= 0.026). There were no significant differences in aortic dimensions between groups.

Conclusions

We describe for the first time that compared to non-Barlow (mostly FED), patients with MVP due to typical Barlow disease have larger ventricular dimensions and volumes, which are disproportionate to the degree of MR. We therefore hypothesize that the connective tissue alterations in these patients may also involve the myocardium resulting in LV dilation independent of MR. Further investigation and clinical implications of these findings is mandatory.
P293 Assessment of right ventricle parameters during stress in patients with asymptomatic primary mitral regurgitation
Authors: Zvirblyte R , Tamulenaite E , Merkyte I , Saniukaite A , Vaskelyte J J
Published: January 2020

Background

Evaluation of right ventricle (RV) function and pulmonary artery pressure (PAP) during stress, plays an important role in identifying worse prognosis for patients with chronic mitral regurgitation (MR) and may help to optimise the time of surgical interventions.

Purpose

The aim of the study was to evaluate changes of RV function and systolic PAP in patients with asymptomatic primary MR during stress echocardiography.

Methods

Resting and stress (veloergometry as per protocol 25 + 25 W every 3 minutes) echocardiography were performed in 63 asymptomatic patients (age 56.12 ± 13.97 years) with preserved left ventricle (LV) ejection fraction (EF) (>50%) at rest. 39 (61.9%) patients with moderate (grade 2-3) MR (MR group) and 24 (38.1%) patients without significant heart valves disease (control group) were included in the study. Statistical analyses were performed using the SPSS 20.0 software. The value of p < 0.05 was considered as statistically significant.

Results

Anthropometric and clinical characteristics, LV EF (64.96 ± 9.14% vs. 64.87 ± 6.46%, p = 0.97) and LV global longitudinal strain (GLS) (-19.24± 3.12% vs. -19.28 ± 3.36%, p = 0.055) at rest were not significantly different between MR and control groups. Diameter of RV was larger in MR group (36.07 ± 5.34 mm vs. 33.13 ± 3.48 mm) however difference was not significant (p = 0.971). Parameters of RV function (longitudinal myocardial velocity - S’, fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE)) were similar in both groups at rest, during stress and at recovery phase (Picture 1). However TAPSE and S’ at rest (p = 0.037 and p = 0.205, respectively) and minimal stress (p = 0.006 and p = 0.035, respectively) were significantly lower in patients with MR who had highly increased (>60 mmHg) systolic PAP during stress. Also TAPSE (p = 0.002) and S’ (p = 0.017) during recovery phase were significantly lower in subjects with reduced LV contractile reserve (whom LV EF increased <4% or GLS <1.9% during stress). Systolic PAP during stress was growing much faster in patients with MR (Picture 1).

Conclusions

Patients with asymptomatic moderate primary mitral regurgitation had higher systolic PAP during stress even though at rest it was similar as in controls. Prominent severe pulmonary hypertension during stress was related to worsening parameters of RV function.

Abstract P293 Figure. Parameters of RV during stress
P295 Impact of Pre-existing Mitral Regurgitation on the Mid-Term Left Ventricular Mass Regression following Transcatheter Aortic Valve Implantation for Aortic Valve Stenosis
Authors: Horinouchi H , Nagai T , Ohno Y , Murakami T , Miyamoto J , Sakai K , Okada K , Nakazawa G , Yoshioka K , Ikari Y
Published: January 2020

Background

Transcatheter aortic valve implantation (TAVI) results in an immediate and greater aortic pressure gradient improvement in patients with severe aortic valve stenosis (AS), and induces early left ventricular (LV) mass regression, which may be related to favorable effects on the mid to long term outcomes. However, the extent of LV mass regression after unloading of chronic pressure overload is varying, and its determinants are still unknown. Thus, the study aims to identify echocardiographic determinants of LV mass regression following TAVI.

Methods

We retrospectively screened all TAVI procedures in symptomatic AS from 2017 to 2019, and selected 74 successful TAVI cases that had serial echocardiographic studies both at the baseline and at the mid-term follow-up (4 to 6 months after the procedure). Through the digitalized medical records, clinical and echocardiographic data as well as angiographic grading (0-3) of post-procedure paravalvular leakage (PVL) were obtained. LV mass was calculated by using Cube formula. Thus, the extent of LV mass regression was defined as the differences of left ventricular mas index (LVMI) between at the baseline and at the follow-up (ΔLVMI). Quantification of the baseline mitral valve regurgitant volume was performed by stroke volume method with pulmonic site measurement on the assumption of no pre-existing intra/extra cardiac shunt. Cases with prior mitral valve replacement were excluded.

Results

At the post-procedure angiogram, only 3 cases had significant PVL (grade 2≤). At the mid-term follow–up, average LVMI decreased significantly from the baseline (165 ± 38 g/m2vs 140 ± 37 mg/ m2, P < 0.0001) and 57 cases (70%) experienced the reduction of LVMI, although average relative wall thickness (2 × posterior wall thickness/left ventricular diastolic dimension) did not change (0.565 ± 0.135 vs 0.586 ± 0.168, P = 0.314). Among the baseline clinical and echocardiographic variables, the baseline peak A wave velocity, E/A ratio, mitral valve regurgitant volume and LVMI revealed simple correlation with ΔLVMI (γ=-0.298, p = 0.0188;γ=0.251, P = 0.0417;γ=0.354, p = 0.0041;γ=0.375, p < 0.0010; respectively), whereas no correlation was observed in angiographic PVL grade. Stepwise multiple regression analysis demonstrated baseline mitral valve regurgitant volume and LVMI as the determinants of ΔLVMI (β=0.344, p = 0.032; β=0.335 P < 0.0001; respectively).

Conclusions

Pre-existing mitral regurgitation has an impact on the mid–term left ventricular mass regression following TAVI. In severe AS, mitral regurgitation might be functioning as an afterload adjuster, and thus, produces protective effects on LV structure.
P299 Acute effects of Levosimendan on myocardial function in patients with severe mitral regurgitation and left ventricular dysfunction undergoing MitraClip repair
Authors: Cammalleri V , Tavernese A , De Vico P , Macrini M , Gismondi A , Muscoli S , Mauceri A , Stelitano M , Uccello G , Mollace R , Marino M M , Romeo F
Published: January 2020

Background

MitraClip system has developed as a valid therapeutic option in patients affected by moderate to severe and severe mitral regurgitation, low left ventricular ejection fraction (LVEF) and high surgical risk. Often, after the procedure occurs afterload mismatch, an acute and transient worsening of LVEF. Inotropic drugs can improve hemodynamic values at the prize of severe side effects. Levosimendan increases myocardial contractility without an elevation of intracellular calcium concentration, tachyarrhythmia and cardiomyocytes necrosis.

Purpose

Aim of our study was to assess the acute Levosimendan effects on LVEF of patients who underwent MitraClip procedure

Methods

Among 160 patients who underwent MitraClip procedure in our institute, 99 patients, with LVEF ≤35%, were included in the study. Transthoracic echocardiogram was performed in all patients, at moment of hospital admission and at discharge; transesophageal echocardiogram was performed during the procedure. We recorded the LVEF by modified Simpson’s rule. Periprocedural hemodynamic parameters were also recorded. 59 patients received Levosimendan during and early after the procedure (L-group) and 40 patients did not (no-L-group). Levosimendan perfusion was started at 0.01 μg/kg/min 1 h before the procedure without a loading dose, and maintained for 12h, according to hemodynamics.

Results

In the overall population, patients suffered from a severe reduction of LVEF (29.5 ± 5.3%) and high systolic pulmonary arterial pressure (sPAP) (51 ± 14.2 mmHg), without significant difference between the two groups. Acute procedural success was achieved in 98% of the study population, with 2 procedural failures in no-L-group (p = 0.16). During the procedure we observed a significant improvement of LVEF compared to baseline values only in L-group (from 29.6 ± 5.7% to 32.1 ± 7.6%, p = 0.046); in no-L-group the LVEF improved from 29.4 ± 5% to 30.2 ± 4.9% (p = 0.47); at discharge the LVEF was 31.3 ± 4.9% and 30.8 ± 5.7%, in L-group and no-L-group, respectively (p = ns compared to baseline and procedure). At discharge the sPAP significantly reduced in the overall population to 46.3 ± 12.7 mmHg (p 0.015): from 50.8 ± 12.3 mmHg vs 48.7 ± 11.9 in L-group (p = 0.35); from 51.2 ± 16 to 44.3 ± 13.2 mmHg (p = 0.04) in no-L-group. In-hospital mortality was 1.7% in L-group (1 patient die) and 0% in no-L-group. No relevant arrhythmias were reported in any patient during the hospital recovery.

Conclusion

In MitraClip patients with severe reduction of LVEF, Levosimendan has proven to improve hemodynamic outcome, increasing myocardial contractility during and early after procedure.
P300 Reappraisal of aortic stenosis severity grading inconsistencies using 3D aortic valve area
Authors: Capogrosso C , Beneduce A , Stella S , Ancona F , Ingallina G , Falasconi G , Pannone L , Melillo F , Ancona M , Montorfano M , Agricola E
Published: January 2020

Funding Acknowledgements

no fundings

Background

Different 3D imaging modalities have been proposed to overcome the limitations in aortic stenosis (AS) grading derived from underestimation of left ventricular outflow tract (LVOT) area by 2D transthoracic echocardiography (2D-TTE). Transesophageal echocardiography manual and software measurements (3D-TEEm and 3D-TEEs) and multidetector computed tomography (MDCT) have been recently been shown as valuable tools for AS grading using a combined approach incorporating 3D LVOT measurements and 2D Doppler parameters in the continuity equation (CE). This approach results particularly useful in cases of 2D-TTE grading inconsistence. As all these 3D imaging modalities provide larger AVA compared to 2D-TTE, we have recently proposed a 1.2 cm2 AVA cut-off could to define AS severity with 3D-TEE and MDCT.

Purpose

To compare AVA measurements with 3D-TEEm and 3D-TEEs using MDCT as gold standard in order to assess inconsistencies and evaluate the impact of a 1.2 cm2 AVA cut-off on AS severity grading.

Methods

288 patients (80 ± 11 years, 52.4% male) with symptomatic AS underwent 2D-TTE, 3D-TTEm, 3D-TEEs and MDCT within the same hospitalization. 3D-TEE LVOT reconstruction was performed manually and with semi-automated software (EchoPAC version 201). 3D-TEEm, 3D-TEEs and MDCT LVOT areas were combined with 2D-TTE Doppler parameters to calculate AVA by CE. The grading of AS was reassessed in patients with low flow-low gradient AS using a 1.2 cm2 cut-off for severity.

Results

Patients were classified according to flow state (stroke volume index ≥35 ml/m2 or <35 ml/m2) and mean pressure gradient (MPG ≥40 mmHg or <40 mmHg) into 4 groups: normal flow-high gradient (NF-HG; n 173, 60%), normal flow-low gradient (NF-LG; n 45, 15.5%), low flow-high gradient (LF-HG; n 39, 13.5%), and low flow-low gradient (LF-LG; n 31, 11%) AS. Among patients classified as LF-LG AS, 95%, 55%, 29% and 55% of cases were classified as severe by 2D-TTE, 3D-TEEm, 3D-TEEs and MDCT respectively using a 1.0 cm2 AVA cut-off. When the proposed severity AVA cut-off of 1.2 cm2 was applied using 3D imaging modalities, the proportion of severe AS significantly increased to 84% (p = 0.012) (3D-TEEm), 52% (p = 0.046) (3D-TEEs) and 71% (p < 0.001) (MDCT) respectively.

Conclusion

The use of a 1.2 cm2 AVA cut-off for 3D-TEE and MDCT significantly reduces the number of cases of inconsistently graded AS, increasing the proportion of patients with severe AS.
P304 The importance of echocardiographic pulmonary flow notch ratio in the assessment of patients with acute pulmonary embolism
Authors: Kurnicka K , Furdyna A , Goliszek S , Lichodziejewska B , Ciurzynski M , Dzikowska-Diduch O , Kostrubiec M , Palczewski P , Pruszczyk P
Published: January 2020

Background

There are several echocardiographic features such as right ventricle dilatation, interventricular septum flattening, McConnel sign and 60/60 sign reflecting the extent and severity of acute pulmonary embolism (APE). In quite a large number of APE patients we can observe a pulmonary flow (PF) profile abnormality in the form of a mid-systolic notch (MSN).

Purpose

To assess the profile of pulmonary Doppler flow in consecutive patients with acute pulmonary embolism and to establish its clinical utility.

Methods

We reviewed pulmonary Doppler flow profiles from 127 consecutive patients (m. age 64 years,72 F) with symptomatic APE managed in our department. APE was confirmed by contrast-enhanced multi detector computed tomography when thromboemboli were visualized at least in segmental pulmonary arteries. Individuals with preexisting pulmonary arterial hypertension were excluded. The pulmonary flow notch ratio (PNR) defined as the time from onset of PF until mid-systolic notch divided by the time from notch to the end of pulmonary ejection was evaluated. The comparison of patients with PNR < 1 (Group 1) and PNR > 1 (Group 2) was performed.

Results

We found the MSN in 50 patients (39.4%). Seventy seven patients had a normal shape of Doppler PF envelope. The presence of MSN was associated with more pronounced echocardiographic signs of right ventricle overload (RVOT diameter 32.4± 5.2 vs 29.1 ±3.3 mm, p < 0.001; TRPG 42.3 ± 14.4 vs 24.8 ±9.5 mmHg, p < 0.0001; RVSP 49.4 ±14.9 vs 31.2 ±10.6 mmHg, p < 0.0001; TAPSE 20.3± 4.1 vs 23.4 ±4.0 mm, p < 0.001; PF Acceleration Time 64.5 ±13.7 vs 109.8 ±24.6 ms, p < 0.001, and a presence of septal flattening). Obviously, patients with MSN presented more proximal location of thrombi in comparison to those with symmetrical shape of PF envelope (in MPA 18% vs 5.2%, p = 0.038 and in both LPA + RPA 22% vs 9%, p = 0.08, respectively). The PNR < 1 was found in 35 (70%) of 50 patients with MSN (Group 1). In these patients thrombi were located more proximally than in patients with PNR > 1 (Group 2), and angio-CT confirm anatomically massive PE. A percentage of patients with thrombi in both, left and right pulmonary arteries, in both lobar pulmonary arteries and lobar+ segmental arteries was higher in Group 1 (PNR < 1) than in Group 2 (PNR > 1): LPA + RPA: 28.6 vs 6.7%, lobar L and R: 57 vs 26.6%, lobar + segmental: 31 vs 20%. A number of patients with thrombi in the MPA was similar in both groups.

Conclusion

A noninvasive pulmonary flow notch ratio (PNR) may be useful for indicating APE patients with more extensive disease and proximal location of thrombi, at least in lobar pulmonary arteries.
P306 Left ventricular volumes during 3D transesophageal echocardiography in comparison to those obtained by 3D transthoracic echocardiogram. A feasibility study
Authors: Saha S K , Kiotsekoglou A , Gopal A S
Published: January 2020

Background

Three dimensional (3D) transthoracic echocardiogram (TTE) has been validated to have good agreement with cardiac magnetic resonance for the assessment of left ventricular ejection fraction (LVEF) with good interobserver reproducibility. Despite the increased use of perioperative transesophageal echocardiogram (TEE), TEE assessment of left ventricular (LV) function and volumes have never been validated against 3D TTE.

Objective

To evaluate whether 3D TEE measurement of LV function shows better agreement with 3DTTE, compared to 2DBiplane and X-plane TEE.

Methods

A total of 60 patients were included from a single large volume tertiary center, the mean age of 71.9 years, 40% were female; TTE and TEE studies were performed within one week. LV function parameters including LV EF, LV end-diastolic (LVEDV) and end systolic volumes (LVESV), stroke volumes (SV) were calculated with Qlab version 9, and 3DQ advanced software, with semi-automated endocardial contours for 3D TTE and 3D TEE. LV function parameters for 2D X-plane and Biplane TEE data sets were assessed using AGFA with manual endocardial contours. Mean differences were compared with paired, two-tail T-test, and limits of agreement were determined using the Bland-Altman analysis. Correlation between TTE and TEE values were tested using Pearson’s correlation test.

Results

3D transthoracic LV EDV, ESV, SV, and EF respectively were 112± 46 ml, 57 ±32 ml, 55± 55 ml, and 51 ±11%. Comparisons and correlations between TTE and TEE for the four measures were: for EDV bias = 9.94 ml and 95% lower and upper limits of agreements being -68.7 and 88.5 ml, and r= 0.7; for ESV the bias was -0.3 ml with 95% lower and upper limits of agreements being -55 to 55 ml, and r = 0.7: for stroke volume bias= 0.2 with 95% lower and upper limits of agreements being -37 to 67 ml, and r = 0.2; for LVEF the bias was 2.7% with 95% lower and upper limits of agreements being -18.9% to 24.3%, and r= 0.7 (Fig)

Conclusion

Left ventricular volumetric assessments during 3D transesophageal echocardiography is not only feasible but also comparable to 3D transthoracic echocardiography obtained LV volumes and EF. Data from multicenter studies with a larger number of subjects are needed to corroborate our findings.

Abstract P306 Figure. Fig. 3D LV volumes by 3D TEE vs. 3D TTE
P308 Changes in the echocardiographic phenotype during the evolution of cardiac amyloidosis from preserved to reduced left ventricle ejection fraction
Authors: Faga V , Mora Llabata V , Roldan Torres I , Saad A , Cuevas Vilaplana A M , Perez Gil M M , Arbucci R , Callizo Gallego R , Esteban Esteban E , Lowenstein J
Published: January 2020

Introduction

Cardiomyopaties like Cardiac Amyloidosis (CA), are an important cause of Heart Failure (HF). They can cause endocardial or transmural involvement. It is possible to characterize the kind of affectation thanks to different phenotypes identified by 2D speckle tracking echocardiography. Purpose: To study the pattern of myocardial involvement in patients (p) affected by CA and HF. Methods: Comparative study of 30 p with CA and HF, in NYHA class ≥II/IV, of which 16 had preseved left ventricle ejection fraction (pLVEF) and 14 had reduced LVEF (rLVEF), considering as cut point a LVEF > 50%. There was a control group (CG) of 16 healthy subjects. Twist, radial strain (RS), circunferential strain (CS) and longitudinal strain (LS) were determined using 2D speckle-tracking echocardiography, along with mitral annulus plane systolic excursion (MAPSE) and basal-apex distance (B-A). The following indexes were calculated: Twist (apical rotation + basal rotation, °); Torsion (twist/B-A, °/cm); Torsion Index (TorI: twist/MAPSE, °/cm), and Deformation Index (DefI:twist/LS,°). The last indexes are dynamic parameters that allow for a more realistic assessment of LV torsion, since they include longitudinal shortening measures such as MAPSE and LS, describing in a more complete and physiological way the global LV systolic movement.

Results

There were differences of age between the three gropus, being older the p with rLVEF and younger the ones in the CG (63,7 ± 2,8; 68,2 ± 11,5; y 73,9 ± 12,9 years respectively). LS and CS were lower in rLVEF group when compared with pLVEF group, as well as in pLVEF group compared with the CG. The p with pLVEF showed increased values of the dynamic torsion parameters (DefI and TorI), indicating a compensatory increase of LV twist that disappears in p with rLVEF. Twist and Torsion are significantly lower only in the rLVEF group (see table).

Conclusions

In both CA groups, LS and CS deterioration indicates endocardial and transmural involvement. The loss of compensation given by the increased LV twist, reflected by DefI and TorI, marks the transition to the deterioration of LVEF.

Results Table LVEF (%) LS (%) CS (%) TWIST (°) Torsion (°/cm) TorI (°/cm) DefI (°/%) Control Group (n = 15) 68.2 ± 6.3 -20.6 ± 2.5 -22.7 ± 4.9 21.7 ± 6.1 2.7± 0.8 16.4 ± 4.7 -1.0 ± 0.3 CA pLVEF (n = 16) 60,6 ± 5.4* -11.7 ± 4.2* -17.2 ± 4.8* 19.8 ± 8.3 2.5± 1.1 27.7 ±13.5* -1.8 ± 0.9* CA rLVEF (n = 14) 37.2 ± 8.8** -8.7 ± 3.2** -13.0 ± 3.4** 8.3 ± 5.6** 1.0 ± 1.7** 13.4 ± 9.6** -1.0 ± 0.7** *:p value <0,01 between CG and pLVEF group; **:p value <0,01 between pLVEF and rLVEF
P310 The role of the left ventricle deformation parameters determining reverse remodeling due to six months of spironolactone therapy
Authors: Sacharczuk W , Dankowski R , Baszko A , Sowinska A , Ozegowski S , Szyszka A
Published: January 2020

Introduction

Spironolactone is widely used in the pharmacotherapy of patients (pts) with HFrEF. However, there is still little information on the influence of spironolactone therapy on the global and regional left ventricular (LV) function.

Aim

Evaluation of the influence of regional deformation parameters on global LV systolic function as a result of six months of spironolactone therapy.

Methods

The study included 39 pts (mean age 64 years, with stable heart failure; NYHA class II-III, mean LVEF 37,4%, mean wall motion index score, WMSI 1,62). All pts received optimal standard treatment before entering the study. Then therapy of spironolactone 25mg daily was introduced. Clinical status, treadmill exercise test (compilation time and effort level), NT-pro-BNP and speckle tracking echocardiography (STE) assessment were analyzed. Two groups were created according to LV reverse remodeling (PRR -responders, 10% increase in LVEF and/or 15% decrease in LVESV; NRR- nonresponders). Differences between NRR I PRR, at the start point and after six months therapy of spironolactone for the above-mentioned parameters, were analyzed.

Results

Reverse remodeling was observed in 21 pts (PRR). There were no differences between PRR I NRR in: exercise test on the treadmill (compilation parameters: 27,86 vs 29,41), NYHA class, Nt-pro BNP levels (1071 vs 1172 pg/ml). WMSI in both groups was similar (respectively: 1,62 vs 1,61), however akinetic region in apical and septal regions of LV in NRR were more often represented (NRR 91,6% vs PRR 35% pts). PRR showed significantly better improvement of peak systolic longitudinal (LS) and circumferential (CS) strain in the apical (AP) and LV septal region of LV (SEP) depending on the post-infarction condition. (table 1)

Conclusions

Improvement of left ventricle systolic function depends on the regional contractility status of the myocardium. Longitudinal (LS) and circumferential (CS) peak systolic strain, regardless of ejection fraction and WMSI are the sensitive parameters determining improvements of the LV systolic function. The study showed that cut-off values to predict reverse LV remodeling must be lower than -10.08% for CS and -11.55% for LS.

Tab.1. CS nad LS value at the end point Region of LV NRR mean strain % PRR mean strain% p value (NRRvs PRR) CS AP -11,42 -15,47 0.03 CS SEP -12,3 -17,04 0.02 LV 3CH -13,42 -16,30 0.04 CA AP-circumferential strain in apical LV region, CS SEP- circumferential strain in septal LV region, LV 3CH- longitudinal strain in three-chamber view of LV
P313 Prognostic value of automated measurement of mitral annular displacement by speckle-tracking echocardiography in asymptomatic aortic stenosis patients with preserved left ventricular ejection fraction
Authors: Hozumi T , Teraguchi I , Takemoto K , Fujita S , Wada T , Kashiwagi M , Shimamura K , Shiono Y , Kuroi A , Matsuo Y , Ino Y , Kubo T , Tanaka A , Akasaka T
Published: January 2020

Background

Management of patients with asymptomatic severe aortic stenosis (AS) and preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies have shown prognostic value of decreased LV global longitudinal strain in AS patients with preserved LVEF. Tissue-tracking mitral annular displacement (TMAD) in single apical four-chamber view (AP4) by speckle-tracking echocardiography provides automated rapid assessment of LV longitudinal deformation (Figure). This simple method may be useful for the prediction of cardiac events in asymptomatic severe AS patients with preserved LVEF.

Purpose

The purpose of this study was to examine the value of TMAD to predict cardiac events in asymptomatic severe AS patients with preserved LVEF.

Methods

The study population consisted of 103 patients with severe AS and preserved LVEF [aortic velocity >4m/s or aortic valve area (AVA) <1.0 cm², LVEF >50%]. After exclusion of 56 patients who met the exclusion criteria (symptomatic, atrial fibrillation, significant mitral valve diseases, history of cardiac surgery, short follow-up period <120 days, and inadequate echocardiographic images), the final study population consisted of 47 patients. Using TMAD analysis software (QLAB 10.5, Philips), the base-to-apex displacement of automatically defined mid-point of mitral annular line in AP4 was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated . We investigated the occurrence of the cardiac events including appearance of symptoms, decreased LVEF (< 50%), and cardiac death.

Results

%TMAD was successfully and quickly evaluated in 44 (94%) of 47 patients. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 1.9 vs 12.1 ± 2.6%, p= 0.002). There were no significant differences in the other parameters including age, LVEF, aortic velocity, AVA, tricuspid regurgitation pressure gradient, early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’ between the patients with and without the cardiac events. Receiver operating characteristic analysis revealed that area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac events (hazard ratio 14.8, 95% CI, 2.75-79.3; p= 0.002).

Conclusions

The present results suggest that automated TMAD measurement by speckle-tracking echocardiography may be useful to predict cardiac events in asymptomatic severe AS patients with preserved LVEF.

Abstract P313 Figure
P326 Changes in left atrial dimensions during stress echocardiography: linear vs planimetric methods
Authors: Torres M A R , Texeira T F , Camarozano A C , Bertoluci C , Heidemann Jr A I , Pianca E G , Branchi M N , Quevedo N M , Bellagamba C C A , Rodrigues J , Simbine R E B , Morrone D , Ciampi Q , Picano E
Published: January 2020

OnBehalf

On behalf of the Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)

Background The measurement of left atrium (LA) can be obtained with simple linear or more complex biplane disk summation Simpson (S) method at rest and during stress echocardiography (SE). Although planimetric methods are mandatory to accurately assess resting LA volume, we sought to study if linear (L) methods can be equally valuable in assessing dynamic changes during SE.

Purpose

To assess accuracy of LA- SE with S compared to L method.

Methods

SE was performed in 34 patients (age 59 ± 16 years, 18 females) with known or suspected coronary artery disease. All had acceptable acoustic window at rest and were referred for clinically-driven SE (dobutamine in 21, dipyridamole in 13). LA was measured at rest and peak stress with both methods: 1- S biplane method from 4- and 2-chamber views; 2- L method with measurement of anteroposterior diameter from 2-D targeted M-mode in parasternal long-axis view. Two independent observers measured a set of 20 clips and repeated the measurements after 1 month on the same images. Stress-rest differences of L and S were compared with Spearman non-parametric correlation.

Results

LA measurement was obtained in all patients with L, 34/42 with S (feasibility 100%, and 80%, respectively). The off-line analysis time at each step (rest and stress) measured by stop-clock was 22.3 sec for L and 93 sec for S method (p < 0.001). The intra-rater intra-class correlation coefficient for L was 0.965 for single measures and 0.982 for average measures. For S, it was 0.830 in single measures and 0.907 for average measures. The inter-rater correlation coefficient for L was 0.920 for single measures and 0.958 for average measures. For S, it was 0.901 for single measures and 0.948 for average measures. Absolute LA dimensions were moderately correlated between S and L at rest (r = 0.61, p < 0.01), and during stress (r = 0.476, p < 0.01). Rest-stress variations were not correlated (r = 0.004, p = NS).

Conclusion LA measurement is highly feasible during SE with L and S methods. Absolute values with both are only moderately correlated at rest, less at peak stress, and not correlated when only rest-to-stress variations are considered. Although L is more feasible, less time-consuming, and more reproducible, S should be the first choice for more accurate assessment of rest-stress LA dimensions in pharmacologic SE.

Abstract P326 Figure. Correlation of LA rest-stress
P332 is 3D analysis of longitudinal strain useful to predict cardiac events in patients undergoing mitral valve repair?
Authors: Volpato V , Mantegazza V , Manfredonia L , Gripari P , Fusini L , Tamborini G , Pepi M
Published: January 2020

Background

The presence of abnormal 3D left ventricular (LV) strain values in patients diagnosed with mitral valve prolapse (MVP) and significant mitral regurgitation (MR) has been described previously. Recently, some studies showed an addictive prognostic role of Global Longitudinal Strain (GLS) in patients with severe aortic regurgitation. Few data are available about the prognostic role of LV strain in patients diagnosed with severe MR secondary to Myxomatous or fibroelastic deficiency (FED) MVP, undergoing MV repair.

Purpose

The aim of the study was to determinate whether LV GLS, strain rate, twist rate and left atrial strain (LAS) may identify a subgroup of patients with MVP and severe MR at higher risk of clinical events after surgical repair in both Myxomatous and FED disease.

Methods

We retrospectively studied 100 patients diagnosed with MVP and severe MR due to Myxomatous or FED disease, eligible for MV surgery between 2012 and 2015. Only patients with normal LV function who underwent a 3D transthoracic echocardiographic examination were included. 3D LV GLS, strain rate, twist rate and LAS were measured using 3D analysis software. Clinical data were recorded during a median follow-up of 48 months. Clinical events included cardiac death, arrhythmia and cardiac hospitalization for heart failure or arrhythmic events.

Results

65 patients were diagnosed with Myxomatous and 35 with FED disease. A total of 13 events were recorded during the follow-up, including 1 death, 2 hospitalizations for heart failure and 10 minor arrhythmic events, mostly isolated premature ventricular complex. The number of events was not statistically different between the two groups. In both groups no significant correlation was found between clinical events and each of the echocardiographic parameters measured.

Conclusion

In patients with MVP and severe MR but normal LV function, undergoing MV repair, LV strain analysis was not able to predict long term cardiac events., regardless of the etiology.
P343 Evaluation of the age-related reference values of aortic pulse wave velocity in healthy subjects using Doppler echocardiography
Authors: Styczynski G , Cienszkowska K , Ludwiczak M , Szmigielski C
Published: January 2020

Introduction

Aortic pulse wave velocity (aPWV) is a measure of aortic stiffness, which is an indicator of vascular aging and has established independent prognostic role in predicting cardiovascular complications. aPWV can be measured with various non-invasive methods, but with different reference values depending on the technique used. The Doppler echocardiography method is potentially widely accessible and has been recently showed to have high correlation with invasive reference method of aPWV based on intraarterial pressure evaluation.

Purpose

The aim of the study was to establish reference values of aPWV, measured by Doppler method during a standard echocardiography in healthy subjects.

Methods

121 healthy adults, normotensive, non-smoking, without chronic diseases and not taking medication, were included. All the patients were divided into 5 groups due to age criterion (D1-age 21-30 yrs., n = 33; D2-age 31-40 yrs., n= 23; D3-age 41-50 yrs., n = 26; D4-age 51-60 yrs., n = 22; and D5-age 61-70 yrs., n = 17). During a routine echocardiographic examination with a cardiac probe, standard echocardiographic and anthropometric parameters were acquired. Additionally, 10 Doppler waveforms were recorded in the distal aortic arch and then in the left external iliac artery. The transit time was calculated as a difference between time delay of the two points of the Doppler recordings relative to ECG signal. The distance between proximal and distal points was measured over the body surface using a flexible measuring tape. aPWV values were calculated according to the formula: PWV = distance/transit time.

Results

The mean age of the studied group was 42 ± 13 yrs., BMI 24.5 ± 3.4, SBP 123 ± 10.39 mm Hg, DBP 76.98 ± 6.53 mm Hg, HR 64 ± 10 bpm. aPWV 5.28 ± 1.07; LVEDD 4.6 ± 0.4 cm; LA 3.65 ± 0.33 cm; aorta 3.26 ± 0.38 cm; LVMI 87.12 ± 15.00 g/m2. In the studied subjects, aPWV did not differ according to sex (females, n = 53, aPWV 5.38 ± 1.21 m/s vs. males, n = 68, aPWV 5.21 ± 0.94 m/s, p = 0.37). In the multivariate linear regression analysis only age and SBP were independently associated with aPWV, but none of the echocardiographic parameters studied. Mean aPWV values with 95% confidence interval (95%CI) for each decade of life were recorded as follows: D1-age 21-30, aPWV 4.56 m/s (95%CI 4.41 to 4.72), D2-age 31-40, aPWV 4.65 m/s (95%CI 4.37 to 4.94), D3-age 41-50, aPWV 5.15 m/s (95%CI 4.88 to 5.43), D4-age 51-60, aPWV 5.96 m/s (95%CI 5.54 to 6.38), D5-age 61-70, aPWV 6.88 m/s (95%CI 6.42 to 7.34).

Conclusions

We report age-related values of aPWV in a healthy population measured by Doppler echocardiography method. This may be helpful in future research exploring the associations between aortic stiffness, cardiac function and cardiovascular prognosis in a large population of patients referred for echocardiography.
P345 Temporal changes of left atrial function after orthotopic heart transplantation in a single-center prospective study
Authors: Dohy Z , Czimbalmos C , Assabiny A , Tarjanyi Z , Szakal-Toth Z , Parazs N , Toth A , Suhai F , Kiraly A , Edes I , Becker D , Sax B , Merkely B , Vago H
Published: January 2020

Funding Acknowledgements

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

The geometry and function of the left atrium (LA) change after orthotopic heart transplantation (HTX) with bicaval technique, as the LA has a recipient part around the pulmonary veins and a donor part, and these often contract separately. Because of this altered LA function, the recognition of left ventricular diastolic dysfunction can be challenging. The standard echocardiographic diastolic parameters are often in abnormal range in HTX patients despite of normal left ventricular diastolic function.

The aim of our prospective study was to investigate the LA volumes and function and their temporal changes after HTX using cardiac magnetic resonance (CMR).

To better understand the cardiac characteristics of HTX patients, we started a prospective trial in January 2018. CMR was performed at one, three and six months after HTX. Left atrial contour detection was performed in 2- and 4-chamber views. Patients who had ≥Grade II allograft rejection before the CMR examination, were excluded (n = 2). In the remaining HTX patients (n = 21) and in a control group (n = 21) LA ejection fraction (EF), BSA-corrected maximum and minimum LA volume (Vi), stroke volume (SVi) were evaluated using bi-plane mode. LA global longitudinal strain (GLS) was defined with CMR based deformation imaging, called feature tracking.

HTX patients had significantly higher LA volumes (maxLAVi 71 ± 22 vs. 47 ± 6 ml/m2, minLAVi 53 ± 22 vs. 18 ± 5 ml/m2) lower LASVi (19 ± 7 vs. 29 ± 4 ml/m2), LAEF (27 ± 10 vs. 62 ± 8%) and LA-GLS (8 ± 3 vs. 39 ± 10%) compared to the control group (p < 0.0001).

Analysing the temporal changes in HTX patients, we found an increase in the LAEF (26 ± 8 vs. 30 ± 5%) and LA-GLS (8 ± 3 vs. 11 ± 3%) at three months (p < 0.05), there was no significant difference between the LA parameters at three and six months.

Better understanding of the changes of left atrial function after HTX could help us to recognise pathological conditions.

Abstract P345 Figure. Strain analysis of the left atrium
P347 Profile of coagulase negative staphylococci native valve infective endocarditis in a referral hospital
Authors: Ruiz Martinez B , Vallejo Camazon N , Seder Colomina E , Gonzalez Lopera M , Nunez Aragon R , Dolores Quesada M , Mateu L , Ferrer Sistach E , Pedro Botet L , Bayes Genis A
Published: January 2020

Coagulase-negative staphylococci (CNS) are the most frequently isolated microorganisms in early

prosthetic endocarditis. On the other hand, they rarely affect the native valve, so the profile of

native valve endocarditis by CNS is little known.

METHODS

Prospective observational study with retrospective analysis of 468 episodes of infectious

endocarditis (IE) admitted to our hospital from 2003-2018. Of these, 54 (11%) corresponded to IE by

CNS, and 22 were in native valve. We describe the characteristics of these 22 patients and compare

them with the group of IE by CNS in prosthesis and devices.

RESULTS

Average age was 67 years, with 77% male sex. There were no differences in predisposing

factors. Acquisition was predominant in-hospital (54%), but only previous manipulation was

detected in 31%. The presence of clinical and echocardiographic complications was similar, with

higher incidence of heart failure in the native group (81 vs. 34%, p = 0.001). Surgery was indicated in

86%, but only 50% underwent surgery. Mortality was very high (68% ) even greater than the

prosthetic/device group, although without significant differences.

CONCLUSION

IE due to CNS in native valve present clinical complications, frequently require surgery

and has a high mortality rate.
P353 Structural, functional, and electromechanical alterations in patients with paroxysmal atrial fibrillation compared to healthy controls
Authors: Trivedi S , Stefani L , Brown P , Kizana E , Kumar S , Thomas S , Thomas L
Published: January 2020

Background and Methods

We sought to evaluate the clinical and echocardiographic differences between healthy controls and paroxysmal atrial fibrillation (AF) patients. Clinical and echocardiographic parameters (performed in sinus rhythm) in 46 paroxysmal AF patients were compared with a departmental database of 83 health controls.

Results

AF patients were older and had increased body size (Table 1). 39/46 (84%) of AF patients had hypertension and 23/46 (50%) had diabetes mellitus.

AF patients had increased left ventricular (LV) mass, and reduced diastolic function (lower e’ and increased E/e’ ratio) when compared to healthy controls. Left atrial (LA) volumes were significantly increased in the AF group. All strain parameters – reservoir, conduit, and contractile strain – were impaired in AF patients compared to controls. LA mechanical dispersion (MD) was significantly increased in AF patients. A ratio of indexed LA volume/LA reservoir strain was significantly higher in AF patients over controls.

The duration of AF had an inverse correlation with LA reservoir strain (Fig 1) (r=–0.78; p < 0.001).

Conclusions

Compared to healthy controls, patients with paroxysmal AF have significant structural, functional and electromechanical alterations. LA strain is significantly impaired in paroxysmal AF and correlates with AF duration.

Table 1. Echocardiographic parameters Parameter Controls (mean ± SD) AF patients (mean ± SD) P value Age (years) 48 ± 18 58 ± 14 0.001 Body surface area (m2) 1.9 ± 0.2 2 ± 0.2 0.014 LV mass (g) 178 ± 48 223 ± 68 <0.001 Average e’ velocity (cms-1) 10.3 ±2.7 8.1 ± 2.2 <0.001 E/e’ 7.4 ± 1.9 9.3 ± 3.4 0.001 Indexed LA end systolic volume (ml/m2) 27.2 ± 7.1 39.0 ± 11.6 <0.001 LA ejection fraction 55.2 ± 10.4 48.5 ± 14.0 0.007 LA functional index 43.7 ± 14.6 29.8 ± 14.3 <0.001 LA reservoir strain (%) 34.3 ± 6.8 27.9± 8.1 <0.001 LA conduit strain (%) 18.4 ± 6.2 13.5 ± 4.7 <0.001 LA contractile strain (%) 15.9 ± 3.9 14.4 ± 5.5 0.007 LA mechanical dispersion (ms) 25.8 ± 9.6 30.9 ± 11.6 0.018 Indexed LA volume / Reservoir strain ratio 0.8 ± 0.3 1.6 ± 0.9 <0.001 LV = left ventricular; LA = left atrium; SD = standard deviation

Abstract P353 Figure. Fig 1. AF duration vs. Reservoir strain
P366 Role of mechanical dispersion in the prediction of heart failure admissions in dilated non ischemic cardiomyopathy
Authors: Travieso Gonzalez A , Ferrandez Escarabajal M , Islas F , Luaces M , Perez De Isla L , Olmos C
Published: January 2020

Introduction

Non ischemic dilated cardiomyopathy (DCM) is a disease with poor prognosis and limited therapeutic options. Several echocardiographic measures attempt to provide good estimators of the risk of heart failure (HF) admissions.

Purpose

To assess the potential additional value of mechanical dispersion (MD) compared to global longitudinal strain (GLS) in the prediction of outcomes in DCM.

Methods

74 patients with DCM and left ventricle ejection fraction (LVEF) of less than 50% were prospectively evaluated from 2015 to 2019. MD and GLS were blindly measured using 2D speckle tracking echocardiography. Hospital admissions due to worsening HF were examined.

Results

Mean LVEF was 29.4%, and median follow-up time was 14 months. Baseline characteristics are shown in Table 1.

Patients with high MD, defined as >67 ms, showed a significantly higher risk of admissions due to HF (50.5% vs 22.0%, p = 0.026), even when adjusted with LVEF and end-diastolic volume in multivariable analysis, with a hazard ratio of 2.6 (95% confidence interval 1.1-6.1) (Figure). No differences in the use of cardiac resynchronization therapy and implantable cardioverter defibrillator were observed in both groups. This cut off value had a Sensitivity of 52.2% and Specificity of 76.5%.

Despite significant correlation between MD and GLS (R = 0.36, p = 0.002), a GLS of less than -10% was not significantly associated with higher incidence of HF admissions in this population (40.6% vs 23.8%, p = 0.229).

Conclusion

Mechanical dispersion, measured by 2D speckle tracking echocardiography, predicts HF admissions more accurately than global longitudinal strain in patients with non-ischemic DCM.

Table 1 Mech. Disp <67 ms (n = 50) Mech. Disp ≥67 ms (n = 24) p Age 62.2 (±2.2) 64.6 (±3.0) 0.538 Female sex 13 (26.0%) 10 (41.7%) 0.173 NYHA class III-IV 4 (8.5%) 3 (13.6%) 0.882 CRT 23 (46.0%) 12 (50.0%) 0.747 ICD 27 (54.0%) 17 (70.0%) 0.167 QRS duration (ms) 144.2 (±8.6) 152.7 (±7.9) 0.496 NTproBNP (pg/ml) 4495 (±964) 4488 (±1529) 0.997 LVEF (%) 29.9 (±1.1) 28.6 (±1.7) 0.520 LVEDV (ml/m2) 93.0 (±5.6) 95.2 (±5.8) 0.802 Table 1: baseline characteristics in population with MD <67 ms or ≥ MS. Data is shown as N(%) or Mean(±SD). CRT: cardiac resynchronization therapy. ICD: implantable cardioverter defibrillator. LVEDV: LV end-diastolic volume.

Abstract P366 Figure