bluuebunny/crossref_metadata_2025 huggingface dataset:
P929 Routine Left Atrium Strain in acute STEMI: to do or not to do
Authors: Tadic S , Ilic A , Stefanovic M , Stojsic-Milosavljevic A , Stojsic S , Popov T
Published: January 2020

Introduction and purpose

Left atrium strain (LAS) is a very useful, modern method of establish left atrium (LA) function and rarely use in predicting adverse events (AE) in acute anterior ST-elevated myocardial infarction (STEMI). The purpose of our study was to compare LAS among other echocardiographic parameters of LA and left ventricle (LV) function, in patients that developed AE (heart failure, all cause mortality, reinfarction and rehospitalization) after acute anterior STEMI during one year follow up.

Methods

All 101 patients with a first acute anterior STEMI treated by primary PCI had early echocardiography in first 24 hours. After one year follow up, patients were divided in two groups: AE group (27 patients; 27%) and non-AE group (74 patients; 73%). We compared: LA size, LA maximal volume index, LAS, systolic and diastolic left ventricle parameters, between groups for the purpose of identifying early AE predictors.

Results

Among all left atrium parameters, LA strain was most prognostic for AE between groups (AE group vs. non-AE group): LA diameter (3,7cm vs. 3,5cm, p = 0,03), LA maximal volume index (27 ml/m2 vs. 24,5 ml/m2, p = 0,03), LAS (30% vs.37%, p < 0,0001)

Statistically significant differences in systolic and diastolic LV function between AE and non-AE groups were: ejection fraction (p < 0.0001), stroke volume index (p < 0.0001), fractional shortening (p < 0.0001), cardiac index (p < 0.0001), LV systolic work (p < 0,0001), WMSI- wall motion score index (p < 0,0001), average LV peak systolic longitudinal global strain- LGSav (p < 0,001), mitral inflow peak early velocity/average mitral annular peak early velocity- E/e"av (p < 0,001).

After adjustment for all echocardiographic parameters, LA strain (OR 0,91 95% CI, p = 0,04), WMSI ≥ 2 (OR 6.1 95% CI, p < 0.001), average peak systolic left ventricle LGS (OR = 15.1 95% CI, p < 0.0001) and cardiac index (OR 2.6 95% CI, p = 0.01) were independently associated with adverse outcomes.

Conclusion

Routine left atrium strain is very prognostic parameter of high-risk STEMI patients for adverse events and could possibly be considered as an important component of the new predictive score system for MACE and mortality of STEMI patients in the near future.
P934 Left atrial strain association with left ventricular diastolic function
Authors: Rodriguez Sanchez I , Anton A , Onaindia J J , Velasco S , Florido J , Oria G , Cacicedo A , Urkullu A , Benegas A
Published: January 2020

Objectives

to evaluate the relationship between left atrial (LA) peak strain and left ventricular (LV) diastolic function and determine whether LA strain could be used to detect elevated filling pressures in a population of patients with preserved LV ejection fraction (LVpEF).

Background

the assessment of diastolic function is complex and multiparameter. 2016 ASE and EACVI algorithm has simplified this approach, but there are still patients with discrepant values leading to an indeterminate diagnosis, specially in patients with preserved ejection fraction.

Methods

we prospectively included 129 patients in our cohort. Inclusion criteria were LVEF > 50% and sinus rhythm. Patients with atrial fibrillation, significant mitral valvulopathy or poor quality imaging were excluded. Two-dimensional speckle tracking was used to measure peak LA strain in all LA segments (using apical 4 chamber, 2 chamber and 3 chamber views). We evaluated the association of LA global peak strain and LA 4 chamber peak strain with the different categories of diastolic function according to the 2016 ASE and EACVI algorithm.

Results

Both LA global peak strain and 4 chamber LA peak strain showed a progressive decrease with worsening diastolic dysfunction (DD) severity (Table 1). A global LA peak strain cutoff value of 28,35% was very accurate to differentiate normal from elevated filling pressures (normal function or grade 1 DD from grades 2 and 3 DD). Diagnostic accuracy: 80.20%; area under the curve: 0,80 (0,72-0,88); A significant group of patients (21,1%) could not be categorized using 2016 algorithm.

Conclusions

Both LA global peak strain and 4 chamber LA peak strain demonstrated a progressive decrease with worsening DD severity. Global LA peak strain value of 28,35% was an accurate cutoff to differenciate patients with normal vs elevated filling pressures.

LA strain values and diastolic function Total LA global peak STRAIN LA 4C STRAIN N (%) p-value p-value Total 129 30.90 %(11.77) 30.43 (12.36) Diastole <0.0001 <0.0001 Normal function 36 (28.13) 39.72% (9.59) 39.98 (10.59) Indeterminate Diastolic Function 23 (17.97) 31.07% (7.97) 30.19 (7.50) Indeterminate DD 4 (3.13) 30.68 % (6.72) 29.75 (7.31) grade 1 DD 22 (17.19) 32.69 % (12.54) 32.98 (14.46) grade 2 DD 36 (28.13) 23.90 % (9.32) 23.53 (9.49) grade 3 DD 7 (5.47) 15.43 % (5.72) 15.85 (7.32)
P935 Association of intracellular iron status with left ventricular systolic function response to exercise in heart failure with preserved ejection fraction
Authors: Przewlocka-Kosmala M , Jasic-Szpak E , Jankowska E A , Ponikowski P , Kosmala W
Published: January 2020

The intracellular iron depletion has been recognized to contribute to the dysregulation of cell energetics. The soluble transferrin receptor (sTfR) is regarded as a marker of cellular iron balance, and its elevated level reflects an insufficient iron delivery to target tissues. Despite the strong pathophysiological link, there is a scarcity of data on the impact of intracellular iron status on myocardial performance.

Aim

To investigate the association between the intracellular iron status, as assessed by sTfR, and left ventricular (LV) function in a well-characterized population with heart failure and preserved ejection fraction (HFpEF).

Methods

A complete echocardiogram including evaluation of LV global longitudinal deformation by speckle tracking (GLS) was performed at rest and immediately post-exercise in 83 pts (age 66 ± 8 yrs) with symptomatic HFpEF.

Results

Pts with the highest sTfR concentrations (from the 3rd sTfR tertile) demonstrated significantly lower exertional GLS than their peers from the other 2 tertiles and lower resting GLS vs. the 2nd tertile (Table). Exercise GLS was inversely correlated with sTfR (r=-0.27, p = 0.01), and this association remained significant after adjustment for age, sex, BMI, LV mass, exercise blood pressure, hemoglobin and serum galectin-3 – a marker of fibrosis (beta=-0.24, p = 0.04).

Conclusions

In HFpEF, higher sTfR reflecting a decreased global intracellular iron content is independently associated with reduced LV longitudinal contractility response to exertion. This might represent another mechanism of exercise intolerance and should be considered in management strategies in this condition.

Abstract P935 Figure.
P936 Early signs of cardiac dysfunction in obesity patients, results of the CARDIOBESE study
Authors: Snelder S M , De Groot - De Laat L E , Biter L A , Castro Cabezas M , Pouw N , Birnie E , Boxma - De Klerk B , Klaassen R A , Zijlstra F , Van Dalen B M
Published: January 2020

Introduction

Obesity is becoming a global epidemic. Current knowledge on early signs of cardiac dysfunction in obesity patients is insufficient. The onset of heart failure in obesity patients cannot be fully explained by the presence of traditional cardiovascular risk factors.

Purpose

To detect early signs of cardiac dysfunction in obesity patients without known cardiovascular disease.

Methods

The CARDIOBESE-study is a cross-sectional multicentre study of 100 obesity patients scheduled for bariatric surgery (body mass index (BMI) ≥35 kg/m2) without known cardiovascular disease, and 50 age-matched and gender-matched non-obese controls (BMI ≤30 kg/m2). Speckle tracking echocardiography, biomarkers and Holter monitoring were used to identify parameters that are able to show cardiac dysfunction at a very early stage in obesity patients.

Results

Obesity patients had impaired left ventricular ejection fraction, global longitudinal strain (GLS) and diastolic function parameters (e.g. septal e" velocity, lateral e" velocity, E/e’ and E/A-ratio) as compared to the non-obese controls (Table). C-reactive protein (CRP) and heart rate were increased, whereas heart rate variability (Standard deviation of NN intervals, SDNN) was decreased. Obesity patients were subdivided in patients with impaired (< -17%, n = 56) or normal GLS (n = 36). Comparison between these patients revealed no differences regarding BMI, prevalence of traditional cardiovascular risk factors or CRP value. Nevertheless, patients with abnormal GLS had a higher waist circumference and lower SDNN.

Conclusion

There is a high prevalence of subclinical cardiac dysfunction as measured by GLS in obesity patients (56%), which appears to be related to abdominal fat and decreased heart rate variability and not to BMI, traditional cardiovascular risk factors or CRP.

Non-obese controls (n = 50) Obesity patients (n = 100) p-value Obesity patients with normal GLS (n = 36) Obesity patients with impaired GLS (n = 56) p-value Age (years) 49.2 ± 9.5 47.9 ± 7.6 0.36 47.6 ± 7.1 48.3 ± 7.6 0.68 BMI (kg/m2) 24.9 ± 3.2 42.9 ± 4.1 <0.001 42.7 ± 4.2 42.7 ± 4.1 0.98 Waist circumference (cm) 81.1 ± 10.4 133.1 ± 12.3 <0.001 128.2 ± 11.5 135.2 ± 10.5 0.006 E/A- ratio 1.19 ± 0.26 1.01 ± 0.3 <0.001 1.08 ± 0.2 0.96 ± 0.27 0.048 Septel e" velocity 10.3 ± 9.8 8.1 ± 1.8 0.03 8.2 ± 1.9 7.8 ± 1.7 0.24 E/e" 8.5 ± 2.1 8.9 ± 2.5 0.32 9.5 ± 2.4 8.7 ± 2.5 0.14 CRP (mg/L) 1.9 ± 2.9 8.8 ± 8.8 <0.001 8.5 ± 7.3 9.3 ± 10.1 0.67 SDNN 160.2 ± 35.4 109.4 ± 46.0 <0.001 130.4 ± 48.3 98.9 ± 41.2 0.001 Table: Selection of parameters. Values are means ± SD. SDNN= Standard deviation of NN intervals (heart rate variability)
P947 Left- and right ventricular mechanics in athletes: a true marker of fitness?
Authors: Lakatos B K , Kiss O , Sydo N , Tokodi M , Fabian A , Kantor Z , Bognar C , Major D , Kovacs A , Merkely B
Published: January 2020

Regular physical exercise results in marked changes of ventricular morphology and function, also referred as the athlete’s heart. Despite the marked changes of cardiac morphology and function in athletes, data is scarce regarding the relationship between exercise performance and cardiac adaptation to exercise.

Accordingly, our aim was to examine the relationship between ventricular morphology and function and exercise capacity in a prospective cohort study.

Young elite soccer players (n = 18, age: 16 ± 1 years) were enrolled and examined at baseline and following 1 year. Athletes underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Following exercise testing, 3D echocardiography was performed and LV and RV focused loops were obtained. By off-line analysis, we measured left- (LV) and right ventricular (RV) end-diastolic volume indices (EDVi) and LV mass index (LVMi) indexed to body surface area and LV and RV ejection fractions (EF). By 3D speckle-tracking analysis of the LV and RV we also determined global longitudinal (GLS) and circumferential (GCS) strains.

We found improved and decreased peak exercise performance as well during the 1 year follow-up with an overrall increased mean exercise capacity (dVO2/kg: 2.6 ± 7.3 ml/min/kg). LV and RV morphology did not change significantly according to LVEDVi and RVEDVi (LVEDVi: 84 ± 14 vs. 80 ± 7 ml/ m², RVEDVi: 82 ± 11 vs. 84 ± 10 ml/m², both p = NS). LVMi significantly increased (82 ± 14 vs. 89 ± 9 g/m², p < 0.001). LV and RV EF did not change during one year follow-up (LVEF: 58 ± 4 vs. 57 ± 5%; RVEF: 57 ± 4 vs. 55 ± 6%, both p = NS), while LVGLS decreased compared to baseline (19.7 ± 1,8 vs. 19.3 ± 2,8%, p < 0.01). The change in VO2/kg showed correlation with decreased LVGLS and also with decreased RVGCS (dLVGLS vs. dVO2/kg: r=-0.56, dRVGCS vs. dVO2/kg: r=-0.50, both p < 0.05)

During 1 year follow-up cardiac morphology and function significantly changed in our athlete cohort, and these changes showed relationship with the changes of peak exercise performance. Detailed assessment of myocardial mechanics may help to monitor training in athletes.
P948 Assessment of maternal cardiac remodeling and systolic function by 3D echocardiography in gestational hypertension and preeclampsia
Authors: Ilic A , Stojsic S , Papovic J , Stefanovic M , Grkovic D , Miljkovic T , Bjelobrk M , Tadic S , Ilic D J , Radisic B , Milovancev A , Bjelic S , Bogdanovic D , Stojsic-Milosavljevic A
Published: January 2020

Background

It was recently showed that there is a difference between 3D and 2D evaluation of the left ventricular (LV) myocardial mass and cardiac function in gestational hypertension (GH) probably due to more pronounced heart shape changes in hypertensive pregnant women. It is also known that preeclampsia (PE) is associated with a deterioration in maternal cardiac function. Purpose: We were interested whether there was a difference in 3D morphological and functional parameters of the LV in relation to the blood pressure (BP) profile in GH, but also between GH and PE. Methods: 22 women and 55 with GH (28 with dipping pattern of BP, and 27 non-dippers) underwent 3D echocardiography and ambulatory blood pressure monitoring in the third trimester. LV mass index, LV volumes, SV index and parameters of systolic function of the LV: CO index, EF, longitudinal strain (LS), circumferential strain (CS), radial strain (RS) and area strain (AS) were estimated using 3D software. These three groups (PE, dippers and non-dippers) were each other"s control. Results: Groups did not differ in age and LV massi. SVi was significantly lower in non-dippers (p = 0,045) and PE (p = 0,031) compared with dippers, without significant difference between non-dippers and PE (p = 0,59). Similar results were obtained when we analyzed the EF in these three groups. COi was the lowest in PE (2,76 ± 0,3), compared with dippers (3,43 ± 0,5; p< 0,0005), with significant difference between non-dippers (2,97 ± 0,4; p< 0,0005) and dippers, and with a small difference between PE and non-dippers (p = 0,045). Evaluation of the systolic function by 3D strain, also showed that the systolic function was significantly lower in PE, but also in non-dippers compared to dippers (Table 1). Multivariate regression analysis revealed that nocturnal BP (p = 0,001; OR 1,106; 95% CI 1,029 - 1,142) and presence of proteinuria (p< 0,0005; OR 7,2; 95% CI 1,896 – 36,5) strongly predict preterm delivery. Conclusions: Deterioration of 3D systolic function is more pronaunced in PE, but also in non-dipping pattern of BP in GH compared with dippers, without significant difference in 3D LV massi between groups.

Values od 3D strain in groups Dippers Non-dippers PE p1 p2 p3 LS -18,62 -16,99 -16,91 p< 0,0005 p< 0,0005 ns CS -18,22 -16,22 -16,21 p< 0,0005 p< 0,0005 ns RS 52,85 48,3 48,1 p< 0,0005 p< 0,0005 ns AS -31,77 -27,67 -27,98 p< 0,0005 p< 0,0005 ns p1 - difference between dippers and non-dippers; p2 - difference between dippers and PE; p3 - difference between non-dippers and PE
P950 Impact of True Vue-Trans- Illumination rendering imaging for intraoperative echocardiography in a wide range of interventions
Authors: Gavazzoni M , Zuber M Z , Taramasso M T , Pozzoli A P , Maisano F M
Published: January 2020

Background

Volume rendering methods have been improved to further enhance the quality of imaging and make the communication between echocardiographers and interventionists more fast, reliable and simple. The last innovation in this field is the "3D Real Time True Vue-Transillumination (TI)" rendering method. This allows to freely move virtual light inside a sample volume to enhance image details and depth. No studies have addressed the advantage of this method in the context of procedural guidance for structural interventions.

Purpose

The aim of the present paper is to test the advantages of this method when applied to interventional TOE during cardiac structural interventions.

Methods

During different procedures we prospectively collected the apparent added value of TI compared to conventional rendering scored independently by two cardiologists in charge of procedural guidance, one being in training (observer 1) and one trained (observer 2). The score was performed in a Likert scale from 1 to 5 with refer to advantage of TI for different procedural concerns (from 1 that meant "strongly disagree" to 5 "strongly agree"). We tested the inter-rater reliability with the K coefficient of agreement between the two observers. In this analysis we included multiple procedural targets to be imaged during different procedures.

Results

We included 8 complex procedures performed in our institutions between November 2018 and March 2019 and collected the agreement of the two observers about the following procedural concerns: evaluation of MV area for MV repair procedures; evaluation of MV main target lesion at the beginning of repairing procedure for procedural planning; evaluation of calcifications of MV leaflet and annulus and cleft for patients selection; evaluation of device trajectory with 3D real time imaging before crossing the valve plane during orienting manoeuvre; assessment of residual lesion after first clip for procedural decision making; evaluation of para-valvular leak: site and amount;evaluation of inch point of leaflets for direct annuloplasty in mitral valve and tricuspid valve regurgitation; visualization of coronary sinus during the implant of anchors of Cardioband in posterior part of tricuspid annulus. We collected the scores for a total of 13 records. The 2 observers perceived an added value for TI for all the procedural concerns analysed (mean score of 4.0 ± 0,75); a good agreement was obtained about the superiority of TI rendering in these 13 concerns with a Kappa coefficient of inter-agreement of 0.71, p < 0.0001.

Conclusions

this is the first experience comparing the new 3D TI rendering with 3D conventional rendering in the context of intra-procedural guidance for structural valve interventions. We obtained good inter-agreement between two echocardiographist with different levels of experience suggesting that TI may have advantages even for education.
P956 Prognostic role of right ventricular hypertrophy in anderson fabry disease
Authors: Graziani F , Lillo R , Panaioli E , Pieroni M , Locorotondo G , Lombardo A , Sicignano L L , Manna R , Lanza G A , Crea F
Published: January 2020

Background

Right ventricular hypertrophy (RVH) is a common finding in Anderson Fabry disease (AFD). In other infiltrative and storage cardiomyopathies right ventricular (RV) involvement may influence prognostic stratification. Nevertheless, the prognostic implications of right ventricle involvement in AFD have never been assessed.

Purpose

Evaluation of the prognostic significance of RVH and RV systolic function in AFD cardiomyopathy.

Methods

Forty-five AFD patients (56% male) with extensive baseline evaluation, including assessment of RVH and RV systolic function, were followed-up for an average of 44.9 ± 8.5 months. RV systolic function was assessed by standard and tissue Doppler echocardiography and quantified using RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and Systolic tissue Doppler velocity of the tricuspid annulus (RV Sa). Cardiovascular events were defined as new-onset atrial fibrillation, heart failure or pace-maker implantation; renal events were defined as progression to dialysis and/or renal transplantation or significant worsening of glomerular filtration rate; cerebrovascular events were defined as stroke or transient ischemic attack. The outcome was defined as the time to death or the first event in any of the above predefined categories.

Results

Fourteen patients (31.1%) presented RVH, while RV systolic function was normal in all cases. During the follow-up period, 13 patients (28.8%, 11 male) experienced major events including two deaths. Pace-maker implantation (6 cases) was the most common type of event. At univariate analysis several variables were associated with the occurrence of events, including RVH and indexes of RV systolic function. However, at multivariate analysis only proteinuria (HR:8.3, 95% CI: 2.88 to 23.87, p ˂0.001) and LV mass indexed (HR: 1.01, 95% CI: 1.00 to 1.03, p = 0.03) were independent predictors of outcome.

Conclusions

The presence and extension of RVH is not associated with outcome in AFD. Our study confirms that at variance with other infiltrative or storage cardiomyopathies, RV involvement in AFD is an innocent bystander and does not influence prognosis.
P964 Assessment of long-term durability of transcatheter implanted aortic valves - structural and nonstructural deteriorations in 5 years follow-up
Authors: Linkova H , Petr R , Paskova E , Kocka V , Tousek P
Published: January 2020

Introduction

Transcatheter aortic valve implantation (TAVI) is the method of choice for patient with a significant stenosis (AS) who are contraindicated for cardio-surgical procedure. Medium – term results of TAVI are comparable with results observed for surgical replacements. There is limited knowledge of structural, nonstructural and clinical complications in five years follow-up which could contribute to TAVI indication for implantation in young patients.

Goal. The aim of this study is to assess structural and non-structural deterioration of TAVI prosthesis by echocardiography and clinical evaluation at 5 years follow-up.

Methods

By the end of 2013, 112 patients were implanted TAVI in our center( average age, 80,4 ± 7,2 y, 53(47% ) males. All patients underwent both clinical and echocardiographic examination once a year and underwent native CT after five year. We analysed mortality, structural and non- structural deteriorations, and standard echocardiographic parameters before and after implantation, and at 5 years follow-up.

Results

5-years mortality was 58%. There was not a statistically significant difference in age between the patients who survive and who died (80,2 ±7,3 vs 80,6 ± 7,3 p = 0.77) ,they had similar logistic EUROSCORE (17,0 ± 12,4 vs 16,9 ± 15,0, p = 0,96) and EF 53,8 ± 11,1 vs 52,3 ± 11,7,p= 0,51) before the procedure. 48 patients underwent the five years follow –up. Only one patient had to undergo reTAVI due to the earlier prosthetic degeneration. The average EOA was 1,88 ± 0,33 cm2), the average V max. after five years was 1,8 ± 0,4 m/s, PG max 13,6 ± 6,2 mm Hg a PG mean 8 ± 3,6 mm Hg ( no significant increase in time),Post procedural paravalvular regurgitation ≥ 2/4 appeared in 14 % patients. Twenty –three patients underwent CT scan which resulted in Agaston score O on TAVI replacement in 19(83 %) patients.

Conclusion

After 5 years follow-up, low rates of structural and nonstructural deterioration after TAVI were noted, suggesting good long- term durability.
P976 Can calcium score predict the appropriate treatment for high risk patients? (a 5 years follow up study)
Authors: Stanciu S , Gurzun M , Dumitrescu S , Naftanaila F , Spanu A , Cuzino D
Published: January 2020

Coronary artery calcium score (CAC) measures the calcium contained in the artery wall and it is evaluated using multi-slice cardiac CT and CAC represents a useful tool for appreciating the burden of coronary atherosclerosis and for determining the risk for cardiovascular events.

The purpose of this study is that CAC can be use for guiding treatment strategy in patients classified as high risk based on Framingham score .

We prospectively enrolled 64 pts (79% male), 62,7+/-5 year, between 2002-2017. All included patients were considered high risk based on EuroSCORE model.

A multislice heart CT scan was performed for every patient with CAC score determination quantified with the Agatston score and expressed as Agatston Units (AU). The patients were divided in 3 groups according to the treatment that they received during the 5 years follow up: optimal medical treatment for coronary artery disease (OMT) – 35.9% (23), percutaneous coronary angioplasty (PCA) – 29.7% (19) and coronary artery bypass graft (CABG) – 34.4%.

The CAC score for pts treated by OMT vs CABG +/_ PCA were compared using the ROC curves. CAC score was statistically significantly superior in CABG+ PCA patients versus OMT (AUC: 0.96, p < 0.001 vs AUC 0.42, p = 0.212). Also, a comparison of CAC score score for CABG vs OMT revealed the same results (AUC: 0.96, p< 0.001 vs AUC: 0.42, p = 0.264). OMT vs CABG + PCA presented a cut-off value of 382 AU with a specificity of 90% and a sensitivity of 95%. OMT vs CABG presented a cut-off value of 530 AU with a specificity of 89% and a sensitivity of 95%.

In conclusion, CAC score has a good predictability and sensitivity in determining the outcome and can be a promising tool to guide therapy in high risk patients, mainly regarding medical vs surgical treatment for coronary artery disease.
1026 Prognostic implications of global and regional RV strain in patients with heart failure and conduction delays
Authors: Janicijevic A , Stankovic I , Zivanic A , Stefanovic M , Putnikovic B , Neskovic A N
Published: January 2020

Background

Right ventricular (RV) dysfunction is present in a substantial proportion of candidates for cardiac resynchronization therapy (CRT) but its prognostic implication has not been fully determined. We investigated the association of different echocardiographic indices of RV function and survival in patients with heart failure (HF) and conduction delays.

Methods

A total of 122 HF patients with bundle branch blocks (BBB), not treated with device therapy, were included in this retrospective observational study. RV function was assessed by measuring the tricuspid annular plane systolic excursion (TAPSE) and RV free wall longitudinal strain (RVFWSL). Patients were followed for cardiac mortality during a median period of 33 months.

Results

Both TAPSE ≤ 18 mm and RVFWSL≥-25% were associated with unfavorable long-term survival (log rank p < 0.05 for both, Figure A and B). Importantly, in patients with normal TAPSE, RVFWSL remained predictive of long-term outcome (HR 1.15, 95% CI 1.003-1.327; p = 0.045). In the multivariate regression analysis, only NYHA class (HR 2.21, 95%CI (1.122 – 4.357; p = 0.022) and RVFWSL (HR 1.11, 95%CI 1.029 – 1.204; p = 0.008) were independently associated with cardiac mortality. Significant differences among segmental RVFWLS values were observed, including a basal-to-apical gradient with the highest strain values in the base and the lowest in the apex (Figure C).

Conclusions

RV dysfunction is associated with unfavorable survival in HF patients with BBB. RVFWSL appears to be stronger predictor of mortality than TAPSE. Different segments of the RV may contribute differently to RV dysfunction in patients with conduction delays.

Abstract 1026 Figure.
1049 High single-beat Doppler signals in low-gradient aortic stenosis are associated with higher aortic valve calcium
Authors: El-Am E , Alsidawi S , Oguz D , Scott C , Thaden J , Pislaru S , Morant K , Pellikka P , Oh J , Nkomo V
Published: January 2020

Funding Acknowledgements

Mayo Clinic

Background

Variability in Doppler signals is common in patients with atrial fibrillation (AF) and AF is common in low-gradient AS (LGAS). Presence of high single beat Doppler signals (peak velocity ≥4m/s or mean gradient ≥40mmHg) is not factored into decision-making in low-gradient aortic stenosis (LGAS).

Objective

Determine prevalence of at least one high Doppler signal in AF LGAS and its relationship to computed tomography aortic valve calcium score (AVCS) versus sinus rhythm (SR) high-gradient aortic stenosis (HGAS).

Methods

Consecutive patients with aortic valve area ≤1cm2 and left ventricular ejection fraction ≥50% during echo were identified (January 1, 2012-December 31, 2016). At least three consecutive Doppler signals were averaged in sinus rhythm (SR) and five in atrial fibrillation (AF).

Results

Of 1,854 patients, age 76± 11 years, male 52%, 301/1,854 (16%) were in AF and LGAS was present in 122/301 (41%). At least one high Doppler signal in AF LGAS was present in 43/122 (35%). AVCS within 1 year of echo was available for 36% of patient with SR HGAS and 34% of AS LGAS. Median AVCS was not different in SR HGAS 2424 (IQR 1623, 3445) vs AF LGAS with at least one high Doppler signal 2509 [IQR1547, 3119], p =0.10 AVCS threshold for severe AS (men >2000 women >1200) was met in 80% SR HGAS vs 86% AF LGAS with high signals.

Conclusions

High Doppler signals in AF LGAS are associated with high AVCS more frequently exceeding thresholds for severe AS. Single-beat high Doppler signals instead of the average correlate better with AVCS and classic HGAS.
1102 Rare association of left ventricular non-compaction and hypertrophic cardiomyopathy
Authors: Hotta V T , Monge N M S , Vieira M L C , Fernandes F , Mady C
Published: January 2020

Background

LVNC and HCM are cardiomyopathies with distinct clinical presentation that may present common genetic mutations. Some studies suggest a common genetic basis between HCM and LVNC and the possibility of a phenotypic association of these two cardiomyopathies in the same patient.

Case report

A 39 year old man was referred to our hospital with syncope. His past medical history was unremarkable. His father died of sudden death, at age 49, without investigation of Left ventricular non compaction (LVNC) or Hypertrophic cardiomyopathy (HCM). Physical examination was unremarkable. Electrocardiogram showed sinus rhythm with left chambers overload and isolated ventricular extrasystoles. Transthoracic Echocardiogram (TTE) evidenced significant left ventricular (LV) hypertrophy predominantly in the apical region and inferolateral wall, in the absence of a significant intraventricular gradient at rest and after provocative maneuvers, with preserved LV function, suggesting non-obstructive HCM. Cardiac magnetic resonance imaging (CMRI) showed LV hypertrophy predominantly in the lateral wall, with a maximum thickness of 35 mm, no signs of left ventricular outflow tract (LVOT) obstruction and prominent apical trabeculation, compatible with the association of LVNC and HCM. A genetic test was performed on this patient with inconclusive results.

Conclusions

The association of diagnostic criteria in cardiac imaging tests (TTE and CMRI) compatible with LVNC and HCM in the same patient is uncommon. This patient shows an infrequent location of the most prominent hypertrophy in the inferolateral wall.This case highlights the importance of integrating cardiac imaging methods in the diagnosis of these two disctinct and rare cardiomyopathies.

Legend Figure 1: 2D TTE evidencing prominent hypertropfhy and intraventricular recesses at apical region and inferolateral wall (red arrows), abnormalities suggesting HCM and LVNC at LV apex (blue arrows) in Paraesternal Long Axis (A and B), Short Axis View (C to F), Apical 4 Chambers (G and H) and Apical 2 Chambers View (I and H). Speckle tracking analysis evidencing incipient LV systolic dysfunction by reduced global longitudinal strain (GLS:-8,9%) despite the preserved LVEF (K to N). CMR evidencing findings compatible with the association of LVNC (blue arrows) and HCM (red arrow) in 4 Chambers (O and P), 2 Chambers (Q and R) and Short Axis Views (S to V).

Abstract 1102 Figure 1
1111 Atrial thrombi or cardiac tumors? The challenge of multimodality imaging of intracardiac masses
Authors: Castrichini M , Albani S , Pinamonti B , Bussani R , Belgrano M , Sinagra G
Published: January 2020

A 83-year-old man with hypertensive cardiomyopathy with left ventricular dysfunction diagnosed 5 years before (without coronary artery disease) in permanent atrial fibrillation since 8 years, was admitted to the ER for heart failure. He was not in anticoagulation therapy because contraindication for the presence of cerebral venous angiomas found several years before.

An urgent ultrasound scan was performed that showed bilateral intra-atrial masses. UFH was started.

The echocardiography(Fig. 1 panel A)show within the left atrium an isoechoic, not pedunculated mass, 8x5 cm, with lobulated margins, attached to the anterior wall and left atrial appendage, and expanding in the atrial cavity. Within the right atrium a smaller mass with the same characteristics was attached to the anterior wall, 4 x 3 cm (Fig. 1 panel B). TEE confirmed these characteristics and showed also vacuolated aspects inside the masses (Fig. 1 panel C).

MDCT was then performed, the atrial masses appeared morphologically very similar to atrial myxomas, but they didn’t enhance iodine contrast agent resembling a typical thrombus behavior (Fig. 1 Panel D). No systemic emboli nor extracardiac tumors were found. CMR could not be performed due to patient claustrophobia.

Considering intra-atrial thrombi as a main hypothesis, the treatment with UFH was continued and the masses were monitored by TTE. However, after more than one week the masses volume did not change.

A contrast echocardiography with IV Sonovue was performed. A mild contrast enhancement of left atrial mass was seen, thus suggesting the diagnostic hypothesis of cardiac tumor (Fig. 1 Panel E).

In this context we decided to perform transvenous biopsy of right atrial mass under intracardiac echocardiography guidance. The biopsy samples from the outer wall of the right atrial mass showed thrombotic features.

After a long discussion in heart team, patient underwent to surgical resection of the masses through atrial approach and the surgical inspection was suggestive of neoplastic origin.

The histological examination was performed showing thrombotic material with several phases of organization and mild aspects of neo-angiogenesis combined with mild lymphocyte infiltration and necrosis areas (Fig. 1 Panel F).

We hypothesized that the histological features of the lesion, with the presence of vessel within the mass could explain the mild late contrast enhancement at Sonovue echocardiography simulating the features of cardiac tumor.

In summary, in this case, despite a multimodal imaging approach, the nature of the bilateral intra-atrial masses could not be defined and the histological examination after surgical removal had a key diagnostic role showing organized thrombotic material. A proper differential diagnosis is extremely important in order to decide the appropriate treatment, but sometimes it is extremely challenging.

Abstract 1111 Figure 1
1116 Atypical, cardiac location of melanoma
Authors: Zapolski T , Mariusz Kozak M K , Agnieszka Styczen A S , Marta Karas Glodek M K G , Andrzej Tomaszewski A T , Elzbieta Czekajska Chehab E C C
Published: January 2020

A 66 – year – old woman, never treated because of any cardiac illnesses in the past, suffering from the chest pain evoked by physical activity, came to the outpatient clinic on January, 12 th 2019 for the diagnostics. Clinical examination, apart from an elevated blood pressure – 180/100 mmHg, showed no changes. In the ECG – SR 55 bpm. Performed TTE revealed an abnormal structure, having the dimensions 41x29 mm. Heart chamber dimensions, except for moderately enlarged LA, were in the normal range; ejection fraction was preserved. The patient was referred to the Department of Cardiology aiming at further diagnostics. In the course of hospitalization CT of the heart was done, during which the presence of hipodensic, mobile tissue change, having irregular borders, coming out of left ventricle wall was confirmed. PET examination excluded the existence of other remote changes. TEE corroborated the diagnosis of a tumor, originating from the inferior wall of left ventricle. Performed angiography ruled out significant changes in coronary arteries. Subsequently, the patient underwent the removal of the left ventricle tumor on February, 2 nd 2019 in the Department of Cardiosurgery. Histopathological examination result after the surgery wasn’t unequivocal – differential diagnosis should have included melanoma, myoepithelial cancer and MPNST ‘high – grade’ sarcoma. Immunohistochemical examination was continued. In the meantime, a control TTE was performed, which detected a tumor 14x10 mm.

After the immunohistochemical examination results a woman was qualified to immunotherapy with the usage of pembrolizumab, initiated on March In TTE done on March, 30th 2109 the dimensions of tumor 30x20 mm suggested the disease progression. Therapy was continued. Next echocardiography didn’t visualise the presence of tumor. The patient was after the second cycle of chemotherapy.

Abstract 1116 Figure.
1159 Right ventricular electromechanical dyssynchrony in relation to right ventricular remodeling, dysfunction and exercise capacity in Ebstein anomaly
Authors: Akazawa Y , Fujioka T , Kuhn A , Hui W , Slorach C , Roehlig C , Mertens L , Vogt M , Friedberg M
Published: January 2020

Background

Abnormal atrioventricular conduction and functional right ventricular (fRV) dysfunction are common in patients with Ebstein anomaly (EA). However, the relation of fRV dyssynchrony to fRV function in EA has not been studied.

Purpose

We hypothesized that fRV electromechanical dyssynchrony is associated with fRV remodeling, dysfunction and exercise intolerance in EA patients.

Methods

Non-operated EA patients and age-matched controls prospectively underwent echocardiography, cardiovascular magnetic resonance imaging (CMR) and cardiopulmonary exercise testing to quantify RV remodeling, dysfunction and exercise capacity, respectively. The relation of these to fRV dyssynchrony was investigated. RV mechanical dyssynchrony was defined by early septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and the maximal intra-RV delay (difference in time to peak of lateral basal RV and apical septal segments) using 2-dimensional strain echocardiography.

Results

Thirty-five EA patients (age 31.6 ± 17.3 years, 19 female) and 35 age-matched controls were studied. QRS duration and intra-fRV mechanical delay were significantly longer in EA compared with controls. 19/35(54%) of EA patients had early activation of septal segments with simultaneous stretching and consequent late activation and post-systolic shortening of RV lateral segments. QRS duration correlated with fRV end-diastolic (fRVEDVI, r = 0.46, P <0.01) and end-systolic indexed volumes (fRVESVIr = 0.57, P <0.001). Intra-fRV delay correlated with RV global longitudinal strain (GLS, r=-0.45,P <0.05) and RV fractional area change (r=-0.56, P <0.01). Intra-fRV delay was also associated with fRVEDVI (r = 0.43, P <0.05), fRVESVI (r = 0.63, P <0.001), fRVEF (r=-0.46,P <0.05) and predicted peak VO2 (r=-0.39, P < 0.05). EA patients with versus without a septal flash had lower fRVEF (45 ± 11 vs. 54 ± 8%, p < 0.05) and predicted peak VO2 (0.71 ± 0.19 vs. 0.92 ± 0.33, p < 0.05).

Conclusions

In EA, fRV electromechanical dyssynchrony is associated with fRV remodeling, dysfunction and impaired exercise capacity and may constitute a therapeutic target.

Abstract 1159 Figure.
1184 Left atrial volumes by 3-dimensional but not 2-dimensional echocardiography predict cardiac death and events in patients with heart failure with reduced ejection fraction
Authors: Velcea A E , Andronic A A , Rimbas R C , Luchian L M , Chitroceanu A , Serban E , Mihaila-Baldea S , Vinereanu D
Published: January 2020

Background

Patients with heart failure with reduced ejection fraction (HFrEF) are at high risk for mortality and morbidity. Left atrial volumes (LAVs), measured by 2-dimensional echocardiography (2DE), have been suggested as possible prognostic markers. However, LAVs measured by 2DE are prone to errors due to geometric assumptions and increased variability, whereas 3-dimensional echocardiography (3DE) has been proved to be a more accurate and reproducible method for volume assessment.

Purpose

To assess the comparative prognostic value of LAVs, measured by 2DE and 3DE, in patients with ischemic and non-ischemic HFrEF, on best clinical care.

Methods

135 consecutive patients (59 ± 15 years, 91 males), diagnosed with HFrEF, in sinus rhythm, were assessed by 2DE and 3DE, including full-volume multi-beat acquisitions of the LA and left ventricle (LV). Maximal and minimal indexed LAVs were measured from the 2DE datasets using biplane area-length formula (2D_LAVmax and 2D_LAVmin); and from the 3DE datasets using a dedicated software package (3D_LAVmax and 3D_LAVmin). Patients were followed for 23 ± 14 months after the index event. Primary outcome was cardiac death (CD); secondary outcomes were: 1) HF hospitalization (HFH); 2) a composite cardiac events (CE) end-point, of cardiac death or hospitalization for heart failure, myocardial infarction, coronary revascularization, arrhythmias, or cardiac resynchronization therapy.

Results

26 CD, 32 HFH, and 48 CE occurred during follow-up. 2DE and 3DE measurements are in the table. LAVs measured by 2DE did not correlate with outcome. However, 3D_LAVmax and 3D_LAVmin correlated with CD (r = 0.40 and r = 0.38) and CE (r = 0.30 and r = 0.29), all p < 0.05, but not with HFH. By multivariate linear regression analysis, only 3D_LAVmax and 3D_LAVmin were independent predictors for CD and CE, in patients with HFrEF (r²=0.30 and r²=0.32; p < 0.01).

Conclusion

In patients with HFrEF, LA volumes measured by 3DE, but not by 2DE, were independent predictors for cardiac death and events. However, even LA volumes by 3DE did not have predictive value for future HF rehospitalizations.

Echo features for patients with HFrEF 3D end-diastolic LV volume (ml/m2) 101 ± 32 3D end-systolic LV volume (ml/m2) 71 ± 29 3D LV ejection fraction (%) 30 ± 8 2D_LAVmax (ml/m2) 52 ± 18 2D_LAVmin (ml/m²) 31 ± 15 3D_LAVmax (ml/m2) 43 ± 18 3D_LAVmin (ml/m2) 29 ± 16
1187 Evaluation of left and right ventricular functions with 3D speckle tracking in patients with mitral stenosis
Authors: Seckin O , Unlu S , Tacoy G
Published: January 2020

Background

The function of both ventricles have been suggested to be affected in patients with mitral stenosis. In this study, it was aimed to investigate deformation properties of right (RV) and left ventricles (LV) in mild and moderate rheumatic mitral stenosis (MS) patients with three-dimensional speckle tracking echocardiography (3D-STE).

Methods

A total of 60 patients were included in the study (20 patients with mild MS diagnosis, 20 patients with moderate MS diagnosis and 20 healthy volunteers). Three-dimensional echocardiography datasets were obtained for both ventricles in all patients. An example for RV assessment is shown in Figure 1. LV global longitudinal strain (GLS), LV torsion, RV free wall (FW) LS and interventricular septal (IVS) LS measurements were analyzed.

Results

The LV ejection fraction (EF), RV fractional area change and tricuspid annular plane systolic excursion values were statistically similar and in the normal range. The LV GLS measurements were significantly different among the groups by being highest in the control group and least in the moderate stenosis group (ANOVA,p < 0.001) (Table 1). Patients with MS showed higher torsional values, correlated with MS severity (ANOVA,p < 0.001) (Table 1). IVS LS, RVFW LS values obtained by RV analysis also differed significantly among groups. The FW-GLS values only showed significant difference between the control group and moderate MS group (Table 1).

Conclusion

Patients with mitral stenosis showed lower LV-GLS and higher LV torsion values. Although the LV GLS is affected; the LV EF was detected to be normal due to increase in LV torsion. RV deformation indices showed signıficant decrease in correlation with the severity of the mitral stenosis. In conclusion, our data suggest that subclinical LV and RV systolic dysfunction is present in mild-moderate MS patients and this dysfunction can be detected by 3D-STE.

Table 1 Parameters Control group Mild MS Moderate MS P LV GLS (%) 23.3 ± 2.08 18.9 ± 1.3 17.5 ± 1.8 <0.001 LV torsion 1.5 ± 0.6 2.1 ± 0.6 2.6 ± 0.5 <0.001 IVS LS (%) 23 ± 3.0% 20 ± 2.6 17.1 ± 2.9 <0.001 RV FW LS (%) 25.4 ± 5 22.7 ± 3.2 21.1 ± 4.8 <0.001 FW; free-wall, GLS; global longitudinal strain, IVS; interventricular septum, LV; left ventricular, RV; right ventricular

Abstract 1187 Figure 1
1225 Diagnostic accuracy of left ventricular diastolic strain imaging by speckle tracking echocardiography in detecting ischemic etiology of acute chest pain
Authors: Ishii K , Hyodo E , Seo Y , Ishizu T , Tada E , Kihara H , Daimon M , Tanaka A , Akasaka T , Watanabe H , Ito H , Yoshikawa J
Published: January 2020

Funding Acknowledgements

none

OnBehalf

A TRAC-SI Multicenter Trial

Background

Two-dimensional speckle tracking echocardiography (2D-STE) has been reported to be useful for the diagnosis of myocardial ischemia by detecting delay in regional myocardial expansion (diastolic stunning) up to many hours after an episode of angina. The aim is to evaluate the diagnostic accuracy of Left ventricular (LV) diastolic longitudinal, circumferential, transverse and radial strain imaging by STE to detect the presence of acute coronary syndrome (ACS) in patients with acute chest pain.

Methods

388 consecutive patients with acute chest pain and without wall motion abnormality, who were admitted to an emergency department (ED) at 1 of 12 clinical sites in Japan, were enrolled and underwent 2D-STE at ED. Left ventricular (LV) longitudinal, circumferential, transverse and radial strain values at aortic valve closure (A) and one-third of diastole duration (B) were measured. The strain imaging diastolic index (SI-DI) was value was determined as: (A-B)/A × 100% to assess the LV diastolic strain imaging and was used to identify the regional LV delayed relaxation. All patients underwent coronary CT or coronary angiography to establish the diagnosis of ACS. Clinicians were blinded to the 2D-STE results.

Results

Out of 388 patients, 2D-STE analysis was possible in 358 patients (92%). With assessment of coronary CT or coronary angiography, ACS was diagnosed in 118 patients (33%). 2D-STE was obtained at a mean of 5.3 hours after chest pain episode. SI-DI of longitudinal, circumferential, transverse and radial strain of ischemic segments were significantly lower than those of non-ischemic segments (p value < 0.001), and transverse and radial SI-DI demonstrated high diagnostic accuracy, compared with longitudinal SI-DI (Figure 1). Sensitivity, specificity, and negative predictive value for ACS of transverse SI-DI are 87%, 88%, % and 95%, respectively, using a cut-off value of 63.3.

Conclusion

LV diastolic strain imaging by 2D-STE at ED increase the sensitivity, specificity and accuracy to predict the presence of ACS in patients with chest pain. Compared with longitudinal diastolic strain imaging, transverse diastolic strain imaging is more sensitive marker to detect the myocardial ischemic episode (UMIN000013859).

Abstract 1225 Figure 1