bluuebunny/crossref_metadata_2025 huggingface dataset:
930 FULL EVALUATION OF LEFT AND RIGHT ATRIAL FUNCTION AFTER TAVI IMPLANTATION
Authors: Giamundo Angelo , Aquila Iolanda , Sorrentino Sabato , Bellantoni Antonio , Panarello Alessandra , Bruno Federica , Spinali Martina , Sportelli Martina , Mascaro Giuseppina , Mongiardo Annalisa , Indolfi Ciro , Spaccarotella Carmen
Published: December 2022

Aims

patients with severe aortic stenosis (AS) experience an increase in left ventricular filling pressure. This leads to changes in the structure and a deterioration in the function of the left (LA) and right (RA) atrium. Patients undergoing TAVI usually experience a reduction in the filling pressure of the left ventricle, thereby decreasing the wall tension of the atria in a retrograde way. The aim of this study was to demonstrate that patients with severe AS, undergoing TAVI, experience a positive remodeling of left and right atrium, with an improvement of their function.

Methods and results

we enrolled 38 symptomatic patients with severe AS (mean age 84,75 ± 12 years, 60% male, and pre-TAVI aortic valve area 0.75 ± 0.25 cm2 and mean gradient 47,96 ± 23 mmHg). 2D transthoracic echocardiography and 2D speckle tracking echocardiography at baseline and 12 months of follow up were performed. The variation of continuous variables was evaluated using a Student's T test for paired data. P values < 0.05 were considered significant. When compared to baseline, at 12 months a statistically significant improvement was observed for RA strain (p < 0.001) and LA (biplane) strain reservoir, conduction and contraction (p < 0.001, p < 0.012 and p < 0.001, respectively). The LA FE increased significantly (26.01 ± 9.16 vs 32.66 ± 10.95; p < 0.001). After TAVI, the LA (biplane) strain reservoir/end systolic volume ratio increased by 0.33 ± 0.18 to 0.49 ± 0.26 (p > 0.001). Left atrial end-systolic and end-diastolic volume decreased significantly (p > 0.001).

Conclusion

within 12 months after TAVI, there was a reverse LA and RA remodeling and an improvement in strain reservoir, condunction and contraction function. Also, there was a significant improvement of LA (biplane) strain reservoir/end systolic volume ratio.
1038 RIGHT VENTRICULAR-PULMONARY ARTERIAL (UN)COUPLING ESTIMATION IN PATIENTS WITH TRICUSPID REGURGITATION
Authors: Iseppi Manuela , Niro Lorenzo , Tafciu Elvin , Maffeis Caterina , Benfari Giovanni , Bergamini Corinna , Rossi Andrea , Luciano Ribichini Flavio
Published: December 2022

Background

right-ventricular (RV)-pulmonary arterial (PA) uncoupling expressed by Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Artery Systolic Pressure (PAPs) ratio is associated with poor outcomes in patients with heart failure (HF). TAPSE/PAPs ratio has been poorly investigated in patients with tricuspid regurgitation (TR) with related volume overload and progressive right chambers remodeling.

Purpose

to assess the effectiveness of other estimation methods of RV-PA coupling in different TR severity groups compared to the classic TAPSE/PAPs ratio.

Material and Methods

116 stable patients with TR were enrolled at the time of echocardiography (43 men, 37%; mean age 74±13 years). TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RV function was assessed by RV Free Wall Longitudinal Strain (FWLS).

PAPs was obtained using the following formula: 4*(peak tricuspid regurgitation velocity)2 + right atrial pressure (RAP); meanPAP was estimated using TR continuous wave signal mean gradient (PAPmIT) and pulmonary artery regurgitation peak gradient (PAPmIP), adding RAP for both. RV-PA coupling was evaluated by TAPSE/PAPs ratio, TAPSE/PAPmIT and TAPSE/PAPmIP ratios.

Result

TR was quantified mild in 23 patients, moderate in 49, severe and torrential in 29 and 15 patients respectively. Mean RV-FWLS was -26.4±6.9% in mild, -21.8±7.4% in moderate, -18±7% and -18.3±4.2% in severe and torrential TR respectively (p<0.0001).

Mean TAPSE/PAPs ratio was 0.6±0.23 mm/mmHg, 0.44±0.19, 0.38±0.19 and 0.37±0.12 mm/mmHg in mild, moderate, severe and torrential TR respectively, with a statistically significant difference between the 4 groups (p<0.0001).

Mean TAPSE/PAPmIP ratio was 1.08±0.5 mm/mmHg in mild TR, 0.68±0.34 in moderate, 0.67±0.5 in severe TR and 0.47±0.13 mm/mmHg in torrential TR with a statistically significant difference between distinct TR grades (p=0.004).

Mean TAPSE/PAPmIT in mild TR was 0.92±0.5 mm/mmHg, 0.63±0.29 in moderate, 0.53±0.29 and 0.51±0.16 mm/mmHg in severe and torrential TR respectively with a statistically significant difference between the groups (p<0.0001).

Finally, an analysis of covariance with RV-FWLS as potential confounder was performed: only the adjusted means of TAPSE/PAPmIP and TAPSE/PAPmIT ratios preserved a statistically significant difference between distinct TR groups (p=0.01 and p=0.019 respectively).

Conclusion

TAPSE/PAPmIP and TAPSE/PAPmIT ratios seem to preserve a stronger relation with increasing TR grade and worsening of RV disfunction, suggesting it as a more powerful index in this subset of patients. The progression of TR grade leading to a right chamber remodeling could influence the reliability of RV-PA uncoupling expressed by standard TAPSE/PAPs ratio.
921 GLOBAL AND SEGMENTAL LONGITUDINAL STRAIN OF THE LEFT VENTRICLE IN THE STRATIFICATION OF ARRHYTHMIC MITRAL VALVE PROLAPSE
Authors: Landi Irene , Eltayeb Abdalla , Anwar Kashif , Alenazy Ali , Alotaibi Anwar , Vriz Olga
Published: December 2022

Background and aim

Mitral valve prolapse (MVP) is a common benign valvular disease though with an incidence of 0.2-1.9%/year of sudden cardiac death (SCD) related to complex ventricular arrhythmias in the form of arrhythmic MVP (AMVP). In MVP, first diagnostic approach is transthoracic echocardiography (TTE) that should be used to described morphological and functional valvular features and also the presence of mitral annular disjunction (MAD) which seems associated with AMVP. The aim of our study is to describe the association between advanced TTE markers of myocardial stretching such as global and focal longitudinal strain (GLS) and ventricular arrhythmias in MVP patients with and without MAD.

Methods

88 patients with MVP were prospectively enrolled. All of them underwent 12-lead ECG and TTE including global and focal GLS of the left ventricle. In addiction, 40 had 24-hour Holter.

Results

MAD + patients were younger than MAD - (32.22±12.49 vs 41.64±15, p= 0.007) and mostly were females (30 females vs 9 males, p= 0.027). MAD + patients had higher burden of complex ventricular arrhythmias such as premature ventricular contractions (PVCs) with right bundle branch block (RBBB) morphology, bigeminy, non-sustained ventricular tachycardia (NSVT) and VT (Figure A). MAD + group had higher GLS (mean -21.5%±3% vs -20%±2.7%, p=0.0153) with notable difference in the inferior wall GLS (-19.4%±8% vs -16.4%±8%, p= 0.045), figure B.

Conclusions

Increased global and inferolateral GLS of left ventricle indicates longitudinal deformation in segments exposed to greater tension and mechanical stress by prolapsing leaflets and MAD which are associated with higher arrhythmogenic burden. Advanced echocardiographic techniques, such as global and segmental GLS could be considered as an advanced tool in the arrhythmic stratification of MVP patients.
898 ROLE OF 3D ECHOCARDIOGRAPHY IN AORTIC VALVE ABNORMALITIES: TWO CASES REPORT
Authors: Monaco Maria Lo , Stankowski Kamil , Oliva Angelo , Figliozzi Stefano , Fazzari Fabio , Mantovani Riccardo , Curzi Mirko , Cannata Francesco , Marconi Manuel , Fumero Andrea Davide , Stefanini Giulio Giuseppe , Torracca Lucia , Bragato Renato Maria , Volpe Massimo , Condorelli Gianluigi
Published: December 2022

Introduction

Aortic valves with a number of cusps different from two or three are infrequent congenital anomalies that might manifest with valvular disease in young patients. We present two cases of unicuspid and quadricuspid aortic valve diagnosed in our Center.

Clinical Cases

Case 1. A 23-year-old asymptomatic male was admitted to our Hospital because of the necessity of bone marrow transplantation for Hodgkin lymphoma. He had a previous diagnosis of bicuspid aortic valve and presented a 5/6 mid-systolic harsh murmur, heard best at the right upper sternal border and radiating to the neck. ECG showed sinus rhythm with left ventricular hypertrophy. BNP was in normal range (31 pg/ml).

At trans-thoracic echocardiography, there was severe aortic stenosis [peak/mean gradient of 100/67 mmHg with an aortic valve area of 1.04 cm2 (0.54 cm2/m2); V max was 5 m/s] without regurgitation and dilation of the ascending aorta (39 mm), however the morphology of the aortic valve remained undefined. Left ventricle showed hypertrophy (maximum wall thickness = 13 mm) with normal volumes and systolic function. Thus, the patient underwent to 3D-Transesophageal echocardiography, which demonstrated unicuspid aortic valve with a lone commissure between L-NC and anterior calcification. After multidisciplinary discussion, the patient underwent close follow-up and aortic valve replacement was planned after the bone marrow transplantation.

Case 2. A 21-year-old male was referred by general practitioner to our outpatient clinic for palpitations. Cardiovascular physical examination and ECG were normal with no evidence of arrhyhtmia or cardiac murmurs.

Transthoracic echocardiography revealed central mild aortic valve regurgitation in a suspected quadricuspid aortic valve (i.e., an X-shaped commissure pattern during diastole and a rectangular appearance during systole in the parasternal short-axis view). Left ventricular size and function and ascending aorta dimensions were normal. There was no associated congenital cardiovascular abnormality. 3D-Transesophageal echocardiography confirmed the evidence of a quadricuspid aortic valve. The cusps appeared to be of different size: two equal larger cusps and two equal smaller cusps (Type C, Hurwitz and Robert's classification), thin and mobile. The patient was advised to echocardiographic follow-up at intervals of 12 months.

Conclusions

We describe two cases of aortic valve congenital anomalies in two coetaneous patients with completely different impacts on hemodynamics. Severe aortic stenosis complicated unicuspid aortic valve whereas quadricuspid aortic valve was associated with mild aortic regurgitation. 3D-Transesophageal echocardiography was essential for accurate morphological characterization of the aortic valves.
785 ACCURATE ASSESSMENT OF RIGHT VENTRICULAR FUNCTION BECOMES MORE CHALLENGING IN PATIENTS WITH SEGNIFICANT TRICUSPID REGURGITATION: A CASE REPORT OF RIGHT VENTRICULAR DYSFUNCTION AFTER TRICLIP IMPLANTATION
Authors: Lucchino Alessandro , Aquila Iolanda , Calvelli Pierangelo , Romano Letizia , Augusto Florinda , Mascaro Giuseppina , Mongiardo Annalisa , Indolfi Ciro
Published: December 2022

Introduction

anatomically and functionally different from the left ventricle, the right ventricle (RV) plays an increasingly recognized role in determining symptoms and outcomes in multiple conditions. Due to RV complex anatomy and mechanics, the evaluation of its size and function is challenging. The ideal imaging technique should be capable of comprehensive, accurate and reproducible assessment of RV morphology and contraction. In the absence of a single reliable 2DE measure of the RV systolic function, several surrogate echocardiographic parameters have been proposed for clinical use, from one-dimensional (TAPSE) to 3D techniques.

Clinical Case

we report a case of an 82-year-old female patient who was admitted to our hospital because of dyspnoea, with a history of atrial fibrillation, hypertension, diabetes mellitus, chronic kidney disease, and a last year hospitalization for heart failure. A transthoracic echocardiography (TTE) was performed, showing a high-grade tricuspid valve regurgitation. Further investigation using transoesophageal echocardiography (TEE) showed, in four chambers view, dilatation of right sections and confirm TR was significant, so screening for TriClip implantation was performed. The exam was diagnostic for massive TR, moderate Mitral Regurgitation, and the estimated PAPs about 50 mmHg, so, in the absence of anatomical exclusion elements, severe pulmonary hypertension and poor RV function, transcatheter treatment with TriClip was offered. We had evaluated RV function, obtaining a FAC about normal limit (which should be corrected by valvular regurgitation), and a reduced Strain value. The patient received an edge-to-edge reparation of the tricuspid valve using the TriClip XTR (Clip) system with 2 clips placed. The post-interventional echocardiographic results were an optimal correction of valvular regurgitation, with, however, a clear right ventricular disfunction. Those finding were confirmed by further echocardiographic follow up exams, even during inotropic treatment by low dobutamine dose.

Conclusion

estimating RV function remains challenging because of the complex geometry of the RV. In the presence of significant TR, the accurate assessment of RV function becomes even more challenging because of the load and angle dependency of TAPSE, RVFAC and RVEF. Significant TR result in a reduction in RV afterload, which may preserve the markers of TV function even when contractility is impaired. 2d-STE in less angle and load dependent than traditional RV function indices and less confounded by RV geometry and passive motion.
1095 WHICH IS THE BEST MYOCARDIAL WORK INDEX FOR THE PREDICTION OF CORONARY ARTERY DISEASE? A DATA METANALYSIS
Authors: Ajello Manuela , Parlavecchio Antonio , Vetta Giampaolo , Caminiti Rodolfo , Magnocavallo Michele , Lofrumento Francesca , Foti Rosario , Della Rocca Domenico Giovanni , Micari Antonio , Carerj Scipione , Di Bella Gianluca , Zito Concetta
Published: December 2022

Background

Early diagnosis of Coronary Artery Disease (CAD) plays a key role to prevent adverse cardiac events such as myocardial infarction and Left Ventricular (LV) dysfunction. Myocardial Work (MW) indices derived from echocardiographic speckle tracking data in combination with non-invasive blood pressure recordings are able to predict CAD even in the absence of impairments of standard echocardiographic parameters. Our aim was to compare the diagnostic accuracy of MW indices to predict CAD and to assess intra-observer and inter-observer variability of MW through a metanalysis.

Methods

Electronic databases were searched for observational studies evaluating the MW indices diagnostic accuracy for predicting CAD and intra-observer and inter-observer variability of MW indices. Pooled sensitivity, specificity, and Summary Receiver Operating Characteristic (SROC) curves were assessed.

Results

5 studies enrolling 501 patients met inclusion criteria. Global Constructive Work (GCW) had the best pooled sensitivity (89%) followed by GLS (84%), Global Work Index (GWI) (82%), Global Work Efficiency (GWE) (80%) and Global Wasted Work (GWW) (75%). GWE had the best pooled specificity (78%) followed by GWI (75%), GCW (70%), GLS (68%) and GWW (61%). GCW had the best accuracy according to SROC curves, with an Area Under The Curve of 0.86 compared to 0.84 for GWI, 0.83 for GWE, 0.79 for GLS and 0.74 for GWW (Figure 1). All MW indices had an excellent intra-observer and inter-observer variability.

Conclusions

GCW is the best MW index proving best diagnostic accuracy in the prediction of CAD with an excellent reproducibility.

Figure 1: Pooled sensitivity, pooled specificity, SROC curves and AUC of Myocardial Work indices and GLS
1009 INTRAMYOCARDIAL HEMORRHAGE: A DIFFERENTIAL DIAGNOSIS OF HYPERTROPHY
Authors: Procopio Maria Crstina , Licordari Roberto , D´angelo Tommaso , Frumento Francesca Lo , Perfetti Silvia , De Sarro Rosalba , Irrera Natasha , Bitto Alessandra , Squadrito Francesco , Costa Francesco , Micari Antonio , Di Bella Gianluca
Published: December 2022

Hypertrophic cardiomyopathy (HCM) is a muscle disorder with impairment of microvascular circulation. Intramyocardial hemorrhage (IMH) represents a possible complication in patients with myocardial infarction (MI) involving left ventricular (LV) myocardial tissue and micro vascularization. We describe a case of a HCM patient with anterior STEMI with evidence of IMH.

Case Report

A 61-years-old male patient from Sri Lanka with no prior medical history presented to the emergency Department with persistent chest pain started from 3 hours. He was a smoker. The first ECG revealed ST-segment elevation in V2-5 leads and symmetric negative T-wave in I and aVL leads. Primary percutaneous coronary intervention (PCI) was performed, revealing sub-obstructive stenosis in the proximal left anterior descending artery (LAD) associated with extensive endoluminal thrombus. Invasive coronary angiogram also showed a critical stenosis in distal right coronary artery (RCA) and a chronic occlusion in the proximal left circumflex coronary artery (LCx). After tirofiban intravenous administration and rheolytic thromboaspiration, drug-eluting stent (DES) implantation of the LAD artery was performed successfully.

Transthoracic echocardiography, performed after primary PCI, documented akinesia of proximal LAD territories and LV ejection fraction (EF) of 45%. The curious feature was the evidence of concentric hypertrophy in absence of an apparent reason. Therefore, three days later, the patient underwent cardiac magnetic resonance (CMR), showing mildly reduced LV function (LVEF 42%). CMR images also showed subendocardial late enhancement in proximal LAD territory and transmural LGE with no-reflow phenomenon in mid-apical anteroseptum. (Figure) On T2-weighted images, there was an hypointense core enclosed in the transmural hyperintense area in basal-mid anteroseptum, likely in keeping with intramyocardial hemorrhage (Figure). After a staged PCI with the implant of another DES in RCA, patient was discharged in DAPT (aspirin + ticagrelor).

Conclusion

IMH is considered a severe form of MVO, which occurs in the core of the infarcted area in patients with myocardial infarction. We describe an intriguing case with IHM in HCM patient. Moreover, it raises several questions on which is the best treatment option.
426 SPECKLE-TRACKING GLOBAL LONGITUDINAL STRAIN AS A PREDICTOR OF CLINICAL OUTCOMES IN SYSTEMIC SCLEROSIS PATIENTS
Authors: Stronati Giulia , Alfieri Michele , Bastianoni Gianmarco , Paolini Federico , Brugiatelli Leonardo , Benfaremo Devis , Moroncini Gianluca , Dello Russo Antonio , Guerra Federico
Published: December 2022

Introduction

Cardiac involvement in patients affected by systemic sclerosis is frequent, although mostly asymptomatic, and associated with a negative prognosis. It may be secondary to pulmonary hypertension or defined as an actual systemic-sclerosis related cardiomyopathy, a standalone entity affecting the heart primarily and globally. Speckle-tracking derived global longitudinal strain (GLS) has been proven to be a cost-effective tool in the detection of LV and RV dysfunction in patients with SSc and no overt cardiac disease. The aim of our study was to assess whether GLS can predict clinical outcomes in patients with systemic sclerosis.

Methods

We conducted a prospective observational study enrolling all consecutive patients referred to our “cardiology clinic for autoimmune diseases and pulmonary hypertension” between June 2016 and January 2022. All patients had a confirmed diagnosis of SSc according to the EULAR guidelines and no overt cardiac disease, pulmonary hypertension, or atrial fibrillation at the time of enrollment. For each patient, echocardiogram and GLS calculations were performed at baseline and at each follow-up. We also collected all data regarding clinical history, hospitalizations or adverse events and ECGs.

Results

164 patients (148 female, 58±14 years)were enrolled. 19 (11.6%) patients died during a median follow-up of 3.2 years for mainly non-cardiovascular deaths (7.3%) while cardiovascular deaths were lower (3% non-sudden, 1.3% sudden). Left GLS at first visit was associated with all-cause death, with a 1% left GLS worsening associated with a 19% increased risk of death after adjusting for age, gender, and LVEF (adjusted HR 1.19; 95% CI 1.05-1.35; p=0.007).Similarly, right GLS at first visit was associated with all-cause death, with a 1% right GLS worsening associated with a 12% increased risk of death after adjusting for age, gender, and TAPSE (adjusted HR 1.12; 95% CI 1.03-1.21; p=0.005).Patients with a left GLS worse than -20% had a 3.5-fold increased risk of death when compared to patients with better left GLS (HR 3.55; 95% CI 1.28-9.88; p=0.015). Similarly, patients with a right GLS worse than -20% had a 4.5-fold increased risk of death when compared to patients with better left GLS (HR 4.47; 95% CI 1.4-13.74; p=0.009).Both left and right ventricular GLS were not associated with changes in risk of all-cause hospitalizations, cardiovascular hospitalizations or subsequent diagnosis of pulmonary hypertension.

Conclusions

GLS is a reproducible, cost effective echocardiographic based method to assess both primary heart disease and its progression. It has proven to be associated with clinical outcomes in patients with systemic sclerosis, therefore allowing a prompt intervention when needed in order to try and prolong the life expectancy of this cohort of patients.
227 THE PROGNOSTIC VALUE OF RIGHT ATRIAL STRAIN IN PATIENTS WITH SECONDARY TRICUSPID REGURGITATION
Authors: Tomaselli Michele , Paolo Badano Luigi , Paolo Perelli Francesco , Radu Noela , Oliverio Giorgio , Francesca Heilbron , Stucchi Davide , Pece Cinzia , Camponetti Virginia , Cascella Andrea , Caravita Sergio , Baratto Claudia , Ciambellotti Francesca , Parati Gianfranco , Gavazzoni Mara , Muraru Denisa
Published: December 2022

Background

in secondary tricuspid regurgitation (STR), the remodeling of the right ventricle (RV) and the right atrium (RA) is associated with different outcomes. However, the potential prognostic role of right RA function in this setting, assessed by 2D-speckle tracking echocardiography (2D-STE), remains to be tested. Accordingly, the aim of our study is to assess the prognostic value of RA 2D-STE in patients with significant (i.e. moderate or severe) STR.

Methods

we retrospectively studied 227 (mean age 74±14, 40% men, 59% sinus rhythm) consecutive patients with significant STR, acquired between May 2012 and June 2021. RA 2D-STE was obtained from a dedicated, non-foreshortened RV-focused apical 4-ch view, using a dedicated software package (AFI LA, EchoPAC 204, GE Vingmed, Horten, Norway). Among the three longitudinal strain components provided by the software package (reservoir, conduit and, contraction), we focused on RA longitudinal strain during reservoir (RASR). Patients were divided into two groups according to the median value of RARS (12%). A combined endpoint of heart failure hospitalization and all-cause mortality was defined.

Results

after a median follow-up period of 14 months (IQR, 1-27), 93 patients (41%) reached the combined endpoint. The predictive power of RARS<12% (AUC 0.64 [IC 95% 0.56-0.71]), was significantly higher than RA maximum volume (AUC 0.38 [IC 95% 0.31-0.47]). Patients with RARS ≤ 12% were more symptomatic (according to NYHA class), had larger RA volumes (119 vs 89 mL, p<0.001) and, a reduced right ventricular systolic function (TAPSE: 14.7 vs 18.9 mm; FAC 37.7 vs 42.4%; RV free-wall strain: 17.5 vs 20.8%; all p<0.001). In addition, patients with RARS<12% had more severe TR (corrected EROA: 0.85 vs 0.41 cm2; p<0.05). Prevalence of atrial fibrillation (58 vs 61%), left ventricular ejection fraction, and right ventricular size were similar between the groups. Patients with RARS ≤12% had a significant risk for death (log rank, p<0.001), even after correcting for confounding variables. Moreover, RA strain was independently associated with the combined endopoint in multivariate analysis (p < 0.001)

Conclusions

in patients with significant STR, RARS is an independent predictor of the combined endpoint of heart failure hospitalization and all-cause mortality and provides incremental prognostic value over RA volume.
642 VALUE OF CORONARY CTA TO RULE OUT OBSTRUCTIVE CORONARY ARTERY DISEASE IN HIGH-RISK PATIENTS CANDIDATES FOR TAVI
Authors: Virgili Giacomo , Busi Gherardo , Fumagalli Carlo , Acquafresca Manlio , Moroni Mario , Migliorini Angela , Meucci Francesco , Valenti Renato , Di Mario Carlo , Marchionni Niccolò , Carrabba Nazario
Published: December 2022

Background

Coronary computer tomography angiography (CTA) is currently considered a reliable method to rule out obstructive coronary artery disease (O-CAD) before valvular heart surgery in patients with low-intermediate pretest probability. However, its role in excluding O-CAD before transcatheter aortic valve implantation (TAVI) is less well established.

Purpose

To assess the value of coronary CTA in safely ruling out O-CAD in high-risk patients undergoing TAVI in a tertiary center.

Methods and Results

We conducted a single-center retrospective study where patients with severe symptomatic aortic stenosis underwent coronary CTA and then invasive coronary angiography (ICA) if indicated, as part of the TAVI planning. All patients were examined with a retrospectively ECG gated CT scan of the heart, followed by a high-pitch-scan of the vasculature access route utilizing a single intravenous bolus of 70 mL iodinated contrast agent, with an average interval of 31.65 (± 42.50) days to ICA. In both coronary CTA and ICA, O-CAD was defined as a ≥ 50% stenosis in an epicardial vessel ≥ 2 mm diameter. Based on coronary CTA, in case of minimal/non O-CAD, invasive ICA was omitted, whereas it was performed in case of obstructive CAD or inconclusive test.

Our registry included 163 patients, out-off 28 did not receive coronary CTA for clinical reasons. Thus, 135 patients (87 female – 64%) presenting a mean age of 87.27 (± 1.23) years underwent coronary CTA. Twenty-one (15%) CTA test were judged positive for O-CAD and 25 (18.5%) were inconclusive (and considered as positive). All of these patients underwent ICA and 17/21 (80.95%) and 16/25 (64%) resulted positive for O-CAD, respectively. About the positive O-CAD and inconclusive CTA group, 11/21 (52.38%) and 11/25 (44%) patients were treated with PCI of ostial or proximal/middle segment lesions, respectively. On a per-patient analysis, coronary CTA showed: a specificity of 78.76% (95% CI 70.07% - 85.89%); a positive predictive value of 82.48% (95% CI 76.75% - 87.04%); and the accuracy was 89.38% (95% CI 82.92% - 94.02%). In patients with minimal/non O-CAD, coronary CTA led us to safely avoid invasive ICA in 65.92% (n=89) patients, with no need for additional contrast agent and without occurrence of related adverse events during the procedure and during the follow-up (up to 12 months).

Conclusion

Pre-procedural coronary CTA may help us to safely rule out O-CAD in an eligible significant proportion of high risk patients undergoing TAVI. Quite the opposite, the added value in the management of O-CAD by CTA is scarce and it remains to be clarified.
1060 HOW TO EVALUATE RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH SIGNIFICANT TRICUSPID REGURGITATION: PRELIMINARY DATA BEFORE AND AFTER TRICLIP IMPLANTATION
Authors: Volpe Lorenzo , Aquila Iolanda , Lucchino Alessandro , Mancuso Cinzia , Ventura Ettore , Levato Letizia , Vizzari Francesca , Mascaro Giuseppina , Mongiardo Annalisa , Indolfi Ciro
Published: December 2022

Objective

transcatheter tricuspid valve repair (TTVR) has recently become available as a treatment option for patients with symptomatic significant tricuspid regurgitation (TR) not eligible for tricuspid valve surgery. In the absence of a single reliable measure of the RV systolic function, a number of surrogate echocardiographic parameters have been proposed for clinical use (tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), peak S wave velocity of the lateral tricuspid annulus by tissue Doppler imaging (S’ RV-TDI) and RV 2D-FWS. At present, TTVR is not recommended in patients with severe PH and poor RV function, but exact cut-offs when TTVR should be rejected are lacking. Aim of this study was to assess RV function before and after Triclip implantation.

Materials and methods

from June 2021 to June 2022 clinical and echocardiographic data of 8 patients with TR who underwent TTVR intervention in our division were evaluated for RV function. TAPSE, FAC, S’RV-TDI, RV GS and RV FWS at baseline and 1 month of follow up were assessed. Continuous variables are presented as mean ± standard deviation (SD). Categorical variables were presented as frequencies and percentages.

Results

the mean values of RV function assessed before and after Triclip implantation were respectively (18,75 mm± 4,04 vs 18,38 mm ± 3,34) for TAPSE, (10,50 cm/sec± 2,33 vs 10,38 cm/sec ± 1,19) for S’ RV-TDI, (38% ± 0,05 vs 37% ± 0,04) for FAC, and (-17% ± 0,03 vs -19% ± 0,02) for RV FWS. The number of patients that show at baseline RV dysfunction, according to the cut-offs indicated from guidelines, were 4 for TAPSE; 3 S’ RV-TDI; 1 for FAC and 7 for RV 2D-FWS. At 1 month of follow-up, patients with ventricular dysfunction were respectively 3,2,2,4.

Conclusions

in the presence of significant TR, the accurate assessment of RV function becomes even more challenging as a result of the load and angle dependency of TAPSE, RVFAC. Significant TR results in a reduction in RV afterload, which may preserve the aforementioned markers of RV function even when contractility is impaired. Probably RV 2D-STE is less angle and load dependent than traditional RV function indices and less confounded by RV geometry and passive motion.
255 IMPACT OF SEVERE VALVULAR HEART DISEASE IN ADULT CONGENITAL HEART DISEASE PATIENTS
Authors: Graziani Francesca , Iannaccone Giulia , Chiara Meucci Maria , Lillo Rosa , Delogu Angelica Bibiana , Grandinetti Maria , Perri Gianluigi , Galletti Lorenzo , Amodeo Antonio , Butera Gianfranco , Secinaro Aurelio , Lombardo Antonella , Antonio Lanza Gaetano , Crea Filippo , Burzotta Francesco , Massetti Massimo
Published: December 2022

Background

The clinical impact of valvular heart disease (VHD) in adult congenital heart disease (ACHD) patients is unascertained. Aim of our study was to assess the prevalence and clinical impact of severe VHD (S-VHD) in a real-world contemporary cohort of ACHD patients.

Methods

Patients followed-up at our ACHD Outpatient Clinic were enrolled. Clinical characteristics and echocardiographic data were prospectively entered into a digitalized medical records database. VHD at the first access was evaluated and graded according to VHD guidelines. Clinical data at follow-up were collected.

Results

A total of 390 patients were included and S-VHD was present in 101 (25.9%) patients. Over a median follow-up time of 26 months (IQR: 12-48), the primary composite endpoint occurred in 76 patients (19.5%). The cumulative primary endpoint-free survival was significantly lower in patients with S-VHD vs patients with non-severe VHD (Log rank p <0.001). At multivariable analysis, age and atrial fibrillation at first visit (p=0.029 and p=0.006 respectively), lower %Sat O2, higher NYHA class (p=0.005 for both), lower LVEF (p=0.008) and S-VHD (p=0.015) were independently associated to the primary endpoint. The likelihood ratio test demonstrated that S-VHD added significant prognostic value (p=0.017) to a multivariate model including age, severe CHD, atrial fibrillation, Sat O2, NYHA, LVEF and right ventricle systolic pressure>45 mmHg.

Conclusion

In ACHD patients, the presence of S-VHD is independently associated with the occurrence of cardiovascular mortality and hospitalization. The prognostic value of S-VHD is incremental above other established prognostic markers.
687 RIGHT VENTRICULAR DISFUNCTION IN A PATIENT WITH CCTGA TREATED WITH ARNI
Authors: Benvenuto Ciro Pollio , Grandinetti Maria , Massetti Massimo , Aspromonte Nadia
Published: December 2022

Congenitally Corrected Transposition of Great Arteries is a unique condition in which atrio-ventricular discrepancy e ventricular-arteriosus discrepancy are mutually balanced, so that there is the normal oxygenation and distribution of the blood to the tissues, but the morphologically right ventricle and the tricuspid valve have to deal with systemic pressures, developing severe ventricular disfunction and valve regurgitation along the years.

We presented the case of a young male patient from India with Congenitally Corrected Transposition of Great Arteries, Ventricular Septum Defect and Pulmonary Artery Stenosis, for which he was treated surgically by positioning a valved conduit between the morphologically left ventricle and the pulmonary artery; he developed worsening dyspnoea years after the operation and further investigations in our centre demonstrated the patency of the conduit and right (systemic) ventricular disfunction that we decided, in a pioneering manner, to treat with Sacubitril/Valsartan.
607 TRICUSPID VALVE IN VALVE AND RENAL ARTERY ANGIOPLASTY: A RARE CASE OF HEART FAILURE TREATED BY TWO MINIMALLY INVASIVE INTERVENTIONAL PROCEDURES
Authors: Bandini Marta , Cesarini Daniel , Mattesini Alessio , Meucci Francesco , Di Mario Carlo
Published: December 2022

Tricuspid valve pathology has unfavorable anatomy for repair and valve replacement is often required. Biological tricuspid valves have a shorter lifespan compared to aortic and mitral prostheses and their replacement is considered a high-risk procedure. In addition, patients with tricuspid valve disease have multiple comorbidities and a reduced functional class, which contribute to an increased risk of mortality. The recent spread of percutaneous valve treatments has demonstrated a good safety profile and a high short-term success rate.

Regarding nephrovascular hypertension, it is still a matter of debate whether there is a long-term benefit of renal artery angioplasty plus medical therapy over medical therapy alone. According to recent evidence, revascularization would provide benefit only in specific circumstances such as, failure of optimal medical therapy, relapsing episodes of acute pulmonary edema and refractory heart failure.

We present the case of a 62-years-old woman with right heart failure associated with prosthetic tricuspid valve dysfunction and nephrovascular hypertensive crisis, treated by two minimally invasive interventional procedures, with excellent short-term clinical outcome

Tricuspid valve in valve procedure

Renal artery angioplasty
909 TIMING AND DETERMINANTS OF PERMANENT PACEMAKER IMPLANTATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: IS THE NEW GENERATION BETTER?
Authors: Bellantoni Antonio , Sorrentino Sabato , Boccuto Fabiola , Carabetta Nicole , Panarello Alessandra , Bruno Federica , Spinali Martina , Sportelli Martina , Polimeni Alberto , Rosa Salvatore De , Mongiardo Annalisa , Spaccarotella Carmen , Indolfi Ciro
Published: December 2022

Background

conduction disturbances requiring permanent pacemaker (PPM) implantation are among the most common adverse events in patients undergoing transcatheter aortic valve replacement (TAVR). The introduction in clinical practice of a new generation of TAVR devices has contributed to a significant reduction in procedural complications. However, limited data is available regarding the usual timing of PPM implantation after TAVR with the latest available valves. Therefore, in this analysis, we aimed to investigate the incidence, risk factors, and timing of new permanent pacemakers after TAVR, with respect to the type of valve implanted.

Methods

Patients who underwent TAVR at our Institution from September 2008 to June 2022 were included in this analysis. Patients with previous PPM/ICD implantation or receiving only balloon angioplasty were excluded, as well as cases with procedural unsuccess. The independent association between baseline clinical and procedural variables and the occurrence of PPM implantation was investigated with cross-sectional logistic regression analysis.

Results

A total of 497 patients were included in the study, with a mean age of 80.4±5.6 years old; 59% were females, 37.2% of patients had diabetes, 60.2% had dyslipidemia, and 25.8% had chronic kidney disease. The mean left ventricular ejection fraction (LVEF) was 52.1%, and the mean Euroscore II was 7.7±5.1. The new generation of self-expandable valves was used in 280 (56.3%) patients, while the new generation of balloon-expandable devices was implanted in 118 (23.7%). After TAVR, 109 (21.3%) patients underwent PPM/ICD implantation after a mean time of 4.1±3.1 days. After adjustment, self-expandable devices, larger valve sizes (29 or 34 mm), and diabetes were significantly associated with PPM/ICD implantation. Of note, the new generation of valve devices was associated with a lower risk of PPM/ICD implantation.

Conclusion

The necessity for a permanent pacemaker is a well-known possible adverse effect after TAVR. In this analysis, we confirm the previous evidence of an increasing risk of PPM implantation with self-expandable compared to balloon-expandable devices. Interestingly, the new valve generation was associated with a lower risk of conduction disturbances requiring PPM implantation. Further analyses and investigations will be needed to assess the impact of developing interventional techniques and advanced technologies on the occurrence of conduction disturbances.
471 IMPACT OF COMPLETE REVASCULARIZATION ON DEVELOPMENT OF HEART FAILURE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND MULTIVESSEL DISEASE
Authors: Bruno Francesco , Marengo Giorgio , Filippo Ovidio De , Wanha Wojciech , Leonardi Sergio , Rubin Sergio Raposeiras , Fabris Enrico , Giannino Giuseppe , Truffa Alessandra , Gaibazzi Nicola , Ielasi Alfonso , Sardella Gennaro , Gallone Guglielmo , Cortese Bernardo , Montalto Claudio , Ugo Fabrizio , Barbieri Lucia , Morici Nuccia , Mancone Massimo , Campo Gianluca , Sinagra Gianfranco , D´ascenzo Fabrizio , De Ferrari Gaetano Maria
Published: December 2022

Background

The impact of complete revascularization (CR) on survival and occurrence of heart failure (HF) after ACS is still unsettled. Goal of this study was to evaluate the impact of CR on HF hospitalization and adverse outcomes in patients with ACS and multivessel coronary artery disease undergoing PCI.

Methods

Consecutive ACS patients with multivessel disease from the CORALYS registry were included. First hospitalization for HF or cardiovascular (CV) death was the primary endpoint. Patients were stratified according to CR.

Results

Of 14699 patients in the CORALYS registry, 5054 had multivessel disease. 1473 (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary endpoint (adjusted HR 0.66, 95% CI 0.51-0.85), first HF hospitalization (adj HR 0.67, 95% CI 0.49-0.90), CV death (adj HR 0.56, 95% CI 0.38-0.84) and all-cause death (adj HR 0.74, 95% CI 0.56-0.97). The results were consistent in the matched population and in the IPTW analysis. The benefit of CR was consistent across ACS presentations (HR 0.59, 95% CI 0.39-0.89 for STEMI and HR 0.71, 95% CI 0.50-0.99 for NSTE-ACS) and in patients with LVEF>40% (HR 0.52; 95% CI 0.37-0.72), while no significant benefit was observed in patients with LVEF≤40% (HR 0.77; 95% CI 0.37-1.10, p for interaction 0.04).

Conclusions

In patients with ACS and multivessel disease, CR reduced the risk of first hospitalization for HF and CV death, as well as first HF hospitalization, CV and overall death. When feasible, CR should be performed in all patients with ACS to reduce the incidence of HF and death. Future studies are needed to assess the evidence of CR in patients with depressed LVEF.
1140 CLINICAL OUTCOME OF FRACTIONAL FLOW RESERVE GUIDED REVASCULARIZATION STRATEGY OF CORONARY LESIONS: THE HALE-BOPP STUDY
Authors: Caglioni Serena , Campo Gianluca , Gallo Francesco , Scoccia Alessandra , Durante Alessandro , Tedeschi Delio , Verdoliva Sebastiano , Cortese Bernardo , Bilotta Ferruccio , Watkins Stuart , Ielasi Alfonso , Valentini Giuliano , Arena Marco , Mele Daniela , Pavasini Rita , Serenelli Matteo , Pompei Graziella , Scala Antonella , Gibiino Federico , Scollo Ennio , D´aniello Emanuele , Biscaglia Simone , Barbato Emanuele , Tebaldi Matteo
Published: December 2022

Background

There are currently some doubts about the efficacy of fractional flow reserve (FFR)-guided revascularization in different clinical settings.

Aim

To evaluate the long-term outcome of an FFR-deferred strategy in daily practice.

Methods

The Clinical Outcome of FFR-guided Revascularization Strategy of Coronary Lesions (HALE-BOPP) is an investigator-initiated, multicenter, international prospective study consecutively enrolling patients who underwent FFR measurement on at least one vessel. According to decision-making workflow and treatment, vessels were classified in three subgroups: i) angio-revascularized, ii) FFR-revascularized, iii) FFR-deferred. The primary endpoint was the occurrence of target vessel failure (TVF, cardiac death, target vessel myocardial infarction and ischemia-driven target vessel revascularization). The analysis is carried out at vessel- and patient-level.

Results

Overall, 1305 patients with 2422 diseased vessels fulfilled criteria for the present analysis. Wire-related pitfalls and transient adenosine-related side effects occurred in 0.8% (95%CI 0.4%-0.1%) and 3.3% (95% 2.5%-4.3%) of cases, respectively. In FFR-deferred vessels the overall incidence rate of TVF was 0.024% (95%CI 0.019-0.031) lesion/year. After a median follow-up of 3.5 years, the occurrence of TVF was 6%, 7% and 11.7% in FFR-deferred, FFR-revascularized and angio-revascularized vessels, respectively. As compared to angio-revascularized vessels, FFR-guided vessels (both FFR-revascularized and FFR-deferred vessels) showed a lower TVF incidence rate lesion/year (0.029, 95%CI 0.024-0.034 vs. 0.049, 95%CI 0.040-0.061 respectively, p= 0.0001). This was consistent after correction for confounding factors and across subgroups of clinical interest. Patient-level analysis confirmed the lower occurrence of TVF in negative-FFR vs. positive-FFR subgroups.

Conclusions

In a large prospective observational study, FFR-based strategy for the deferral of coronary lesions is reliable and safe and associated with good long-term outcome.
773 CONTRAST-ENHANCED EXCIMER LASER CORONARY ANGIOPLASTY IN THE TREATMENT OF HEAVILY CALCIFIED LESIONS: A STEPWISE APPROACH
Authors: Caminiti Rodolfo , Vetta Giampaolo , Parlavecchio Antonio , Mazzone Paolo , Giacchi Giuseppe , Sacchetta Giorgio , Della Rocca Domenico Giovanni , Magnocavallo Michele , Virga Vittorio , Costa Francesco , Di Bella Gianluca , Carerj Scipione , Contarini Marco , Vizzari Giampiero , Micari Antonio
Published: December 2022

Introduction

The treatment of heavily calcified lesions is a challenge for the interventional cardiologist. The Excimer laser coronary atherectomy (ELCA) is a plaque modification tool and the main mechanism of action seems to be the photomechanical delivering acoustic pressure with a mechanical disruption of the plaque in front of the catheter tip.

Objective

To evaluate the effectiveness of the contrast-enhanced ELCA by a stepwise approach, with incremental frequency/fluency in the treatment of calcified lesions in different contexts.

Methods

We retrospectively enrolled consecutively all patients undergoing contrast-enhanced ELCA-assisted PCIs between 2018 and 2021 at the Cardiology Unit of “Umberto I” Hospital of Syracuse (Italy).

The frequency/fluency ELCA profile used with a stepwise approach were 50/50, 60/60, 70/70 and 80/80. ELCA technical success was defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. Procedural success was defined as <30% residual stenosis after laser and adjunctive therapy. Clinical success requested procedural success with absence of major adverse cardiac events at hospital discharge. Major adverse cardiac events included death of all causes, myocardial infarction, need for target lesion revascularization, tamponade, and life-threatening arrhythmias.

Results

We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI. 58% of the patients had acute coronary syndrome and 42% had chronic coronary syndrome. The left anterior descending artery was the target vessel in 42.1% of cases, the right coronary artery in 26.3%, the circumflex in 10.5%, and the left main artery in 2.3%. The main indication for ELCA was intrastent restenosis (56.2%). The median stenosis was 90% (80% – 90%).

The ELCA catheter tip was 0.9 mm and 1.4 mm was employed in the 89.5% and 10.5% of cases respectively. The most used frequency/fluency profile was 70/70 (39.5%) followed by 60/60 (31.6%), 50/50 (15.8%) and 80/80 (13.2%). Use of contrast-enhanced ELCA was associated with high technical success rate (97.4%), procedural success rate (93.7%), and clinical success rate (97.1%).

Conclusions

In Conclusion, the contrast-enhanced ELCA seems to be a safe and effective treatment for management of calcified lesions.
89 GUIDE EXTENSION CATHETER: INDICATION, USE AND RESULTS IN A LARGE SERIES OF COMPLEX PERCUTANEOUS CORONARY INTERVENTIONS
Authors: Cappannoli Luigi , Marchetta Michele , Ausiello Davide , Romagnoli Enrico , Burzotta Francesco , Cristina Aurigemma , Giambusso Nicole , Fulco Linda , Vergallo Rocco , D´amario Domenico , Leone Antonio Maria , Antonio Montone Rocco , Buffon Antonino , Crea Filippo , Trani Carlo
Published: December 2022

Aims

The guide extension catheter (GEC) is a helpful tool to increase catheter support when facing complex percutaneous coronary intervention (PCI) in unfavorable coronary anatomies. The aim of this study was to describe indication, efficacy, and safety of the GEC in a high-volume center.

Methods and results

From 2014 to 2021, we retrospectively identified and analyzed 351 interventional cases in which GEC was used to complete the procedure. The endpoints of the study were PCI success, procedural success and device failure. GEC use increased over the years and was more frequently used by radial approach (92.1%) in elective setting (90.6%) and using the 6F size (95.3%). The GEC was mostly implemented as bail-out strategy (75.9%) with the aim to improve back-up (89.6%), less frequently to optimize catheter alignment or obtain selective coronary cannulation (10.4%). Intracoronary advancement was performed using the guidewire in 1.3% of cases, after positioning of a second “buddy” wire in 23.2%, with support of a deflated balloon at the distal tip in 12.2%, or with anchoring technique in 63.3%. Mean coronary deep intubation depth was 38.8±23.9mm. Vessel and lesion characteristics are reported in Table I.

Overall, PCI success rate was 92.5%, while procedural success (PCI success without in hospital adverse event) was 88.6%. GEC was successfully used in 92.7% of patients with no device-dependent severe adverse events; in particular, failures were related to inability to cross the target lesion in 4.5% or to device–related complication in 2.85% of cases.

Conclusions

This large real-world registry on GEC use in complex PCI confirms the GEC as a valid and safe tool to increase backup support and overcome the limits of conventional technique during complex PCI.