bluuebunny/crossref_metadata_2025 huggingface dataset:
P1780 Left ventricular golbal longitudinal strain in acute myocardial infarction and incidence of in hospital heart failure
Authors: Ebeid H , Abd El Hady R , El Khashab K , Husein M
Published: January 2020

Background

The occurrence of in-hospital heart failure in the acute phase of myocardial infarction carries an ominous prognosis and is often preceded by abrupt loss of functioning myocardium. However ,In hospital heart failure may occur in patients with apparently only minor myocardial injury and preserved or only moderately reduced left ventricular ejection fraction and still carries a significantly increased risk of adverse outcome. In patients with clinical symptoms of heart failure despite preserved left ventricular ejection fraction(heart failure with preserved ejection fraction), abnormalities in longitudinal myocardial mechanics have been reported suggesting that the discrepancy between near normal left ventricular ejection fraction and clinical symptoms may be partially explained by theses indices.

Purpose

Evaluation of the role of global longitudinal strain in prediction of the occurrence of in hospital heart failure in patients presenting with acute myocardial infarction particularly in patients with normal ,or moderately impaired ejection fraction.

Methods

forty patients with first attack of acute myocardial infarction were ranked according to killip class during their hospital admission and course. The patients were divided into two groups: Group 1: patients having in-hospital heart failure (killip class > 1).Group2: Patients not having in–hospital heart failure (killip class = 1). Echocardiogaraphic examination was done for them including global longitudinal strain within 72 hours after successful reperfusion .Comparison of different echocardiographic parameters between the two groups was done. Patients with mildly impaired ejection fraction (Ejection fraction > 40%) were studied for echocardiographic parameters correlated significantly with the occurrence of in-hospital heart failure .

Results

Patients with in-hospital heart failure had significantly impaired global longitudinal strain(-8.63%+1.57% vs -12.41%+1.31%, p = 0.000), lower left ventricular ejection fraction (34.17%+8.17% vs 42.92 %+7.98%,p < 0.001) and higher wall motion score index (1.57 + 0.32 vs 1.31 +0.24 ,p < 0.006). In patients with left ventricular ejection fraction >40% experienced in-hospital heart failure also exhibited significantly impaired global longitudinal strain p= 0.035 .

Conclusion

Global longitudinal strain can offer accurate, feasible, and non invasive predictor of hemodynamic deterioration in patients with myocardial infarction. Global longitudinal strain was superior to left ventricular ejection fraction , wall motion score index in evaluation of myocardial dysfunction specially in those with preserved left ventricular ejection fraction(EF > 40%).Global longitudinal strain was also superior to left ventricular ejection fraction , wall motion score index in detection of patients with Killip class II ( those without overt heart failure ,and who can be easily missed).
P1786 Impact of exercise on platelet activity in patients with significant ischemic mitral regurgitation qualified for cardiosurgery treatment
Authors: Piatkowski R , Kochanowski J , Budnik M , Huczek Z , Scislo P , Kosior D A , Opolski G
Published: January 2020

Purpose

Platelet activity is believed to play an important role in patients (pts)after myocardial infarction (MI). This study sought to examine a change in platelet activity after 2D echocardiography semi-supine exercise test (ExE) in pts with at least moderate ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABG) or CABG with mitral reconstruction (CABGmr).

Methods

We collected venous blood samples from 70 patients (M 41, 66 ± 9 years) with at least moderate IMR, 3-24 weeks after MI. Platelet activity was estimated with the use of rapid, point-of-care platelet analyzer as the time (in seconds) for flowing whole blood to occlude a collagen-epinephrine ring, with shorter closure times, indicating greater activity (CEPI-CT- for assessing the thromboxane A2 –dependent activation pathway). CEPI-CT was evaluated before (CEPI-CT rest) and 20 min after ExE (CEPI-CT ExE). All the patients received 75-100 mg of aspirin daily (without clopidogrel treatment). Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (moderate ≥10-20, severe ≥ 20 mm²). All the pts were referred for CABG (multivessel coronary disease, ejection fraction (EF) 42,6 ± 10,1%, wall motion score index (WMSI) 1.65 ± 0.36).

Results

We observed a significant decrease in CEPI–CT’s in all analyzed group (rest vs exe: 202 sec vs 124 sec, respectively; p < 0,0001) and in pts with moderate IMR as well as in pts with severe IMR, despite aspirin treatment. The results of the analysis of CEPI-CT and IMR size at rest and after ExE in both groups of pts are shown in Table 1. A negative correlation was found between CEPI-CT ExE and ERO ExE (r=-0,752, p = 0,0042).

Conclusions

1. Significant increase in platelet activity after exercise was observed in patients after MI with IMR qualified for cardiosurgical treatment.

2. The increase in platelet activity after exercise is correlated with exercise changes of IMR size.

3. Aspirin may have a limited antithrombotic effect after physical exercise in patients after MI with significant IMR.

Table 1. CEPI-CT rest CEPI-CT ExE p ERO rest ERO exe p All 202 124 < 0,0001 17 22 <0,001 Moderate IMR 201 124 0,0001 15 20 < 0,0001 Severe IMR 235,5 123,5 < 0,0001 25 31 < 0,0001
P1789 Stress echocardiography in patients with pulmonary arterial hypertension - a pilot study
Authors: Ptaszynska-Kopczynska K , Mickiewicz K , Oleksiuk M , Michalski T , Lisowska A , Kaminski K , Sobkowicz B , Knapp M
Published: January 2020

INTRODUCTION

Pulmonary arterial hypertension (PAH) is a rare, progressive disease with poor prognosis. Stress echocardiography (SE) gives an important data on hemodynamic response to exercise. In patients with PAH SE may be useful for the diagnosis and risk assessment but data are lacking.

AIM OF STUDY

The aim of the study was to analyze exercise-induced response of right heart function and pulmonary artery pressure in patients with PAH.

MATERIALS AND METHODS

Study group consisted of 15 hemodynamically stable patients, 9 women, aged 22-73 (median- 50), diagnosed with PAH treated at Cardiology Department. The patients were subjected to stress echocardiography on supine cycloergometer and underwent assessment before and at peak-exercise. Moreover the standard parameters of clinical assessment: NT-proBNP, WHO functional class, and 6-minute walk test were analyzed.

RESULTS

Nine patients were in WHO class III, 4 of them- WHO class II and 2- WHO class I. The median NT-proBNP concentration was 169.3 (IQR 151.2-989.5) pg/ml. 6-Minute Walk Test distance was 455 (428-489) meters. The median workload was 75 (IQR 50-100) Watts and it was the median 54% (IQR 37-62%) of predicted.

The echocardiographic parameters assessed in SE at rest and shortly after peak-exercise revealed that RV systolic volume did not significantly differ: 70 (49.8-112.3) vs 71.5 (36.6-110) ml, p = 0.3. Right atrial area decreased from median 21.9 (17.4-27.3) to 19.8 (16.4-22.1) cm2, p = 0.05, whereas right atrial volume did not significantly changed - 80 (47.5-99.5) vs 68 (47.3-78.8) ml, p = 0.13. Further, shortly after exercise tricuspid regurgitation peak gradient (TRPG) significantly increased - 43 (25-76.5) vs 71 (50.5-102) mmHg, p = 0.002.

CONCLUSIONS

In stable PAH patients supine SE is feasible. Even in advanced WHO functional classes patients were able to exercise. Among echocardiographic parameters TRPG reflecting systolic pulmonary artery pressure showed the biggest difference between baseline and peak-exercise values. SE and seems to be a valuable tool in PAH patients’ assessment.
P1795 Active acromegaly is associated with enhanced left ventricular contractility - A three-dimensional speckle-tracking echocardiographic study
Authors: Kormanyos A , Domsik P , Kalapos A , Gyenes N , Valkusz Z , Lengyel C , Forster T , Nemes A
Published: January 2020

Introduction

Acromegaly is a relatively rare, chronic hormonal disease resulting in disfigurement. In 90% of the cases, acromegaly is caused by a benign pituitary monoclonal human growth hormone-secreting tumor. Hypertension and left ventricular (LV) hypertrophy are the most common cardiovascular comorbidites, but serious valvular regurgitation and heart failure could also develop at the end-stages. The aim of the present study was to determine the presence of LV deformational abnormalities using three-dimensional speckle-tracking echocardiography (3DSTE) in a group of acromegaly patients.

Methods

Thirty-eight acromegaly patients were involved in the present study. Thirteen patients were excluded due to inadequate image quality. The mean age of the remaining patients were 57.2 ± 13.6 years (7 males). The active acromegaly subgroup consisted of 14 patients (mean age: 58.6 ± 14.6 years, 5 males), while the inactive group contained 11 patients (mean age: 54.0 ± 12.9, 2 males). Their data was compared to an age- and gender matched control population, which comprised of 34 healthy volunteers (mean age: 52.7 ± 4.9 years, 15 males). All subjects have undergone complete two-dimensional Doppler echocardiography extended with 3DSTE.

Results

Significant differences in left atrial diameter and volume, LV end-diastolic diameter and volume, interventricular septum and LV posterior wall thickness could be demonstrated between the acromegaly group and healthy controls. Global and mean segmental 3DSTE-derived LV radial strain (RS)(33.2 ± 13.4% vs. 25.2 ± 10.8%, p =0.01 and 36.0 ± 12.1% vs. 28.2 ± 10.0%, p =0.009, respectively) proved to be significantly higher in acromegaly patients compared to controls. Active acromegaly patients had a significantly higher global and mean segmental RS (35.5 ± 14.4% vs. 25.2 ± 10.8%, p =0.03 and 37.9 ± 13.3% vs. 28.2 ± 10.0%, p =0.03, respectively) as compared to that of controls. Between active and inactive acromegaly groups only basal LV circumferential strain (-30.2 ± 4.8% vs. -26.7 ± 4.1%, p =0.02) was found to be significantly different.

Conclusion

With presented clinical, demographic, therapeutic and echocardiographic features, active acromegaly is associated with enhanced LV-RS as compared to the healthy population.
P1797 Left atrial mechanics in patients with stoke: Implications for emprical anticoagulation
Authors: Sade L E , Keskin S , Colak A , Ciftci O , Can U , Kibaroglu S , Yuce D , Ozin B , Muderrisoglu H
Published: January 2020

Purpose

Detection of atrial fibrillation (AF) after stroke impacts patient management. However, detection of AF is difficult due to its paroxsysmal nature. We sought to test the hypothesis that echocardiographic quantification left atrial (LA) mechanics in patients with stoke can be an imaging biomarker to predict AF.

Methods

We enrolled prospectively and consecutively 131 patients in normal sinus rhythm with a new diagnosis of ischemic stroke. All patients underwent 48-hour Holter monitorization, transthoracic echocardiography with saline injection in addition to routine work-up of stroke evaluation. Two-dimensional and Doppler studies, together with most up-to-date LA quantification tools were performed including 3-dimensional LA phasic volumes (maxiumum and minimum LA Volume index - LAVImax, LAVImin) and LA strain quantification (average strain from apical 4- and 2-chamber during reservoir (Ss) and contraction (Sa) phases). Patients were followed-up and underwent second 48-hour Holter monitorization 6-12 months later if no etiologic cause was found. Any AF episode lasting >30 seconds was considered significant parosysmal AF.

Results

In 49 patients, causes other than AF were identified (Noncryptogenic). In 43 patients no discernable cause was found (NoAF Cryptogenic). Paroxysmal AF episodes lasting longer than 30 sec were documented in 27 patients at first 48-hour Holter and in 12 patients during follow-up (9.2 ± 3.1 months) either by second 48-hour Holter monitorization or clinically (AF cryptogenic). LAVImax and LAVImin were significantly increased, Ss and Sa were significantly reduced in patients with AF as compared to No AF and Noncryptogenic groups (Table). LA volumes and strain measures predicted AF development independently of CHA2DS2-VASc score. Better discrimination between No AF and AF groups was obtained after second Holter monitorization that enabled detection of more cases with paroxysmal AF (Figure).

Conclusions

Our findings underscore the value of echocardiographic assessment of LA function as a marker of AF development and for selection of patients who could benefit from empiric anticoagulation.

Noncryptogenic AF cryptogenic No AF cryptogenic 3D LAVI max (ml/m²) 30.1 ± 9,4 38.1 ± 12.7 28.9 ± 9.2 3D LAVI min (ml/m²) 13.9 ± 7.5 20.7 ± 10.7 13.4 ± 5.3 3D LA EF (%) 55.5 ± 9.4 50.0 ± 10.5 53.8 ± 10.0 Ss (%) 17.4 ± 8.5 12.7 ± 5.3 17.5 ± 8.5 Sa (%) 12.7 ± 6.3 9.0 ± 5.0 12.8 ± 6.3 CHA2DS2-VASc 4.0 ± 1.6 5.0 ± 1.6 3.9 ± 1.5

Abstract P1797 Figure.
P1803 Incidence of venous thromboembolism in patients with granulomatosis with polyangiitis (Wegener"s granulomatosis)
Authors: Borowiec A , Kowalik I , Hadzik-Blaszczyk M , Rusinowicz T , Krupa R , Zycinska K
Published: January 2020

Funding Acknowledgements

none

Background

Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) – associated vasculitis. This primary systemic vasculitis is multisystem disorder characterized by inflammation and necrosis of small and medium sized blood vessels. An increased risk of cardiovascular mortality and incidence of various cardiovascular events has been described among GPA patients.

Purpose

The aim of the present study was to assess the incidence of venous thromboembolism (VTE) and its correlation with echocardiographic parameters and laboratory findings in GPA patients.

Methods

The group of consecutive patients with GPA were followed in the study. In all patients echocardiography and laboratory tests were performed.

Results

One hundred four patients with GPA (mean age 51.6 ± 13.2 yrs) were followed for an average of 4,5 ± 1,9 years. In 24 patients venous thromboembolism was diagnosed during observation, however in majority of them (57%) VTE occurred during first year after diagnosis of GPA. There were no significant differences in creatinine, troponin T and CRP levels between patients with and without VTE. In patients with VTE there were larger right ventricle diameter (29.1 ± 4.4 vs. 32.1 ± 5.6; p = 0.04) and higher right ventricle systolic pressure (32.6 ± 5.4 vs. 37.3 ± 5.9; p = 0.02) observed. In this study group D-dimer was elevated in majority (56%) of patients. In patients with VTE D-dimer correlated positively with age (r = 0.5, p = 0.02), right ventricle diameter (r = 0.63, p = 0.001), right ventricle systolic pressure (r = 0.44, p = 0.04), and negatively with pulmonary artery acceleration time (r= -0.43, p = 0.05).

Conclusions

Venous thromboembolism is a common complication in patients with granulomatosis with polyangiitis, especially during first year after diagnosis. This finding is likely to be associated with changes in endothelial function and with induction of hypercoagulability resulting from changes in pro and anticoagulant factors associated with inflammation and its therapy.
P1811 Prognostic impact of different subtypes of severe aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Pal M , Dekany G , Mandzak A , Piroth Z S , Fontos G , Andreka P
Published: January 2020

Background

Outcomes for different subtypes of aortic stenosis defined by transvalvular flow and gradient after transcatheter aortic valve implantation (TAVI) are still subjects of debate.

Purpose

The aim of the study was to evaluate the prognostic impact of the initial transvalvular flow rate and aortic mean gradient on survival and to assess the changes of left ventricular function after TAVI.

Patients and Methods

From 2008. to 2017.06.30. TAVI was performed in 300 cases in our Institute (127 men, 173 women, mean age 80,0 ± 5,8 years) with severe (aortic valve area <1,0 cm²) symptomatic aortic stenosis (AS) and contraindication or high risk for surgery. Median time for follow-up was 28 (0-115) months, Echocardiography was performed before and 12 months after TAVI. Patients were divided into four groups according to flow (F) , aortic mean gradient (Gr) and ejection fraction (EF):

HG

Gr ≥ 40 mmHg (n = 237)

LF-LG : F ≤ 35 ml/m2, Gr < 40 mmHg and EF < 50% (n = 41)

PLF-LG: F ≤ 35 ml/m2, Gr < 40 mmHg and EF ≥50% (n = 9)

NF-LG: F > 35 ml/m2 and Gr < 40 mmHg (n = 13)

Our primary objective was the analysis of 30-day, 1-year and 3-year all-cause mortality of these groups, secondary goal was to observe the changes in EF after 12 months in the survivors.

Results

In the whole patient group 30-day all-cause mortality was 4,3%, 1-year 17,0% and 3-year 62,0%. The NFLG group had the most favourable outcomes (mortality: 30d 0, 1-year: 7,7%, 3-year: 46,2%). Mortality was low in the HG group in the 1st year (30-day: 3,8%, 1-y: 14,3%), but it increased to 62,8% at 3-year. Mortality rates were intermediate in the PLF-LG group (30-day 0, 1-year 22,2%, 3-year 55,6%) and were the highest in LF-LG (30-day 12,2%, p = 0,03 vs HG, 1-year 34,2% p = 0,005 vs. HG, 3-year 75,6%).

Among clinical and echocardiographic variables only moderate or severe paravalvular aortic regurgitation (p = 0,03) and severe renal dysfunction (GFR <30 ml/min, p = 0,02) were independent predictors of all-cause 1-year mortality.

In patients with severe (EF < 30%) , moderate (EF 30-40%) or mild ( EF 41-50%) systolic dysfunction the EF improved after TAVI (23,5 ± 3,5% vs. 30,3 ± 7,9% p < 0,001, 33,6 ±3,6% vs. 43,0 ± 10,5% p = 0,003, 45,5 ± 3,1% vs. 54,3 ± 8,7% p < 0,001) regardless of the initial flow and gradient subtype of AS.

Conclusions

Low flow-low gradient aortic stenosis is associated with worse short or long term prognosis after TAVI, therefore this subtype of AS needs detailed risk stratification before-, and careful management after TAVI. Improvement of initial left ventricular dysfuncion can be expected after TAVI.
P1823 Feasibility of CCTA in assessment of luminal changes and coronary shear stress evolution after implantation of bioresorbable vascular scaffolds
Authors: Cernica D R , Ferent I , Mester A , Opincariu D , Hodas R , Rodean I , Chitu M , Benedek T , Benedek I
Published: January 2020

Funding Acknowledgements

PlaqueImage - financed by the National Authority of Scientific Research and Innovation and the Romanian Ministry of European Funding

Background

Coronary shear stress (CSS) is a well-established local mechanical factor in atherogenesis, progression and destabilization of atherosclerotic plaques. Analysis of CSS after coronary stent placement is still lacking of large clinical studies. Purpose: The aim of this study was to: (1) test the feasibility of Coronary Computed Tomography Angiography (CCTA) for assessment of local hemodynamic and luminal changes after implantation of bioresorbable vascular scaffolds (BVS), and (2) to investigate CSS modifications after BVS implantation. Methods: We conducted a single center, prospective pilot study on 73 patients with coronary artery disease who underwent elective percutaneous coronary intervention (PCI); group 1 (n = 30) – patients with BVS and group 2 (n = 43) – patients with bare metal stent (BMS) implanted. CCTA scanning was performed in all patients prior PCI and at 12 months after PCI. The mean CSS at proximal and at distal part of the stented segment and at the level of the minimal lumen area (MLA) was calculated at baseline and at 12 months after BVS placement. Results: CCTA revealed a higher incidence of severe coronary stenosis in group 1 (73%) than in group 2 (30%) (p < 0.0001). Sensibility of visual evaluation for identification of in-stent restenosis on CCTA was increased in BVS group (94%) than in BMS group (76.19%) (p = 0.0006), hence the group 1 had lower incidence of non-diagnostic evaluations. Mean CSS at the stented site was significantly lower at 12 months (1.9 +/- 0.68 Pa) that average CSS at baseline (2.87 +/- 3.08 Pa) (p = 0.0001). CSS analysis showed also a significantly decreased values at proximal level from 3.39 +/- 1.93 Pa at baseline to 1.91 +/- 0.68 Pa at follow up (p < 0.0001), but not a significant decrease at distal part – 1.3+/-0.72 Pa at baseline and 1.59 +/- 0.65 Pa at 12 months follow up (p = 0.9). Conclusions: CCTA is a feasible technique for assessment of luminal changes following BVS implantation. BVS implantation contribute to the improvement of local hemodynamics by restoring physiological pattern of coronary flow, as demonstrated by the computational fluid hemodynamics assessment of coronary circulation.
P1827 Impact of coronary microcirculatory dysfunction in the impairment of left ventricular deformation parameters by 4D echocardiographic techniques in hypertrophic cardiomyopathy patients
Authors: Aguiar Rosa S , Branco L , Galrinho A , Lopes L , Fiarresga A , Celas M , Silva F , Carvalho A F , Mota Carmo M , Cruz Ferreira R
Published: January 2020

Background

Coronary microvascular dysfunction has been described as an important pathophysiologic feature in hypertrophic cardiomyopathy (HCM).

Objective

To analyse the impact of coronary microcirculatory dysfunction on left ventricular (LV) deformation parameters obtained by 4D echocardiography in HCM.

Methods

HCM patients (P) prospectively underwent dedicated transthoracic echocardiogram for microcirculation study. The evaluation of coronary flow velocity reserve (CFVR) was performed in apical three chambers view for the left anterior descending (LAD) artery and in an apical two chambers view for the posterior descending (PD) artery. Diastolic coronary flow velocity (CFV) was measured at basal conditions and during hyperaemia, induced with adenosine perfusion (0.14 mg/kg/min intravenously, during 2 minutes). Absolute CFVR was calculated as the ratio of hyperaemic to basal peak diastolic flow velocities.

By 4D TTE (GE E95 equipment) LV global longitudinal strain (GLS), global circumferential stain, global radial strain, area strain, twist and torsion were analysed.

Results

23 P were enrolled (57% male, mean age 57.9 ± 13.7 years). Asymmetric septal hypertrophy was verified in 70% of patients, with maximal wall thickness of 21.6 ± 4.3mm. Obstructive HCM was documented in 35% of patients.

CFV was successfully measured in the LAD in all patients, but only in 70% of patients in the PD due to technical issues related to poor acoustic window and anatomical constraints. 78% of P (n = 18) presented CFVR <2, denoting microcirculatory dysfunction. Relative CFVR (CFVR LAD / CFVR PD) was ≥1 in 43% of P.

At baseline conditions, 4D GLS < -8% was associated with lower LAD flow (34.3 ± 8.3 vs 42.7 ± 9.7cm/s; p = 0.037), trend to lower PD flow (35.3 ± 17.8 vs 49.9 ±18.4 cm/s; p = 0.066). 4D GLS < -8% P presented higher CFVR PD (2.0 ± 0.8 vs 1.1 ± 0.2; p = 0.009), with no significant difference in CFVR LAD.

Global circumferential stain <-13% seemed to be associated with lower basal CFV LAD (32.5 ± 8.8 vs 40.4 ± 9.5 cm/s; p = 0.089) and PD (29.8 ± 9.0 vs 45.6 ± 17.4 cm/s; p = 0.054). P with better global circumferential stain (<-13%) presented higher CFVR PD (2.3 ± 0.7 vs 1.4 ± 0.7; p = 0.005), as well as P with an area strain <-18% (CFVR PD 2.0 ± 0.8 vs 1.4 ± 0.8; p = 0.038). P with LV twist >4deg presented higher CFV PD at baseline (49.6 ± 16.5 vs 33,8 ± 12.9 cm/s; p = 0.039) and during hyperemia (68.0 ± 12.2 vs 52.9 ± 12.1cm/s; p = 0.032).

Conclusion

HCM P with greater impairment in LV deformation parameters by 4D echocardiography presented increased basal diastolic CFV, which can be explained by increased coronary vascular resistance and a higher oxygen demand at baseline conditions. Worse LV performance was also associated with decreased CFVR, mainly in PD.
P1829 A middle aged man with pericardial cyst
Authors: Kandil A , Nata R , Felix P
Published: January 2020

Introduction

Pericardial cysts are rare benign congenital anomaly that are usually accidentally discovered as a mass obliterating the costophrenic angle. The reported incidence is one to 100,000 with males are equally affected as females. They are usually asymptomatic; however, they can cause chest pain, shortness of breath and dry cough.

Case report

We present a 62 years old gentleman who presented with increasing shortness of breath. He was a heavy smoker and was known to have COPD. He was also known to have chronic heart failure with an EF of 40% and had a previous history of pericardial cyst that was initially discovered when he was investigated for shortness of breath. The patient had a one-month history of feeling more dyspneic than usual. His chest auscultation revealed scattered rhonchi and no murmurs were heard on auscultation of the heart. His ECG showed no new abnormality and his chest x-ray showed abnormal right cardio mediastinal silhouette with large opaque area adjacent to the right heart border and the size of the opacity the same compared to his previous x rays.

An Echocardiography was done and this showed moderate to severe impairment of left ventricular systolic function with an EF of 30-35%, mild to moderate mitral regurgitation and showed a cystic lesion anterior to the right ventricle. A CT chest was done for evaluation of the pericardial cyst and showed centrilobular emphysema and a mass in the rt lung abutting the right border of the heart with a maximum diameter of 8.7 cm.

The patient was non-compliant to his medications and repeatedly missed his follow up appointments. He also continued to smoke despite progression of his COPD. The cause of his shortness of breath was likely due to progression of heart failure and COPD with the pericardial cyst probably has no or minimal rule.

Conclusion

Pericardial cysts are rarely symptomatic and usually has a benign course. We aimed at increasing awareness of this rare benign animally.

Abstract P1829 Figure.
P1833 Ultrasonic imaging of radial artery reactive response in patients with hypertension with and without left ventricular hypertrophy
Authors: Parol M A , Majka K , Trawinski Z , Gambin B , Krupienicz A , Obiala J , Nowicki A , Olszewski R
Published: January 2020

Background

Endothelium plays an important role in anti-inflammatory process and regulating vascular tone.

It has been shown in numerous studies that increase of vessel dilation after several minutes hyperemia, was induced by mechanical transient flow stimulation of the endothelium. Most of the reported research experiments were conducted on the brachial artery. We proposed to measure the flow-mediated dilation in the radial artery (FMDr) in patients with hypertension (HT). In order to improve the axial resolution affecting the precision of FMDr determination, radial artery imaging was performed using a high frequency 20 MHz ultrasound.

Aim

The aim of the study was assessment of FMDr in patients with HT using 20 MHz probe.

Methods: Our studies involved two groups

group I consisted of 76 pts. 35 men and 41 women (71 ± 5.6 yr. old); with documented HT and group II consisted of 16 healthy volunteers, 12 men and 4 women (51.4 ± 9.4 yr. old). We divided patients with HT in to three subgroups: IA - 25 pts. with HT and left ventricular hypertrophy (VH), IB - 26 pts. with HT without VH, and IC patients with HT without VH but with coexisting coronary artery disease (CAD).

Results

Statistically significant differences in FMDr between the two groups were confirmed by a Wilcoxon-Mann-Whitney test. In group II FMDr was 11.9 ± 4.8%, and in group I FMDr was significantly less at 5.1% ± 4%. We have not observed any statistical differences in FMDr between groups: IA and IB ( 5.05%, 5.55%) respectively. We calculated FMDr for IC 4.21% (p = 0.018). Fig. 1.

Conclusion

The results confirm the usefulness of the proposed measurements of radial artery FMDr to differentiation of normal subjects from those with documented HT. There are no significant differences between males and females in all considered groups of subjects. We did not find the differences in FMDr between patients with and without VH. Patients with HT, without VH and with coexisting CAD had the lowest reactive response of FMDr.

Abstract P1833 Figure. Fig. 1
P1836 Common carotid artery intima-media thickness correlates with the epicardial fat thickness in patients with ischemic stroke
Authors: Serova D , Serov V , Shutov A , Serova S , Kovalenko A , Braun A
Published: January 2020

The relationship between epicardial fat thickness and coronary atherosclerosis is well known, but the value of the increased epicardial fat thickness in cerebrovascular diseases is still unclear.

Purpose

The aim of this study was to determine the relationship between common carotid artery intima–media thickness (CCA-IMT), the resistance index (RI) in the vertebral and carotid arteries and epicardial fat thickness (EFT) in patients with ischemic stroke.

Methods

98 patients with ischemic stroke (31 females and 67 males, mean age was 68.2 ± 12.1 years) were studied. All patients had arterial hypertension (AH). Most of them (96.9%) had grade 3 hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. Forty-two (43.1%) patients had coronary artery disease and 35 (35.4%) - atrial fibrillation (AF). The exclusion criteria was the presence of chronic obstructive pulmonary disease or other diseases associated with pulmonary hypertension. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8) - 54 (55.1%) patients, moderate NIHSS (9–15) - 23 (23.5%) patients, and severe stroke NIHSS (≥16) - 21 (21.4%) patients. Median NIHSS score was 11.2 ± 1.7. All patients underwent a transthoracic echocardiography and a carotid ultrasound examination.

Results

The common carotid artery intima–media thickness correlated with EFT (r =0.78, p < 0.001), the body mass index (r = 0.7, p < 0.001) and systolic blood pressure (r = 0.25, p = 0.045). The resistance index in the vertebral and carotid arteries correlated only with EFT (r = 0.7, p < 0.001 and r = 0.78, p < 0.001, respectively) and body mass index (r = 0.58, p < 0.001 and r = 0.68, p < 0.001, respectively).

A multiple regression analysis in which the CCA-IMT was a dependent variable and age, body mass index, systolic blood pressure, blood cholesterol level and epicardial fat thickness were independent variables, showed that CCA-IMT was independently correlated with blood cholesterol level (β=0.714, р<0.001) and EFT (β =0.255, р=0.002) in patients with ischemic stroke.

Conclusions

The common carotid artery intima–media thickness and parameters of the arterial stiffness of the extracranial vessels of the head are associated with the epicardial fat thickness and blood cholesterol level in patients with ischemic stroke. The common carotid artery intima–media thickness does not depend on age, gender, body mass index, systolic and diastolic blood pressure in patients with ischemic stroke.
P855 Extensive right heart endocarditis in the past
Authors: Dobrzanska E , Tomaszewski M , Zarczuk R , Tomaszewski A , Czekajska-Chehab E
Published: January 2020

A 38y. old woman was admitted to a Cardiology Department due to increased exertional dyspnea and decreased exercise tolerance.

Echocardiography performed in an outpatient setting has found a substantial enlargement of the right ventricle and severe tricuspid regurgitation.

Physical examination

significantly enlarged liver, pulsation of jugular veins and numerous scars in the pits elbow.

ECG

sinus rhythm 85 / min. Right axis deviation. LPH. Hypertrophy of the right atrium. QS in V1-V4.

Transthoracic and Transesophageal Echocardiography (TTE,TEE) EF 64%, a significant increase in a right heart chambers (RVDD 4.1 cm, severe tricuspid regurgitation with completely disappearing of tricuspid valve ( only part of septal leaflet was present, which was a consequence of pressure equalization between the right atrium and the right ventricle). In addition, it revealed the structure connected with the pulmonary valve leaflet and moving between the right ventricular outflow tract and pulmonary trunk (most probably healed vegetation, 1.2 x 0.5 cm ).

Computed tomography (CT) confirmed the significant enlargement of right heart chambers (EDV 335 ml, ESV 143 ml, SV 192 ml, EF ∼ 58%) with displacement of interatrial septum to the left and the flattening of the interventricular septum . Complete destruction of the tricuspid valve leaflets, with the remaining residual part of septal leaflet was observed. The pulmonary valve was connected mobile irregular structure 2,5 cm x 0,5 cm.

Laboratory tests revealed a history of cytomegalovirus infection (p / body IgG> 500,000U / ml). Other tests (HIV, hepatitis B, reaction W-R) - were negative. There was no laboratory and clinical signs of active infection at present.

Patient demanded to be discharged from the hospital and refused operation.

DISCUSSION

Echocardiography did not confirm diagnosis of pulmonary hypertension. D-dimer values of 396 ng / ml (normal <500 ng / ml) excluded suspicion of pulmonary embolism. Left ventricular ejection fraction was normal (EF ∼ 64%), BNP reached the value of 153 pg / ml (normal 0-100pg / ml).

This case deserves attention because it documents severe right heart endocarditis by the person using drugs intravenously with an extremely rare takeover of both right heart valves and septic pulmonary embolism. Despite such a large morphological change in the heart of a patient remains in a relatively good clinical condition (NYHA class II/ III). The observed structure of the pulmonary trunk should be considered as healed vegetation. In the absence of consent to the surgery the patient is still treated pharmacologically.

Abstract P855 Figure. Pic.1
P258 Giant coronary arteriovenous fistula with significant left-to-right shunt in symptomatic patient - a multimodal diagnostic approach and successful surgical treatment
Authors: Novak M , Nemec P , Sebo M , Veteskova L , Rezek M
Published: January 2020

Funding Acknowledgements

none

OnBehalf

none

Coronary arteriovenous fistula (CAF) is a rare usually congenital defect that occurs in 0.1-0.2% of patients undergoing coronary angiography. A left-to-right shunt exists in more than 90% cases. In approximately 20% of patients CAF is accompanied with coronary artery aneurysm (CAA).

We describe a case of 65-years-old woman with history of murmur from childhood, who presents with symptoms of slowly worsening dyspnea on exertion and strong pericardial pain. A suspicion for CAF was made from echocardiography and finally confirmed by other diagnostic modalities (coronary angiography and computed tomography with 3D reconstructions). We have diagnosed a complex case of a giant CAA involving left main and a periphery of left circumflex artery, accompanied with CAF terminating in the right atrium, responsible for a significant left-to-right shunt and coronary steal phenomenon.

Patient was successfully treated by surgical ligation of the distal part of CAF in the right atrium. There were no signs of an acute myocardial ischemia on beating heart (ECG, perioperative echocardiography) when CAF was temporary occluded by tourniquet and so definitive surgical ligation of CAF was performed back on cardiopulmonary bypass. The postoperative course was uneventful without complications and the patient was discharged 6 days after surgery.

One year after surgery patient is doing well with no complaints. Control echocardiography showed a regression of left and right ventricle volume overload. Coronary angiography showed normal perfusion in the left coronary artery territory, and no more visible collaterals flow right coronary artery.

Abstract P258 Figure. complex coronary artery aneurysm
P903 Myocardial work in moderate to severe aortic versus primary mitral regurgitation
Authors: Bouziane M , Dulgheru R E , Marchetta S , Khaddi S , Cozza F , Habbal R , Lancellotti P
Published: January 2020

Funding Acknowledgements

None

OnBehalf

None

BACKGROUND

Myocardial work is an emerging non-invasive technic based on echocardiographic pressure-strain loops that assess left ventricular (LV) function. The method was studied in a large variety of pathologies, but its role in the assessment of valvular regurgitations is still unknown.

PURPOSE

To compare myocardial work indices in moderate and severe aortic and primary mitral regurgitation.

METHODS

Seventy-eight patients with moderate and severe aortic regurgitation (AR) or primary mitral regurgitation (MR) and preserved LV ejection fraction (LVEF > 50%) were retrospectively analyzed.. Patients with significant valvular stenosis were excluded. Demographic, clinical and echocardiographic data, including LV global longitudinal strain (GLS) and myocardial work indices, were assessed.

RESULTS

The mean age was 58 ± 14 years, and 46 patients (59%) were men. Thirty seven patients had moderate or severe AR and 41 patients had moderate or severe MR. The two groups were homogeneous in terms of demographic and clinical data, except for age. As expected, diastolic blood pressure was lower in patients with AR compared to MR group (67 ± 8 mmHg vs. 73 ± 10 mmHg, p = 0,003), patients with MR had a higher LVEF compared to AR group (63 ± 6% vs 59 ± 6%, p = 0,03), and a higher left atrial indexed volume (53 ± 16ml/m² vs 34 ± 12ml/m², p < 0.0001). Overall, GLS, myocardial work index (GWI) and myocardial constructive work (GCW) were significantly lower in patients with moderate or severe AR compared to MR ( -18,1 ±3% vs -21,3 ±3,3%, p < 0,0001; 1849 ± 393 vs 2285 ± 499, p < 0,0001; and 2194 ± 395 vs 2576 ± 594, p = 0,003, respectively). Global wasted work (GWW) and global work efficiency (GWE) were similar. When comparing only asymptomatic patients, results were similar, with higher GLS, GWI and GCW in moderate to severe MR vs. AR (-22,9 ± 3,4 vs.-18,4 ± 3,4%, p <0,001; 2446 ± 570 vs. 1927 ± 338, p = 0.001 and 2767 ± 688 vs. 2236 ± 377, p = 0.005). Interestingly, when comparing asymptomatic patients with a LVEF > 50% for AR, and LVEF > 60% for MR, GWI and GCW were significantly lower in MR group, despite higher GLS values (1852 ± 398 vs. 2322 ± 527, p < 0.001; 2194 ± 400 vs. 2615 ± 638, p = 0.005; -22,1 ± 3,3% vs. -18,2 ± 2,9, p < 0.001).

CONCLUSION

Patients with moderate to severe MR have higher values of GLS, global work index and global constructive myocardial work. This could translate into the fact that in moderate or severe MR, the myocardium develops a higher amount of work than in AR, maybe to account for the loss of stroke volume into the left atrium. In asymptomatic moderate to severe MR with LVEF > 60%, LV myocardium develops less work than in moderate to severe AR with a LVEF > 50%, suggesting maybe a compensated state.
P974 Sacubitril/valsartan is well tolerated in patients with heart failure and a history of cancer
Authors: Frey M K , Han E , Arfsten H , Pavo N , Huelsmann M , Gyoengyoesi M , Bergler-Klein J
Published: January 2020

Introduction

Sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalisations due to heart failure in patients with reduced ejection fraction when compared to enalapril. Until now, sacubitril/valsartan has not been evaluated in patients with a history of cancer, as these patients were excluded from the pivotal trial, PARADIGM-HF. The aim of the current study was to assess tolerability of sacubitril/valsartan in patients with a history of cancer.

Methods

We retrospectively enrolled all patients at our heart failure out-patient unit who fulfilled the indication criteria to receive sacubitril/valsartan and had a history of cancer. Fifteen patients receiving sacubitril/valsartan had a diagnosis of histologically confirmed cancer: 26.7% breast cancer (n = 4), 13.3% osteosarcoma (n = 2), 13.3% colorectal cancer (n = 2), 13.3% renal cell carcinoma (n = 2), 6.7% non-Hodgkin lymphoma (n = 1), 6.7% lung cancer (n = 1), 6.7% prostate cancer (n = 1), 6.7% bladder carcinoma and 6.7% myeoloproliferative syndrome (n = 1). Surgery due to cancer was performed in 80% of patients (n = 12), 26.7% previously received chemotherapy (n = 6) and 40% radiation therapy (n = 4).

Results

Sacubitril/valsartan was withdrawn in 2 patients (13.3%) because of dizziness and pruritus respectively. After a mean follow-up of 13 ±8 months, NYHA functional class improved significantly (mean -0.5, p = 0.001), ejection fraction as assassed by echocardiography increased (mean +6.8%, p = 0.018) and NT-proBNP was significantly decreased (mean -1552pg/ml, p = 0.026). There was no significant change in creatinine levels (+0.046 mg/dl, p = 0.564 ).

Conclusions

In this pilot study we were able to show that sacubitril/valsartan is generally well tolerated in patients with a history of cancer. Patients with cardiotoxicity induced heart failure can be treated and uptitrated with sacubitril/valsartan to usual dosages similarly as in other causes of heart failure. Larger studies are needed to confirm these findings in cancer patients with cardiotoxicity.
P1592 Papillary- annular continuum is a dynamic component of obstruction in outflow tract of left ventricle in patients with hypertrophic cardiomyopathy
Authors: Pavlyukova E N , Evtushenko A V , Kanev A F , Karpov R S
Published: January 2020

The aim to study was to assess Strain of papillary muscles (PM) and their apical displacement with 3D mitral valve (MV) parameters with maximal size of gradient of obstruction in the left ventricle outflow tract (LVOFT) and the volume of mitral regurgitation (MR) in hypertrophic cardiomyopathy (HCMP) patients.

Material and methods. 72 HCMP patients (aged of 56.9 ± 11.1 years and gradient in LVOFT 70.83 ± 14.83 mm Hg at rest) were investigated. 3D TEE of MV was performed in all patients with follow up

reconstruction. Strain of anterolateral (AL) and posteromedial (PM) papillary muscles (PM) was assess by TTE.

Results

Strain of both PM was decreased in 45 (62.5)% patients. Positive Strain PM PM were found in 20 (27.8%) patients and AL PM -in 7 (9.7%) patients. Apical displacement of PM PM were registered in 19 (38.0%) pts and ALPM in 6 (12.0%) pts. Apical displacement of both papillary muscles was found in 10 (20.0%) patients.

Pts with positive Strain of PM PM had remodeling fibrous ring of MV as compared to patients who had negative Strain of this PM (anteroposterior diameter - 1.97 ± 0.23 sm/m² vs 1.63 ± 0.20sm/m²; p = 0, 01; the perimeter of the ring - 6.92 ± 0.69 sm/m2 vs 6.09 ± 0.93sm/m2; p = 0.02; the area of the ring (3D) - 6.91 ± 1.23sm²/m² vs 5,14 ± 1.31 sm²/m²; p = 0.005). These patients had large areas of the MV leaflets (anterior 4.83 ± 1.03 sm²/m² vs 3.19 ± 0.81 sm² /m² ; p = 0.007; posterior - 4.39 ± 0.42 sm²/m² vs 3.39 ± 1.18 sm²2/m²; p = 0.004), the area of the tenting of leaflets (2.98 ± 1.64 sm²/m² vs 1.24 ± 0.61 sm²/m²; p = 0.04) and the fraction of the tenting (69, 04 ± 24.9% vs 41.27 ± 17.59; p = 0.03). Patients with positive Strain had a greater volume of mitral regurgitation (24.20 ± 11.91 ml vs 14.04 ± 7.58 ml p = 0.004) and the peak gradient in LVOFT was 88.90 ± 37.90 mm Hg vs 66.35 ± 27.00 mm Hg; p = 0.02).

Thus, the parameters of 3D MV and strain of PM represent a fixed papillary – annular continuum causing a dynamic component of the obstruction in the LV OT and the volume of mitral regurgitation in patients with HCMP.
P269 When sudden cardiac death is the first symptom
Authors: Abdala Lizarraga J , Sanchez Alvarez S , Garcia Gonzalez P , Trejo Velasco B , Vidal Urrutia V , Gradoli Palmero J , Simon Machi J M , Fernandez Diaz C , Vano Bodi J , Cardenas Tealdo J P , Paya Serrano R
Published: January 2020

A 43-year-old male was brought to the emergency department due to a recovered sudden cardiac arrest that occurred while performing physical exercise of moderate intensity.

The patient was admitted in a coronary care unit and performed complementary tests to rule out immediate causes of cardiac arrest

electrocardiogram showed sinus rhythm, no repolarization abnormalities and normal QTc interval. Echocardiogram revealed no evidence of cardiac tamponade, massive pulmonary embolism (PE), ventricular dysfunction or valvular heart disease. Absence of pneumothorax in chest X-ray. Arterial blood gas test revealed a high lactate concentration with other parameters in normal range. Cerebral tomography showed absence of an acute hemorrhagic event.

To continue with the study an emergent coronarography was performed showing epicardial arteries with no significant obstructive coronary artery disease associated with an anomalous origin of left main coronary artery in the right sinus of Valsalva with possible interarterial course.

Coronary tomography confirmed the origin of the right coronary artery and the left main coronary artery in the right sinus of Valsalva with an interarterial course, proceeding to the reconstruction of the images with the volume rendering (VR) technique (Figure 1).

Congenital anomalies of the coronary arteries are a rare but life-threatening condition. Most coronary abnormalities are asymptomatic and follow a benign course, however, in some cases they present with ischemic symptoms, heart failure, myocardial infarction, syncope or sudden death. The anomalous origin of the left main coronary artery in the right sinus of Valsalva can cause myocardial ischemia and should be ruled out in young patients who present sudden cardiac arrest induced by physical exercise.

Abstract P269 Figure 1
P274 Continous echocardiographic monitoring in intensive cardiac care unit with external probe stabilizer - preliminary experience
Authors: Wdowiak-Okrojek K , Lipiec P , Kasprzak J D
Published: January 2020

Background

The role of transthoracic echocardiography (TTE) in the intensive cardiac care unit is crucial. Imaging is currently performed at the bedside for diagnosis but TTE has also potential to noninvasively provide critical views to assist in patient monitoring. Continuous monitoring would be especially helpful when the patient is unstable; however, continuous availability of skilled sonographers to obtain appropriate views represents a limiting factor.

Purpose

Recently, an innovative external fixation device allowing prolonged stabilization of transthoracic ultrasound transducer was introduced. The ring-shaped device fitted for TTE probes is attached to the patient by elastic straps to hold the probe in contact with the skin at a fixed but adjustable angle. We developed a research project to assess for the first time the feasibility of continuous TTE imaging with external probe fixation in the intensive cardiac care unit.

Methods

12 patients (10 men, mean age 66,5 ± 15 years) hospitalized in intensive cardiac care unit due to cardiac arrest, myocardial infarction, pulmonary embolism, end-stage heart failure or respiratory failure were included in the study. The echocardiographic probe be was fixed in the apical window providing a four-chamber view to monitor left ventricular function. We assessed the patient’s tolerance and comfort as well as the quality of images acquired at baseline and at the end of monitoring.

Results

Fixation of the probe was successful in all patients (figure 1). The mean time of fixation was 10 ± 1 minute, with a clear learning curve. The quality of obtained images was sufficient for evaluation and was maintained throughout the entire period of monitoring in all patients. Monitoring was stopped at patients’ request when discomfort caused by the compression of the skin by the probe and the fixation device became significant (figure 2). The mean duration of monitoring was 85 + 64 minutes (range 15 to 240 minutes).

Conclusions

In this preliminary series we have demonstrated for the first time the feasibility of echocardiographic continuous monitoring of patients in the intensive cardiac care unit using TTE probe with the external fixation device. The design of the fixation device opens the evident field for optimization to extend monitoring duration at acceptable levels of discomfort in conscious intensive care patients. We hope the improved version of the fixator will decrease the pressure on the body.

Abstract P274 Figure. Fixation of the device