bluuebunny/crossref_metadata_2025 huggingface dataset:
P764 Right ventricular basal diameter, but not volume, can predict severe tricuspid regurgitation
Authors: Previtero M , Guta A C , Ochoa-Jimenez R C , Palermo C , Bottigliengo D , Figliozzi S , Baritussio A , Cecchetto A , Aruta P , Iliceto S , Badano L P , Muraru D
Published: January 2020

Background

According to current EACVI guidelines, right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation are supportive signs to identify severe functional tricuspid regurgitation (TR) by echocardiography. However, the ranking by which those parameters should be considered to identify severe TR remains to be clarified.

Purpose

Accordingly, the aim of this study is to compare RV, RA and TA association with severe TR and to rank them in order of importance to predict severe TR.

Methods

302 patients (59 ± 13 years, 54 % women) with functional TR underwent two- and three-dimensional echocardiography. Using the nonparameteric Variable Importance (VIMP) software package, we assessed the relative importance of 6 differerent parameters (indexed by body surface area) to identify severe TR: 3D RV end diastolic volume (RVEDVi), 3D RV end systolic volume (RVESVi), 3D RA max volume (3DRAi), 2D RA systolic volume (3DRAi), 2D RV basal diameter (2DRVdi) and 2D TAi measured in the apical 4-chamber view.

Results

According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. 3DRAi (VIMP = 0.075) was the most important predictor of severe TR. 2DRVdi (VIMP= 0.005) was the second most important parameter and was the only parameter of RV dilation (RVEDVi= -0.0011 and RVESVi= -0.0012) associated to severe TR. Also, 2DRAi (VIMP= 0.023), and 2D TAi (VIMP= 0.004) showed good predictive ability.

Conclusions

Among the various right heart structures undergoing remodeling in patients with functional TR, RA dilation was the most important predictor of severe TR. Also the RV basal diameter, but not the volumes, was a predictor of severe TR. This underlines the importance of the shape, more than the volume of the RV as a predictor of severe TR.
P771 3D versus 2D transesophageal echocardiography in the detection of thoracic aorta atherosclerosis stage and prediction of coronary atherosclerosis
Authors: Vrublevsky A , Boshchenko A , Bogdanov Y U
Published: January 2020

Background

2D transesophageal echocardiography (TEE) was approved as a suitable method for the assessment of thoracic aorta (TA) atherosclerosis.

Purpose

A comparison between 2D and 3D multiplane TEE for qualitative and quantitative assessment of aortic atheromas and for coronary atherosclerosis prediction.

Methods

180 consecutive CAD patients (104 men, 76 women, mean age 62 ± 7 years) were examined. 2D and 3D TEE was performed using Philips IE33 xMatrix system and a X7-2t multiplane probe. 2D study of TA was performed using Live xPlane mode. 3D study of TA was performed using Live 3D and Full Volume modes. Qualitative and quantitative assessment of every atheroma was performed using 2D and 3D modes. The degree of severity and distribution of the TA atheromatosis was evaluated according to the classification of ASE and EACVI (2015): grade 0 – intimal-medial thickness ≤1 mm, 1 – intimal thickness ≤2 mm, 2 – focal or diffuse intimal thickening of 2-3 mm (small atheromas), 3 – atheromas >3–5 mm (no mobile/ulcerated components), 4 - atheromas > 5 mm (no mobile/ulcerated components), 5 - grade 2, 3, or 4 atheromas plus mobile or ulcerated components. After TEE all patients underwent digital coronary angiography and SYNTAX Score was calculated. Findings were presented as M ± SD or n (%).

Results

620 atheromas were analysed: 109 in the ascending part, 8 in the arch and 503 in the descending part. On average 3,43 ± 2,15 atheromas per patient were revealed. Atheromas height in 3D was significantly higher (p < 0,001), than in 2D, being 0,38 ± 0,09 mm and 0,26 ± 0,07 mm, respectively. Atheromas height increase in 3D was 0,12 ± 0,06 mm. In 3D 88% of atheromas have shown irregular contours while in 2D only 35% of atheromas had rough countors. The mobile component in 6 out of 9 atheromas was revealed only in 3D. In 2D 1-5 stages of TA atheromatosis were revealed in 22 (12%), 103 (57%), 43 (24%), 7 (4%) and 4 (2%) cases, respectively. In 3D 1-5 stages of TA atheromatosis were revealed in 16 (9%), 25 (14%), 90 (50%), 38 (21%) and 10 (5%) cases, respectively. With 3D TEE 72% of patients were found to have higher gradation of TA atheromatosis stage. The direct Spearman’s correlation between a stage of TA atheromatosis and SYNTAX Score which has been established for 2D r = 0,32 p < 0,001 and 3D r = 0,30, p < 0,01, respectively.

Conclusions

A comparison between 2D and 3D TEE has shown, that 3D is more precise method of qualitative and quantitative assessment of aortic atheromas and diagnosis of TA atheromatosis stage. 3D ultrasound stage of TA atheromatosis is a surrogate marker of severity and prevalence of coronary atherosclerosis.
P795 Intraventricular fluid patterns during dobutamine stress echo in patients with significant coronary stenosis
Authors: Filomena D , Cimino S , Maestrini V , Petronilli V , Cantisani D , Neccia M , Monosilio S , Luongo F , Tonti G , Pedrizzetti G , Fedele F , Agati L
Published: January 2020

Background

Dobutamine stress echo (DSE) is a useful tool for the evaluation of patients with suspected stable coronary artery disease (CAD). There has been no detailed investigation about the effects of exercise or pharmacological stress on intraventricular fluid dynamics. The possible association between significant CAD and abnormal fluid patterns has not been studied yet.

Purpose

Aim of the study was to evaluate the intraventricular vortices during dobutamine stress and to find fluid-dynamic patterns associated with the presence of significant CAD.

Methods

36 patients scheduled for coronary angiography (CA) and with clinical indication for DSE for suspected CAD were enrolled. Each patient underwent 2D, 3D and contrast echocardiography for Echo-PIV analysis and vortex quantification, both at rest and at peak stress. Vortex geometric and energetic parameters were evaluated using a post- processional software. Intraventricular pressure gradients were evaluated as well. Positive CA for significant CAD was defined as the presence of at least one epicardial coronary stenosis with ≥70% luminal narrowing.

Result

CA was positive in 58% of patients while DSE in 33%. In the whole population, at peak stress a reduction in vortex area (from 0.36 ± 0.01 to 0.21 ± 0.02; p= 0.001) and in absolute value of vortex intensity (from 0.36 ± 0.1 to 0.26 ± 0.12; p= 0.001) were detected. Vorticity fluctuation and kinetic energy (KE) fluctuation showed a significant increment at peak stress (respectively 0.84 ± 0.17 to 0.93 ± 0.07; p= 0.005; from 1.76 ± 0.37 to 2.47 ± 0.82; p= 0.001), as well as a deviation of flow force momentum angle (φ: from 36 ± 8 to 44 ±9; p= 0.001). Patients with positive CA showed during DSE an higher decrease of the absolute value of vortex intensity (Δ% |vortex intensity| -1.7 ± 0.39 vs -1.3 ± 0.56 vs; p= 0.021), and higher increase of flow force angle (Δ% φ 0.48 ± 0.6 vs 0.1 ± 0.27; p= 0.042). A reversal in the main direction of the vortical flow occurred in 9 patients (25%) at peak stress and 7 of them (64%) were found to have significant right coronary stenosis. This unexpected change in the vortical flow and the presence of right coronary artery stenosis were found significantly associated (X2 p= 0,02). Moreover, patients with circumflex artery stenosis were less likely to have a decrease of vortex length at peak stress (Δ% Vortex length - 0,06 ± 0, 36 vs - 0,34 ± 0,28, p= 0,034).

Conclusion

Significant changes in intraventricular vortices occur during DSE. The presence of significant CAD evaluated with CA was associated with different behavior of fluid dynamics during DSE. Further studies are needed to assess normal and pathological intraventricular flow patterns evaluated during DSE.

Abstract P795 Figure. Vortex reversal at peak stress
P799 The echocardiographic and clinical characteristics of Fabry patients without overt left ventricular hypertrophy but progressing despite on enzyme replacement therapy
Authors: Lee S Y , Lee S H , Park Y H
Published: January 2020

Background

Fabry disease (FD) is X-linked genetic disorder caused by the deficiency or absent activity of lysosomal α- galactosidase. When the heart is involved, progressive left ventricular hypertrophy (LVH) is the key feature. Although, LVH is not present in all subjects, some of them progress with LVH despite enzyme replacement therapy (ERT). The present study aimed to evaluate the characteristics of patient of FD without overt LVH, but progresses with their left ventricular mass index (LVMI).

Method : This study includes subjects carrying genetic mutations for FD without LVH (n = 12) in a single tertiary center. ‘Decreasing LVMI group (Group1)’ was defined when pre-ERT LVMI minus last LVMI value obtained by echocardiography was positive, and when negative, defined as ‘Increasing LVMI group (Group 2)’. The baseline characteristics and echocardiographic parameters including global strain was analyzed.

Result : Total 6 patients were classified as Group 1 and 2 each. The median age at diagnosis for male was 21 vs 27 for each group, and 21 vs 31 for female. The median follow-up duration was 4.0 vs 5.7 yr. The antibody formation for replaced enzyme was 3 for Group 2 and any family member who developed overt LVH was much 1 vs 3 for group 1 vs 2. Initial 3 plane GLS was worse and showed trend to drop in Group 2.

Conclusion : In the Fabry patients get worse with their LVMI but still not developed overt LVH despite enzyme replacement therapy, there are some clinical and echo-parameter difference. These findings could suggest insufficient enzyme replacement therapy.

Group 1 (n = 6) Group 2 (n = 6) Female/Male 4/2 3/3 Age of at Dx (Female) (median) 21 28 Age of at Dx (Male) (median) 21 31 F/U duration (median) 4.0 yrs 5.7 yrs Antibody formation 0 3 Any Overt LVH family Genotype c.56T > C c.40-11T > A, 782_delG, c.658C > T Initial LVMI (Median) 98.2g/m2 70.9g/m2 Initial GLS (3P) -19 -17.8 Continuously elevated LysoGb3 2 4 Proteinuria >300mg 1 3 (1 preparing HD)
P802 Delayed time to peak left ventricular outflow tract velocity is associated with symptomatic status in patients with hypertrophic obstructive cardiomyopathy
Authors: Huurman R , Schinkel A , Bowen D , Hirsch A , Michels M
Published: January 2020

Funding Acknowledgements

None.

The presence and magnitude of left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructive cardiomyopathy (HOCM) patients is weakly associated with presence of symptoms. The factors underlying this are not well understood. We hypothesize that time to peak velocity (TPV) of LVOT flow is associated with symptomatic status.

We included 136 HOCM patients (58% men, mean age 55 ± 14 years) with peak gradients ≥30 mmHg at rest or during Valsalva without aortic valve stenosis. At rest and during Valsalva, continuous wave Doppler tracings from 3 consecutive beats were used to assess peak velocity (PV), left ventricular ejection time (LVET) and TPV, which was defined as the time interval between the onset of flow over the LVOT and the moment of PV. Differences were compared between asymptomatic and symptomatic patients (defined as New York Heart Association class I vs. II-IV). The relation between symptom status and TPV was investigated using logistic regression models. A random sample of 20 patients was examined by 2 observers and reproducibility was assessed using the intraclass correlation coefficient (ICC).

Symptomatic patients were more often female (table) and had significantly higher mean TPV values (figure). In multivariable logistic regression models, TPV was an independent predictor of symptomatic status after correction for PV, LVOT diameter, heart rate and age (odds ratio 1.02 per 1 ms, p < 0.001). The ICC was 0.99 with a mean difference of 0.28 ± 8.5 ms.

Delayed TPV is associated with symptomatic status in HOCM patients, after adjustment for heart rate, peak velocity, LVOT diameter and age, and is an easily measured echocardiographic variable with excellent inter-reader reproducibility. The clinical implications of delayed TPV, particularly in the context risk prediction and clinical decision making, remain to be determined.

Characteristics per group Asymptomatic HOCM patients n = 47 Symptomatic HOCM patients n = 89 p value Age, y 55 ± 14 55 ± 14 0.99 Male gender 34 (72%) 45 (51%) 0.01 Body mass index, kg/m² 27 ± 5 28 ± 5 0.08 Left atrial diameter, mm 46 ± 7 47 ± 7 0.64 Septal wall thickness, mm 18 ± 4 19 ± 5 0.58 LV outflow tract diameter, mm 22 ± 3 21 ± 3 0.001 Peak velocity, cm/s 403 ± 86 434 ± 79 0.03 LV ejection time, ms 316 ± 44 340 ± 42 0.002 Time to peak velocity, ms 157 ± 32 178 ± 32 <0.001 HOCM = hypertrophic obstructive cardiomyopathy, LV = left ventricular.

Abstract P802 Figure. Time to peak velocity per NYHA class
P825 Multi-modality imaging for noninvasive diagnosis of transthyretin amyloid cardiomyopathy-single centre experience
Authors: Gawor M , Wnuk J , Michalek P , Marczak M , Teresinska A , Grzybowski J
Published: January 2020

Background

Thransthyretin amyloidosis (ATTR) is a rare progressive disease that may present as heart failure with preserved ejection fraction, severe aortic stenosis, hypertrophic cardiomyopathy (HCM) or resctrictive cardiomyopathy. There are two types of ATTR: hereditary ATTR (hATTR) caused by mutations in the TTR gene and wild-type ATTR (wtATTR) resulting from deposition of wild-type TTR protein.

Purpose

We describe the clinical heterogeneity of ATTR patients from our centre diagnosed noninvasively in 2018-2019.

Methods

All patients presented intensive cardiac uptake at 99mTc-DPD scintigraphy. Light chain amyloidosis was excluded.

Results

8 patients were diagnosed with ATTR (Table 1). Three unrelated male patients were diagnosed with hATTR due to rare mutations: 2 of them had Phe33Leu, 1 patient had Glu89Lys mutation. Five

patients (males) were diagnosed with wtATTR. Age of onset differed among the patients. Characteristic clinical features included cardiomyopathy with increased left and right ventricular wall thickness. Only 2 patients had restrictive filling pattern, 3 patients had atrial fibrillation. Laboratory examination showed increased level of troponin T and NT-proBNP. Three patients had bilateral carpal tunnel syndrome. Thanks to DPD-scintygraphy we excluded ATTR in two patients with false-positive results of histological exam for TTR-related amyloid deposits.

Conclusions

Although ATTR is known for its broad clinical spectrum, patients from our center presented mostly as HCM phenocopies but in different stages of heart failure. Appropriate diagnosis of ATTR is crucial and have direct therapeutic impact. Echocardiography raise the suspicion of amyloid cardiomyopathy, while other imaging technique (DPD-scintigraphy) confirm it or exclude it in noninvasive way.

Patient 1 2 3 4 5 6 7 8 Mutation Glu89Lys Phe33Leu Phe33Leu wild type wild type wild type wild type wild type Sex male male male male male male male male Age of onset 57 56 55 77 78 80 77 76 Electrocardiogram AF low QRS voltage low QRS voltage AF, RBBB LVH LVH pseudoinfarct pattern, low QRS voltage AF, LVH Maximal wall thickness [mm] 23 20 18 28 22 23 18 20 LVEF% 45 40 40 60 65 60 45 55 Asymmetric hypertrophy pattern + - - - + + - + NYHA III II II II III II II II NT-proBNP pg/ml 2122 1200 1500 2755 222 2630 2426 hs-Troponin T ng/l 50 98 42 65 35 63 64

Abstract P825 Figure 1
P828 Echocardiographic two-dimensional speckle tracking identifies acute myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with MRI
Authors: Chinali M , Franceschini A , Ciancarella P , Lisignoli V , Curione D , Ciliberti P , Esposito C , Del Pasqua A , Rinelli G , Secinaro A
Published: January 2020

Aim

To evaluate the ability of Speckle Tracking Echocardiography (STE), as compared to Cardiac Magnetic Resonance (CMR), in identifying acute and sub-acute abnormalities in systolic function occurring with focal myocarditis in children and adolescents without evident wall motion abnormalities. Methods: We analyzed data from 33 consecutive patients (age 4-17year) with CMR-confirmed focal myocarditis and without regional motion abnormalities and/or reduced ejection fraction. Patients underwent echocardiography with analysis of regional and global longitudinal strain and CMR for the identification of focal edema and myocardial fibrosis. Impaired longitudinal strain was defined according to previously reported age-specific reference values. Results: Despite normal ejection fraction at admission, prevalence of impaired systolic function by STE was present in 58% of patients (n = 19). Reduction in longitudinal strain was regionally related to CMR-identified edema areas, with lowest values found at the level of the infero-lateral segments as compared to the mean of the other segments (p < 0.05). Amount of CMR-edema was strongly correlated with impairment of STE (r=-712; p = 0.01). At follow-up, significant improvement in global longitudinal strain could be observed in all patients (p < 0.001) with STE normalization recorded in 13 of 19 patients. Persistent regional impairement in STE could however still be found 6 patients, consistent with residual focal cardiac fibrosis at follow-up CMR. Conclusion: In children and adolescents with focal myocarditis, STE identifies subclinical abnormalities in systolic function, consistent with regional edema at CMR. In addition, analysis of STE provides insights in the identification of regional recovery or persistent systolic impairment, possibly due to residual focal fibrosis.

Abstract P828 Figure.
P830 Atherosclerotic disease in apparently healthy population: is the femoral arterial region the starting point? In search of the origin of the story
Authors: Perea O G , Pulmari C , Morbidoni J , Ontivero J
Published: January 2020

Introduction

Bifurcations are favorable sites for the development of plates.

goals

To know the prevalence and differential characteristics according to the presence of atheroma plaques in the carotid or femoral bifurcation in a population without a cardiovascular history.

Materials and methods

A multicenter, descriptive, cross-sectional, prospective study with consecutive inclusion of 180 individuals who underwent outpatient Doppler echography of neck and lower limb vessels.

SPSS 23 Software was used for the statistical analysis, a value of p <0.05 was considered significant.

Results

In a population of 180 individuals, the presence of atheroma plaques in the carotid bifurcation (BC) was evident, appeared, revelaed in 11 individuals (6.11%), in femoral bifurcation (BF) in 58 individuals (32.2%); and on the other hand coincidentally in both territories in 22 individuals, (12.22%).

The average age in both groups BC and BF was 66, 64 years.

Male sex was more frequent in the individuals of BF group.

The predominant risk factors in both groups were arterial hypertension, dyslipidemia, sedentary lifestyle and obesity.

Smoking, diabetes mellitus and poor diet were more frequent in BF group.

The latter statistically significant.

The age of maximum femoral involvement (64.33 +/- 2.2 years) is prior to the carotid (68.25 +/- 0.5 years),

P

0.003. See table

Both groups had an average moderate risk score according to Interheart.

The individuals of the group who coincidentally had plaques in both bifurcations as significant differential data, had an average risk according to Interheart higher.

Conclusions

The presence of atheroma plaques was observed more frequently and at a younger age at the level of the femoral bifurcation.

Risk factors such as male sex, smoking, diabetes mellitus and poor diet were more frequent in this group.

table Presence of plaques in bifurcation Age less than or equal to 60 years n% Age between 61 and 67 years n% Age between 68 and 73 years n% Age greater than or equal to 74 years N% Carotid n:11 3 27% 1 9% 4 36,4% 3 27% Femoral n:58 12 20,7% 18 31% 14 24,1% 14 24,1% Carotid and femoral n:22 5 27,7% 7 31,8% 5 22,7% 5 22,7% Distributions of plaques
P837 Isolated cleft posterior mitral valve leaflet
Authors: Rodrigo D , Estandia U , Perez C , Perez P M , Panera E
Published: January 2020

A 78-year-old man with a history of hypertension and diabetes mellitus was referred to the ER of our hospital due to an episode of shortness of breath of new onset, associated with dizziness and central thoracic pain of 5 minutes duration. Significant physical examination findings included a V/VI holosystolic murmur at fourth intercostal space with radiation to the axilla. ECG showed no significant abnormalities and cardiac enzymes were within normal ranges The TTE and 3D TOE showed dilated left atrial with normal ventricular size and function with an isolated cleft posterior mitral valve leaflet that bisected into two separate leaflets of identical morphology. Concomitant posterolateral leaflet prolapse was also present with two eccentric, posteriorly, and interatrial septum directed regurgitant jets visualized with colour flow Doppler.

Cleft mitral valve leaflet (CMVL) is an uncommon congenital cause of mitral regurgitation. Clefts are slit-like holes or defects hypothesized to be a result of incomplete expression of an endocardial cushion defect and most commonly involve the anterior mitral valve leaflet with a paediatric incidence of 1:1340. Clefts affecting only the posterior mitral valve leaflet are extremely rare . Important co-existing anomalies with either posterior and/or anterior CMVL include counterclockwise rotation of the papillary muscles, the presence of an accessory papillary muscle or mitral valve leaflet, atrial septal defects, and mitral valve prolapse. Acquired causes of clefts include infective endocarditis or trauma from surgical exploration.

Regurgitation in CMVL results from blood flow directly through the cleft itself or from malcoaptation from accessory chordae with or without papillary muscle distortion. Early detection through 3D TEE echocardiography can provide accurate anatomical images of the mitral valve structure and identify associated congenital anomalies.

Conclusion

Posterior CMVL is an extremely rare cause of mitral insufficiency. 3D TEE early recognition of this rare clinical entity and co-existent anomalies can identify afflicted patients who can be closely monitored for the progression of symptoms as well as ventricular dysfunction. 3D TEE permits a personalized medicine tailoring the medical treatment to the individual characteristics of each patient.

Abstract P837 Figure. Isolated cleft posterior mitral valve
P853 Bilateral lower limb ischemia in a healthy young man what if the heart was hiding the etiology
Authors: Mouadili M , Tamdy A , El Fatmi B , Elkarimi S
Published: January 2020

Cardiac myxoma is the most common benign cardiac tumor with diverse nonspecific clinical manifestations; moreover, atrial myxoma embolization to the peripheral vessels is rare.

A 24-year-old man presented tothe emergency departement complaining ofpain and coldness of his two lower extremities. The right femoral pulse was normally felt while the pulses of the left lower limb from the femoral down to the posterior and anterior tibial arteries were not felt. Bilateral thrombectomy was performed on emergency basisand a fatty-like mass from the left femoral artery was removed. The histological examination of this mass was suggestive of myxoma.So, transthoracic echocardiography was done and confirmed the diagnosis of myxoma that was seen in the left atrium and measuring about 10X6 cm in its maximal dimensions.

Surgical removal of the myxoma was done later and the patient recovered uneventfully.

Conclusion

Although myxomas are rare, they should be considered in the differential diagnosis of peripheral embolic disease, especially when an embolic event occurs in a young adult without evidence of endocarditis or arrhythmia. Echocardiography is the modality of choice for diagnosis and follow-up of this type of tumors.

FIGURE 1: CTA (computed tomography angiography) showing Occlusion of the left popliteal artery and occlusion of the distal part of the right popliteal artery

FIGURE 2: macroscopic view of gelatinous left atrial myxoma
P884 Rare case of primary cardiac lymphoma in immunocompetent patient
Authors: Iqbal Penwala T , Bin Mohamed Yusof A K , Tan L K
Published: January 2020

Primary cardiac lymphoma is a rare tumour especially in immunocompetent person. It is invariably fatal unless diagnosed and treated early. Our patient was a 76 year old Chinese gentlemen, known case diabetes mellitus and hypertension, who presented with 3 months history of failure symptoms. He also had loss of appetite.

His vital signs were stable. There was bibasal crepitation, raised JVP with normal heart sounds and bilateral pedal edema. Chest X-ray showed bilateral pleural effusion.He was admitted for stabilization of heart failure and started on diuretics.

Echocardiography showed the LV ejection fraction was 50% with grade 1 diastolic dysfunction. There was a global pericardial effusion with effusion size 2.52cm maximum at posterior to LV. There was partial RA collapse .Patient was otherwise hemodynamically stable. Patient was observed closely and diuretics continued. Echocardiography on the third day of admission showed a suspicious looking mass in the right atrial (RA) and right ventricular (RV) wall near the AV groove. It become apparent after pericardial effusion became less. Patient was counselled and agreed for pericardial tapping but procedure had to be abandoned as effusion has reduced compared to before (<20mm).

MRI cardiac showed an infiltrating mass around the right atrio-ventricular groove extending to the right ventricular free wall and around the pericardial lining around the ascending aorta and pulmonary trunks. There is inhomogenous signal in STIR with iso-intensity on T1 weighted images. First pass metabolism revealed some vascularity. There was a patchy myocardial enhancement on late gadolinium enhancement. pericardium was thickened with global pericardial effusion- 16mm. Large right pleural effusion seen and minimal left pleural effusion. Mediastinal lymphadenopathy was seen. The finding were suggestive of cardiac lymphoma with differential sarcoma.

Subsequent day, patient develop acute ischemic stroke which was complicated by aspiration pneumonia and septic shock. Fortunately he recovered after 1 week of antibiotics and non-invasive ventilatory support.

FDG PET- CT scan showed FDG-avid primary cardiac lymphoma with pericardial involvement and conglomerate of multiple group of mediastinal and supra clavicular lymph nodes . Bilateral hypermetabolic adrenal nodule were seen but unable to determine its relevance to the primary pathology(lymphoma). No marrow or other organ involvement. Stage is likely IIE.

We were unable to harvest the lymph node because they were too deep. Patient"s family was counselled for cardiac biopsy but family did not want to take the risk as patient was bedridden and fragile. They were also not keen for any chemotherapy or invasive procedure. Once patient was out of infection, they requested to bring back patient to home. He was sent to nursing home for full time care but succumbed to another bout of aspiration pneumonia one week after discharge.

Abstract P884 Figure. Echo, MRI, Pet CT scan
P901 Left ventricular diastolic and systolic functions are compromised in patients with hypothyroidism
Authors: Tafarshiku R , Henein M Y , Berisha-Muharremi V , Bytyci I , Ibrahimi P , Poniku A , Bajraktari G
Published: January 2020

Background and Aim

Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism.

Methods

This study included 81 (age 42 ± 13 years, 92% female) patients with hypothyroidism, and 22 age and gender matched controls. All subjects underwent a detailed clinical examination followed by a complete biochemical blood analysis including thyroid function assessment and anthropometric parameters measurements. LV function was assessed by 2 dimensional, M-mode and Tissue-Doppler Doppler echocardiographic examination performed in the same day.

Results

Patients had lower waist/hip ratio (p < 0.001), higher urea level (p = 0.002) and lower white blood cells (p = 0.011), compared to controls. All other clinical, biochemical and anthropometric data did not differ between the two groups. Patients had impaired LV diastolic function (lower E wave [p < 0.001], higher A wave [p = 0.028], lower E/A ratio [p < 0.001], longer E wave deceleration time [p = 0.01], and higher E/e’ ratio [p < 0.001]), compared with controls. Although LV global systolic function did not differ between groups, LV longitudinal systolic function was compromised in patients (lateral mitral annular plane systolic excursion - MAPSE [p = 0.005], as were lateral and septal TDI s’ [p < 0.001 for both]).

Conclusion

In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is also impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease, that requires optimum management.
P910 Can left ventricular volume and diastolic flow reversal in descending aorta be useful to rule in or rule out severe chronic aortic regurgitation?
Authors: Gao S A , Polte C L , Lagerstrand K M , Bech-Hanssen O
Published: January 2020

Funding Acknowledgements

The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF¬-agreement

Background and Purpose

Grading severity of chronic aortic regurgitation (AR) by echocardiography may be challenging in cases with few feasible parameters leading to diagnostic uncertainty. The aim of the present study was to transform left ventricular (LV) volume and diastolic flow reversal to quantitative parameters using cardiovascular magnetic resonance (CMR) as reference.

Methods

Patients (n = 120) were recruited either prospectively (n= 45, CMR performed < 4 hours) or retrospectively (n = 75, CMR performed < 21 days (median)). The latter comprised patients with echocardiographic uncertainty. LV end-diastolic volume index (LVEDVI) by Simpson biplane method and end-diastolic flow velocity (EDFV) in the proximal descending aorta were assessed. The patients were randomised to either a derivation (n = 60) or a test group (n = 60).

Results

Severe AR (regurgitant fraction by CMR > 33%) was present in 51% of the patients. In the derivation group, the area under the ROC curves for LVEDVI was 0.80 (95% CI 0.67-0.93) and for EDFV was 0.83 (95% CI 0.71-0.94). LVEDVI > 99 ml/m2 and ≤ 75 ml/m2 were useful to rule in and rule out severe AR, respectively. The corresponding for EDFV were > 17 cm/s and ≤ 10 cm/s. The diagnostic performances of the cut off values in the test group are presented in the Table.

Conclusions

LVEDVI and EDFV are useful quantitative parameters to rule in and rule out severe chronic AR in patients with diagnostic ambiguity. Combination of LVEDVI > 99 ml/m2 and EDFV > 17 cm/s is the most useful to rule in severe AR.

Sensitivity (%) (95% CI) Specificity (%) (95% CI) Positive likelihood ratio (95% CI) Negative likelihood ration (95% CI) Rule in severe AR LVEDVI (> 99 ml/ m2) 48 (29-67) 95 (77-99) 10.0 (1.4-71) 0.55 (0.37-0.82) Rule out severe AR LVEDVI (≤ 75 ml/m2) 91 (73-98) 62 (41-79) 2.4 (1.4-4.2) 0.14 (0.04-0.55) Rule in severe AR EDFV (> 17 cm/s) 44 (28-63) 96 (79-99) 10.2 (1.4-73) 0.58 (0.41-0.82) Rule out severe AR EDFV (≤ 10 cm/s) 96 (82-99) 48 (29-67) 1.9 (1.2-2.8) 0.08 (0.01-0.56) Rule in severe AR > 99 ml/m2 + > 17 cm/s 36 (20-57) 100 (82-100) - 0.64 (0.46-0.87) Rule out severe AR ≤ 75 ml/m2 + ≤ 10 cm/s 91 (72-98) 29 (13-53) 1.3 (0.92-1.8) 0.31 (0.07-1.4)
P924 Benefits of bariatric surgery on subclinical myocardial function using global longitudinal strain in severely obese individuals with and without diabetes
Authors: Piche M , Clavel M A , Pibarot P , Poirier P
Published: January 2020

Background/Introduction: The presence of subclinical myocardial disease confers an increased cardiovascular disease risk. The effects of bariatric surgery on subclinical myocardial function assessed using left ventricular (LV) global longitudinal strain (GLS) in severely obese individuals with preserved LV ejection fraction is unclear.

Purpose

To evaluate changes in subclinical LV myocardial function following bariatric surgery in obese individuals with and without diabetes.

Methods

Thirty-eight severely obese individuals [body mass index (BMI) >35kg/m2] with preserved LV ejection fraction (≥ 50%) who underwent bariatric surgery (Surgery group) (BMI 48 ± 7 kg/m2), 19 obese individuals managed conservatively (Cons. group) (BMI 47 ± 9 kg/m2), and 18 age and sex-matched non-obese controls (Non-obese group) were included. Echocardiography with GLS measurements was performed at the beginning of the study and at 6 months. Abnormal myocardial function was defined as a GLS >-17%.

Results

Mean age of obese patients was 42 ± 11, BMI 48 ± 8 kg/m2, and 82% were female. The percentage of total weight loss at 6 months after bariatric surgery (Surgery group) was 26.3 ± 5.2%. Body weight remains unchanged at 6 months in the Cons. group. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced in the Surgery group. At the beginning, severely obese patients (Surgery group) displayed subclinical myocardial dysfunction vs. non-obese controls (LV GLS, -17.3 ± 2.5 vs. -19.6 ± 1.7%, P = 0.003). Six months after bariatric surgery, the subclinical myocardial function was comparable between both groups (LV GLS, -19.2 ± 2.1 vs. -19.6 ± 1.7%, P = NS). 22 severely obese individuals (58%) in the Surgery group showed abnormal GLS, which normalized in 82% after bariatric surgery (P = 0.0001). On the contrary, half of severely obese individuals managed conservatively (n = 10, 53%) worsened their GLS during the follow-up (P = 0.002). Remission of type 2 diabetes 6 months after bariatric surgery was associated with improvement in GLS (-17.5 ± 2.6 vs. -18.6± 1.8%), whereas obese individuals with type 2 diabetes managed conservatively showed a worsening in their subclinical myocardial function during the follow-up (-18.0 ± 2.4 vs. -17.4 ± 1.7%).

Conclusions

A great proportion of severely obese individuals with preserved LV ejection fraction have subclinical myocardial dysfunction. Bariatric surgery in obese individuals was associated with significant improvements in the metabolic profile and in subclinical myocardial function.
P939 Global longitudinal myocardial strain: an independent predictor of cardiovascular events in patients with hematopoietic stem cell transplantation
Authors: Martin Garcia A , Vallejo Garcia V , Lopez Corral L , Martin-Garcia A C , Castro Garay J C , Cabanillas Cabral A , Diaz-Pelaez E , Castillo Y , Barreiro Perez M , Rodriguez Estevez L , Sanchez Pablo C , Cambronero Cortinas E , Dorado Diaz P I , Caballero Barrigon D , Sanchez P L
Published: January 2020

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) increases the likelihood of potentially serious cardiovascular complications. The scientific evidence on prognostic predictors is limited and cardiac monitoring of these patients is not systematized.

Our aim was to analyze cardiovascular prognosis and identify echocardiographic factors predicting cardiovascular events in the context of HSCT.

METHODS

An observational, retrospective study was designed, including 243 patients (mean age 54 ± 16yo, 60%males, 13% hypertension, 5% diabetes) undergoing a HSCT (60% Allogeneic/40% Autologous) with previous echocardiography, from December 2016 to the present. Clinical data, echocardiographic findings, mortality and cardiovascular events (CVE) were collected and analyzed.

RESULTS

After a median follow-up of 18 [12] months, 22 patients (9%) suffered CVE (54% arrhythmias, 40% heart failure, and 9% ischemic heart disease). Patients with Allogeneic-HSCT (13% vs. 3%; p: 0.007), left ventricular dilatation (40% vs. 8.5%, p = 0.02) or hypertrophy (33% vs. 8%, p: 0.01), dilated left atrium (33% vs. 9%, p:0.03), or pericardial effusion (33% vs. 9%, p: 0.04) in the echocardiographic study performed prior to HSCT suffered significantly more CVE at follow-up. Patients with CVE had significantly higher global longitudinal strain (GLS) (-19 ± 3% vs. -21 ± 3%, p= 0.001). Patients were divided into quartiles based on GLS, those belonging to the fourth quartile (>-19.4%) suffered more frequently CVE (log Rank: 9.6; 18% vs. 6%, p = 0.002) with a significantly lower time to event (27 ± 1.8 vs. 32 ± 0.6 months) (Figure).

In multivariate analysis (Cox regression), Allogeneic-HSCT (HR: 5.6; p = 0.02) and the fourth quartile of GLS (HR: 4.3; p = 0.004) were maintained as independent predictors of cardiovascular event.

CONCLUSION

GLS before HSCT is an independent predictor of cardiovascular events at follow-up. This parameter could allow the identification of high-risk patients who could benefit from intensive protocolized cardiac follow-up.

Abstract P939 Figure. Survival analysis (Kaplan Meier)
P945 Should children, with exercise induced intra-ventricular gradients, be treated with beta blockers?
Authors: Cotrim C , Joao I , Guardado J , Cordeiro P , Sampaio M ANA , Marques A , Cafe H , Martins R , Cotrim H , Baquero L
Published: January 2020

Background

In our experience, treadmill exercise echocardiography (SE) is feasible and safe in children (C). Regional wall motion abnormalities (RWMA) are of limited usefulness, but Doppler often - (in 39% from 258 previously studied C) - documents significant intraventricular gradients (IVG), occult at rest, and allowing to document a possible explanation for exercise related symptoms, or abnormal resting or stress-ECG findings.

Purpose - To assess the effect of ß blockers on the occurrence of IVG, in C, with symptoms or abnormal resting or stress-ECG findings.

Methods – We repeated SE in 66 of the 101 C – (with normal echocardiogram at rest) - that developed IVG on exertion, under treatment with ß blockers. These 66 C who repeated the SE under treatment with ß blockers are the study group. 15 (23%) of them were female and the mean age of the group was 14,6 ± 1,7 years old (11 to 17).

They all underwent SE with 2D and Doppler echocardiographic evaluation of, and during treatment with ß blockers.

Results

Mean IVG in those 66 C submitted to SE was 105 ± 38 mmHg in the first SE evaluation. In SE evaluation performed under ß blockers, 37 of them didn’t develop IVG and in 29 of them IVG was significantly reduced to a mean IVG of 58 ± 32 mmHg (p< 0,0001). The mean heart rate attained at peak exercise was 178 ± 15 bpm in the first SE evaluation and 157 ± 9 bpm in the evaluation performed under treatment with ß blockers (p < 0, 0001). 47 of these C reproduced clinical symptoms (that were indication to SE) of beta-blockers, and only 7 reproduced the symptoms under treatment with beta blockers (p< 0,0001).

Conclusions

In C with symptoms, abnormal rest or exercise ECG on medical evaluation and IVG on exertion, treatment with oral ß blockers prevented the occurrence of IVG or significantly reduced its magnitude. These changes were associated to significant clinical improvement in 85 % of the symptomatic population.

Abstract P945 Figure. SE without and with beta-blockers
P955 left ventricle cardiac remodeling among lithuanian football versus basketball players
Authors: Aldujeli A , Laukaitiene J , Unikas R
Published: January 2020

Background

Regular physical exercise causes a continuous gradual increase of the cardiac left ventricular (LV) mass known as physiological adaptive hypertrophy. The extent of LV remodeling depends on the type, amount, and intensity of the exercise.

Purpose

The aim of this study was to compare structural changes of the heart among Lithuanian football, basketball players and unathletic controls.

Methods

A total of 50 Lithuanian males aged between 20-29 years volunteered to participate in the study. Football players (n = 15) playing for local II league football clubs,and Basketball players (n = 15) playing for local minor league basketball teams. All athletes had been regularly engaged in their sport for at least three years. Inactive healthy volunteers (n = 20) of similar age served as controls. Routine transthoracic echocardiographic examinations to measure end-diastolic LV dimensions were performed by cardiology fellow under the supervision of a fully licensed cardiologist. Statistical analyses were performed using the SPSS 20.0 software. The value of p < 0,05 was considered as statistically significant.

Results

No structural or functional pathologies were evident during the echocardiographic examination in any of the subjects. Absolute interventricular septum (IVS) thickness and LV posterior wall thickness, but not LV diameter, were higher in athletes than in inactive controls (P < 0,001). Indexed LV diameter was higher in football players as compared with non-athlete controls and basketball players (P < 0,05). Left ventricular mass of all athletes were higher as compared with controls (p < 0.001). Relative wall thickness was not increased in football players but was higher in basketball players as compared with controls (p < 0.05).

Conclusion

Cardiac remodeling in Lithuanian football players resulted in left ventricle eccentric hypertrophy due to the LV dilation, increased LV mass and relatively normal relative wall thickness. However in Lithuanian basketball players we noticed an increase in both relative wall thickness and LV mass resulting in LV concentric hypertrophy.

Echocardiographic characteristics Groups n End-diastolic LV diameter(mm) End-diastolic Interventricular septum (mm) End-diastolic LV posterior wall LV mass Football Players 15 56.9 10.8 10.8 242 Basketball players 15 53.6 11.5 11.3 254 Inactive individuals 20 53.2 9.1 9.5 182 P value 0.01 <0.001 <0.001 <0.01

Abstract P955 Figure.
P978 Acute myocardial infarction in young women without atherosclerotic disease
Authors: Sozzi F B , Schiavone M , Gherbesi E , Malanchini G , Mircoli L , Colombo F , Bonanomi C , Vicenzi M , Ciulla M , Lombardi F
Published: January 2020

INTRODUCTION

Spontaneous coronary artery dissection (SCAD) is an established cause of acute myocardial infarction (AMI), with an incidence in young women ranging from 22% to 43%. The increased use of coronary angiography contributed to better recognise this condition. Nonetheless, the presentation remains challenging mainly due to the atypical clinical onset.

AIMS AND METHODS

A very homogeneous case series of 10 young women (age 36 ± 9 years) admitted at our Institution over a period of 10-years with ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI) were analysed. All women had no congenital, coronary, cardiac and/or atherosclerotic disorders. The clinical and angiographic data were evaluated and correlated to the outcome that lasted 5 ± 5 years.

RESULTS

The clinical presentation was typical in 70% of cases and 30% of them developed ventricular arrhythmias and cardiogenic shock. An atypical presentation was documented in 30%. STEMI accounted for 70%, NSTEMI for 30%. Among the predisposing factors, pregnancy was related in 20%, connective tissue disorders in 30% and acute emotional stress associated to smoke habit in 50% of cases. On coronary angiogram all women were affected by distinctive pattern of non-atherosclerotic single vessel disease: LAD dissection (50% of cases with proximal localization), first obtuse marginal branch dissection in 3 cases, proximal RCA dissection in 1. Medical therapy was the first choice in 40%, while 60% were treated with PTCA-stent (multiple in 30%). The ejection fraction early after AMI was normal in 70%, mildly reduced in 1 case and moderately reduced (<45%) in 2 cases. Follow-up was negative for events in all cases, 3 underwent pregnancy at distance.

CONCLUSION

A high proportion of subjects presented with atypical challenging symptoms, while 30% were complicated with ventricular arrhythmias. This might be related to the high prevalence of proximal LAD dissection and anterior AMI in our subjects. An equal distribution of risk factors was recorded. No mortality events and no SCAD-recurrence were documented during follow up.

Abstract P978 Figure. Image 1
1098 Atrial thickening: a surprisingly "gouty" heart
Authors: Rocha B , Lopes Da Cunha G J , Lopes P M , Saraiva M , Albuquerque C , Cristina S , Proenca G , Abecasis J , Trabulo M , Andrade M , Ramos S , Mendes M
Published: January 2020

Case Presentation

A 49 year-old male presented to the emergency department with fever and lower limb myalgia for 5 days. His past history was notable for acute episodes of microcrystalline pyrophosphate oligoarthritis for which he was receiving allopurinol 100mg, colchicine 1mg and prednisolone 5mg. Physical examination was unrevealing. Laboratory workup showed normocytic normochromic anemia (Hb 12.8g/dL), leukocytosis (22 490 /mm3), neutrophilia (86.8%), increased C-reactive protein (CRP

26mg/dL), low procalcitonin (0.82ng/mL) and mildly elevated creatinine-kinase (83 UI/L). The patient was admitted with fever of unknown origin and started on ceftriaxone after blood and urine cultures.

He remained febrile with persistently heightened inflammation. Cultures, infectious and auto-immune tests, bone marrow biopsy, myelogram and abdominopelvic CT scan were negative. Three weeks later, syncope due to complete atrioventricular (AV) block led to temporary pacemaker implantation. Transoesophageal echocardiography (TOE) revealed a left atrial (LA) wall thickening,

evident on MRI as an 8-10mm T2-hyperintensity sign, with right atrial (RA) and ventricular sparing. PET/CT scan showed an 18F FDG uptake exclusively in the LA. As a neoplasia was highly suspected, a transspeptal biopsy was attempted, yet the sample was scarce for analysis. Thus, a biopsy via sternotomy was performed, now sampling both the LA and RA. Indeed, repeated TOE showed de novo RA involvement with a prominent nodular finding (19x24mm) in the lateral wall.

Myocyte inflammation and necrosis accompanied with granulocyte infiltration (mostly neutrophils but also eosinophils) was observed in all samples. There were no findings suggestive of neoplasia. The patient was still on allopurinol, which has been reported to involve the myocardium in a late (type IV) hypersensitivity reaction (the so-called DRESS syndrome), even in the absence of systemic inflammation. Thus, allopurinol was stopped and 1mg/Kg prednisolone was started. The patient

significantly improved and was discharged home with negative CRP the following two weeks. After 1 month, MRI was repeated and no atrial inflammation was found. After 4 months follow-up, he is doing well on 2.5mg of prednisolone and febuxostat 80mg.