bluuebunny/crossref_metadata_2025 huggingface dataset:
P896 Feasibility and accuracy of echocardiographic estimates of tricuspid annular displacement
Authors: Tan Y , Manouras A , Lund L H , Venkateshvaran A
Published: January 2020

Background

Tricuspid annular plane systolic excursion (TAPSE) is a validated index of right ventricular function in heart failure. Current guidelines recommend that TAPSE be measured employing M-mode echocardiography (TAPSEM). However, TAPSEM is often overlooked during routine clinical assessment. This study aimed to assess the correlation and strength of agreement between other retrospectively obtainable echocardiographic equivalents of tricuspid annular displacement during systole (TAD) and TAPSEM.

Methods

An echocardiographic review was performed in consecutive subjects in sinus rhythm referred for the assessment of dyspnoea or heart failure. TAD was measured employing 2D (TAD2D), tissue velocity imaging (TADTVI), and speckle tracking echocardiography (TADSTE) and compared with TAPSEM as reference.

Results

100 subjects were analysed (age: 61± 14; 49% Female) All methods demonstrated good feasibility. Of all the evaluated methods, TAD2D demonstrated the strongest association with TAPSEM with minimal bias and reasonable limits of agreement (Table 1). Bias between methods was further reduced in subjects with significant pulmonary hypertension (RVSP > 50mmHg (35%); Bland-Altman mean ± SD = 0.09 ± 2.0 mm). A good agreement between TADSTE and TAPSEM was as well observed. In contrast, TADTVI yielded an underestimation of TAPSEM.

Conclusions

TAD2D and TADSTE provide feasible and accurate alternatives to TAPSEM and maybe useful during retrospective analysis of RV longitudinal function.

Feasibility, Correlation & B-A Analysis TAD Methods Feasibility R value P Value Bland-Altman mean difference ± SD TAD2D 92% 0.94 <0.001 0.22 ± 1.87 mm TADTVI 88% 0.86 <0.001 1.59 ± 3.1 mm TADSTE 85% 0.87 <0.001 0.47 ± 2.7 mm TAD, Tricuspid annular displacement; 2D, Two dimensional; TVI, tissue velocity imaging; STE, speckle tracking echocardiography
P897 The role of oxidative stress and inflammation for stress induced left ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease patients
Authors: Cherneva Z , Lozanov V L , Sugareva P S , Cherneva R C H
Published: January 2020

Background

Oxidative stress and inflammation have been implicated in the pathogenesis of diastolic dysfunction (DD) and are both present in chronic obstructive pulmonary disease (COPD).

Purpose

To evaluate the role of oxidative stress markers (8-isoprostane) and inflammation (prostaglandin E2, resistin) in the pathogenesis of stress induced left ventricular diastolic dysfunction (LVDD) in non-severe COPD.

Materials and methods

104 patients with non-severe COPD (FEV1 > 50%) and preserved left ventricular ejection fraction >50% underwent incremental cardio-pulmonary exercise testing (CPET). Echocardiography was performed before CPET and 1-2 minutes after peak exercise. Peak E/e’ ratio >15 was a marker for stress LVDD. Urine concentration of 8-isoprostanes was assumed as surrogate marker for oxidative stress; urine concentration of prostaglandine-E2 and plasma resistin levels as inflammatory markers. Mass spectrometry was applied for 8-isoprostane and prostglandine E2 (Cayman. Chemical) measurement. Values were normalised to urine creatinine (µmol/l/cre). ELISA was applied for resistin measurement (Raybio_Human) (ng/ml).

Results

Patients were divided into two groups: subjects with stress LVDD (67) and subjects without stress LVDD (37). 8-isoprostane levels were higher in subjects with LVDD vs those without LVDD (32.9 vs 29.67µmol/l/cre; p< 0.05). The same is observed regarding resistin plasma levels (22.51 vs 15.68ng/ml). Urine concentrations of prostaglandin E2 did not differ between the two groups (50.76 vs 51.07 µmol/l/cre)

Conclusions

In non-severe COPD patients the levels of oxidative stress (8-isoprostanes) and inflammation (resistin) seem to be associated with stress induced left ventricular diastolic dysfunction.
P909 Diagnostic evaluation of rheumatic heart disease in aborigonal population
Authors: Chapman M J , Surikow S , Stadler D , Rose J , Henthorn R , Aldridge E , Zeitz C J
Published: January 2020

Background

Among Indigenous Australians, rates of Acute Rheumatic Fever (ARF) continue to be among the highest in the world. Diagnosis remains a clinical decision based on identification of major and minor manifestations of the illness. Treatment involves lengthy prophylaxis and should continue for a minimum of 10 years.

ARF can cause permanent damage to the heart known as rheumatic heart disease (RHD).

We therefore utilised echocardiography as a diagnostic tool incorporating Tissue Quantification Backscatter expressed in decibels (dB) and global LV work efficiency estimated from left ventricle (LV) pressure-strain loops to identify rheumatic changes of the Mitral Valve and help improve early diagnosis of RHD.

Method

Data from patients with suspected RHD (n = 14), and age matched controls (n = 10) underwent Mitral Valve Backscatter Analysis (MVBS). MVBS was expressed as a ratio % (MVBS ratio %) by dividing the average MVBS and the average blood pool value expressed in decibels (dB). Furthermore LV function was utilised via 2D longitudinal strain and indices of myocardial work were derived.

Result

MVBS ratio % was significantly higher in the control group as compared to the RHD group (p = 0.001) (fig1). Of the RHD group echocardiography parameters showed there were no significant mitral valve stenosis or regurgitation. Correlates of LV function included: Global work Index (GWI), Global longitudinal Strain (GLS) and Global work efficiency (GWE). Of the above correlates the control group showed Backscatter vs GLS (r= -0.89, p = 0.001), the RHD group: Backscatter vs GLS (r = 0.52. p = 0.12). Within the RHD group the ratio vs GWE (r= 0.57, p = 0.09) these results showed a trend to significance.

Conclusions

Currently diagnosis of RHD remains a clinical decision based on the identification of major and minor manifestations. In addition treatment involves prophylaxis injections for a minimum of ten years. Of this group there were no significant echocardiography changes, rather clinical manifestation to derive RHD.

This study shows that calibrated MVBS ratio % and determinants of myocardial work may be a promising quantitative tool to detect early manifestation of RHD potentially aiding an early treatment plan and thus reducing the clinical burden of monthly penicillin injections for a ten year period.

Abstract P909 Figure. RHD and Myocardial correlates
P914 Changes of echocardiographic parameters in primary mitral regurgitation and determinants of symptom: an assessment from the Asian valve registry data
Authors: Amano M , Izumi C , Kim Y J , Park S J , Park S W , Tanaka H , Hozumi T , Ling L H , Yu C M , Fukuda S , Otsuji Y , Song J K , Sohn D W
Published: January 2020

[Background]Clinicians often have a difficulty in determining the presence of mitral regurgitation (MR)-relatedsymptoms because of subjectivity.However, there are few actual measurement data for echocardiographic left ventricular (LV) and left atrial (LA) size related to the severity of MR and the relationship between MR-related symptoms and these echocardiographic parameters.

[Purpose] The purpose of this study was to clarify actual values for echocardiographic parameters related to severity of MR and determinant factors of MR-related symptoms.

[Methods] Among patients enrolled in the Asian Valve Registry, we investigated 778 consecutive patients with primary MR showing sinus rhythm. Symptoms were determined by NYHA (≤ II or ≥ III).

[Results]MR severity was mild in 106, moderate in 285, and severe in 387 patients. LA volume index, LV end-diastolic diameter, and LV mass index increased with increasing MR grade [LA volume index: 47.9 (mild), 56.2 (moderate), and 64.9 ml/m2(severe) (p < 0.001), LV end-diastolic diameter: 51.2, 54.5, 58.1 mm (p < 0.001), and LV mass index: 101, 109, 123 g/m2(p < 0.001)]. Regarding moderate and severe MR, 70 patients (10.4%) were symptomatic. Table shows multivariable analysis for being symptomatic in moderate and severe MR patients. LV mass index (p = 0.040), ejection fraction (p < 0.001), female gender (p = 0.004), and heart rate (p = 0.007) were independent factors for MR-related symptoms.

[Conclusions] LV and LA parameters on echocardiography worsened as MR severity progressed. Larger LV mass index and lower ejection fraction were independent determinant factors for MR-related symptoms. We should also pay attention to LV hypertrophy in patients with primary MR.

Determinant factors for mitral regurgita Model 1 Model 2 OR (95% CI) P-value OR (95% CI) P-value Age, per 1-y increment 1.03 (1.00-1.05) 0.035 1.02 (0.99-1.05) 0.053 Sex (female) 2.23 (1.20-4.16) 0.011 2.28 (1.31-3.98) 0.004 Hear rate, per 1 bpm increment 1.03 (1.00-1.05) 0.025 1.03 (1.01-1.05) 0.007 LVDs index, per 1 mm increment 0.99 (0.90-1.09) 0.90 EF, per 1% increment 0.95 (0.92-0.99) 0.019 0.96 (0.93-0.98) <0.001 LV mass index, per 10 g/m2increment 1.12 (1.01-1.25) 0.033 1.09 (1.005-1.18) 0.040 LA volume index, per 10 mL/m2increment 0.96 (0.90-1.03) 0.23 E wave, per 1cm/s increment 1.81 (0.70-4.66) 0.23 TR pressure gradient >40 mmHg 2.11 (0.97-4.57) 0.057 Hypertention 1.40 (0.75-2.63) 0.29
P918 Screening protocol of patent foramen ovale in cryptogenic stroke
Authors: Menezes Fernandes R , Mota T , Bispo J , Azevedo P , Guedes J , Costa H , Bento D , Cafe H , Shamasna M , Fidalgo A P , Jesus I
Published: January 2020

Introduction

Cryptogenic stroke reaches a prevalence of 30% and entails a significant risk of recurrence. Transesophageal echocardiography is the gold standard in identifying potential proximal embolic sources, including patent foramen ovale (PFO). Based on recent evidence, PFO percutaneous closure is recommended in selected cases of cryptogenic stroke, especially if associated with high risk features. Since PFO is present in up to 27% of the general population, the real challenge is to define which patients have a pathogenic PFO.

Purpose

To develop a pathogenic PFO screening protocol in patients with cryptogenic stroke, aimed at secondary prevention.

Methods

We revised the literature, analysing published articles in PubMed in the last 5 years, with the keywords "patent foramen ovale and cryptogenic stroke". Subsequently, we produced a screening algorithm based on cryptogenic stroke definition, on RoPE (Risk of Paradoxical Embolism) Score and on the inclusion and exclusion criteria of the CLOSE, REDUCE and RESPECT studies, which showed promising results of PFO closure in this context.

Results

Our protocol establishes that patients who present with ischemic stroke should be evaluated for risk factors and undergo a detailed etiological study. When the study is inconclusive, the RoPE score is applied to determine the probability of finding a pathogenic or an incidental PFO. If equal or greater than 7 points, in the absence of predefined exclusion criteria, a transesophageal echocardiogram is performed. If the screening is positive, the patient will be referred to the Cardiology Department for therapeutic guidance. If negative, alternative complementary diagnostic methods may be considered.

Conclusion

Through the application of this protocol, patients with high probability of having a pathogenic PFO and, consequently, those who may benefit from percutaneous closure, will be selected to undergo a screening transesophageal echocardiogram. The implementation of a PFO screening protocol in patients who present with cryptogenic stroke is relevant, by proposing to reduce its recurrence rate through the early referral of young patients with indication for an invasive strategy.
P926 High prevalence of left ventricular systolic dysfunction assessed by speckle tracking in asymptomatic HIV patients
Authors: Kapelios C , Bonou M , Basoulis D , Masoura C , Athanasiadi E , Papadopoulou M , Skouloudi M , Psichogiou M , Barbetseas J
Published: January 2020

Background

Cardiomyopathy presenting in people living with HIV (PLWHIV) has been attributed to the effect of inflammation, opportunistic infections, myocyte invasion and cardiac steatosis, while peripheral artery disease (PAD) is linked to immune activation, abnormalities in lipid metabolism, and traditional risk factors. The diagnosis of subclinical myocardial dysfunction and PAD could enable prompt implementation of therapeutic measures. However, data available to date on the specific topic are limited.

Μethods:We investigated the association between global longitudinal strain (GLS) and a) patient history, b) baseline characteristics, c) carotid intima-media thickness (IMT) and presence of carotid atheromatic plaque(s) d) temperature difference (ΔT) along each carotid artery, measured by microwave radiometry (MWR) and e) basic blood panel measurements, including high-sensitivity troponin-T(hsTnT) and NT-proBNP in PLWHIV and no history of cardiovascular disease.

Results

We prospectively enrolled forty asymptomatic PLWHIV on long-term highly active antiretroviral therapy. Thirty-seven (93%) were men, while mean age was 52 ± 13 years. Subclinical left ventricular systolic dysfunction(SLVSD), defined as a value of GLS> -18.7%, was present in 35% of patients. GLS value was significantly associated with age (r = 0.410,P = 0.013), history of hyperlipidemia (r = 0.370,P = 0.026), body mass index (r = 0.462,P = 0.005), waist circumference (r = 0.471,P = 0.007) and right bulb IMT (r = 0.390,P = 0.036). hs-TnT levels were significantly associated with age (r = 0.513, P = 0.001), CD4 count (r=-0.357,P = 0.025), serum creatinine (r = 0.338,P = 0.035) and the presence of carotid plaque (r = 0.374,P = 0.038). NT-proBNP levels were significantly associated with history of diabetes (r = 0.336,P = 0.048) and serum creatinine (r = 0.548,P = 0.001). No significant associations were demonstrated between carotid ΔΤ and other parameters.

Conclusion

Our results indicate that apart from age, a dysmetabolic component, expressed by higher BMI and history of hyperlipidemia, may be implicated in the pathogenesis of SLVSD, which may lead to cardiomyopathy, in PLWHIV.
P952 Left ventricle ejection fraction and global longitudinal strain values in lymphoma patients previously treated with anthracycline-based chemotherapy
Authors: Codina M , Ramirez-Escudero Ugalde G , Manzanal Rey A , Garcia Ibarrondo N , Asla Ormaza C , Lambarri Izaguirre A , Candida Urizar R , Ugedo Alzaga K , Castellanos Alcalde M , Arregui Lopez A , Marquez Navarro J A , Uriarte Elguezabal J , Archocha Torres M F , Ormaetxe Merodio J , Ruiz Gomez L
Published: January 2020

Anthracyclines (anth) are potent antineoplasic agents, although, their efficacy is limited by cardiotoxicity. Most lymphoid malignancies tend to recur and commonly require anthracycline-based chemotherapy (anth-bch) re-treatment. Our aim is to compare the pretreatment left ventricle ejection fraction (lvef) and global longitudinal strain (gls) between patients (pts) with new diagnosis of lymphoma (lym) and pts with lym recurrence that were treated previously with anth-bch.

Among pts referred to assess lvef and gls prior to start ttm, lym patients were selected and divided in two groups: pts with recurrent lymp previously treated with anth and pts with new diagnosis of lymp. Patients data, lvef and gls values were collected retrospectively.

96 pts data were analyzed (see table): 23 pts (24%) with previous anth ttm and 73 newly diagnosed pts. No differences were found in baseline characteristics. Pts who previously had been treated with anth-bch demonstrated significantly lower lvef than the other group and there were more patients with lvef in the normal lower limit. Gls was also lower but the difference was not significant. The fact that gls was not calculated in all patients may explain this finding. No differences were found in diastolic function.

Previous cardiotoxic ttm and lower limit of normal lvef have been described as patient-related risk factors for developing cardiotoxicity. Currently, previous cardiotoxicity risk assessment is critical to allow preventive measures. Cardio-oncology units are crucial to address cardiovascular (cv) needs of cancer patients.

* p < 0.05 Previous anthracycline No previous anthracycline p n (%) 23 ( 24 %) 73 ( 76%) Women, n (%) 9 (39%) 34 (47%) 0,31 Age (m +/- SD) 66,2 +/- 14,6 63,2 +/- 17,4 0,44 Arterial hypertension, n(%) 8 (35%) 26 (36%) 1 Diabetes, n (%) 5 (22%) 8 (10%) 0,29 Dyslipidemia, n (%) 7 (30%) 28 (37%) 0,62 ACE inhibitor, n (%) 2 (8,7%) 4 (5,5%) 0,62 Betablokers, n (%) 5 (22%) 19 (26%) 0,78 FEVI (Simpson)*, m +/- SD 57,3 +/- 7 62,7 +/- 6 0,0007 GLS -19,3 +/- 3 -20,2 +/- 3,7 0,52 LVEF < 55%* 5 (22%) 4 (5,5%) 0,03 Comparison between lymphoma patients treated previuosly with antrhacycline and with no previous cardiotoxic treatment.
P953 When one problem is not enough.
Authors: Craveiro N , Cardoso G , Saraiva M , Vieira M J , Moura A R , Alves M , Pitta M L , Peres M , Martins V
Published: January 2020

Background

Syncope is a serious complication of significant aortic valve stenosis. Left ventricular outflow obstruction, abnormal arterial and venous vasodilatation and arrhythmic events are usually the most common pathophysiological mechanisms. Structurally abnormal native valves with turbulent abnormal flow are a substrate for infective endocarditis in the elderly population.

Clinical Case

We report the case of an 74 year-old woman with a past history of hypertension, type II diabetes, dyslipidemia and degenerative severe aortic stenosis waiting valve replacement surgery who presented to the emergency department with syncope. Elevated inflammatory markers, fever and leukocyturia raised the hypothesis of urinary tract infection. Empirical antibiotic was initiated and the patient was admitted to the Internal Medicine ward. Evolution was unsatisfactory with evolution to cardiogenic shock. Urgent transthoracic echocardiogram showed dilated right cavities, mild pericardial effusion and high gradient flow between the left ventricle and right cavities with an unstructured calcified high mobility aortic valve with perivalvular abscess. Patient was transferred to a tertiary center for emergent surgery. A biologic aortic valve and pericardial bovine patch at the proximal membranous septum was implanted. Six-week empirical antibiotic treatment for endocarditis was completed after surgery. Initial blood cultures and native valve culture were negative. Residual restrictive left to right shunt was observed by TTE evaluation. The patient was discharged home and is doing well at follow-up.

Conclusion

Left-to-right shunt with subsequent cardiogenic shock is a non-common complication of aortic valve endocarditis. Patients presenting with syncope in the context of aortic stenosis must have a careful initial evaluation and mechanical complications excluded.

Abstract P953 Figure. EuroEcho2019
P959 Handheld echocardiography in a real world scenario: concordances compared to standard echo reports
Authors: David Lechinewski L , Vieira I P , Clausell N , Moura L A Z , Barnes M , Tsang T , Gavazzoni Blume G
Published: January 2020

Background

Handheld echocardiography devices(HH) arise as a common tool in clinical examination and screening for various cardiovascular disorders. Despite of it, studies with this method are small, with unselected patients and limited scope of diagnostic comparison.

Purpose

Assess the usefulness of the new miniaturized HH and compare its concordances with the standard high definition echocardiography study(STD).

Methods

Between April and May of 2016 adult patients who were scheduled to regular STD, were also submitted to a HH exam. Experienced sonographers performed and an experienced echocardiographer reviewed the STD exam, and an experienced echocardiographer performed and reviewed the HH study - reviewers were blinded to the other study results. STD exams included 2-dimensional images, Color Doppler and hemodynamics analysis. With the HH hemodynamic assessment was not performed as the machine does not include such technology. Agreement between the reports was analyzed.

Results

110 patients were included. Mean age was 62.4 ± 16.7 years. The κ values(Table) show good correlation between HH and STD on the analysis of left ventricular global and segment functions, right ventricle size and function, mitral and aortic stenosis. On the evaluation of left ventricle hypertrophy, mitral and aortic regurgitations the correlation was modest, while poor correlation was found for pulmonary and tricuspid regurgitations.

Conclusion

In a daily practice scenario with experienced hands, HH demonstrates good results for the assessment of ventricles size and function, while the evaluation of right heart valves was the least reliable performance. Dissemination of HH should occur with considerations and caution.

K Values for Echocardiography Analysis Echocardiography analysis K value Global estimated LV dysfunction 0.85 Wall motion abnormalities 0.78 LV hypertrophy 0.6 RV size 0.83 RV function 0.82 Mitral regurgitation 0.42 Aortic regurgitation 0.56 Mitral stenosis 0.96 Aortic stenosis 0.82 Tricuspid regurgitation 0.26 Pulmonary regurgitation 0.25 LV: left ventricle; RV: right ventricle.
P960 Response of alveolo-capillar membrane diffusion to mitral regurgitation in heart failure with reduced ejection fraction
Authors: Bandera F , Ghizzardi G , Agnifili M , Pizzocri S , Boveri S , Losito M , Labate V , Alfonzetti E , Guazzi M
Published: January 2020

Background

In HFrEF patients, high pulmonary vascular resistances (PVR) imply a combined increase of both pre- and post-capillary pressures, associated with worse outcome. Mitral regurgitation (MR) may play a role in this complex physiopathology. We sought to investigate MR impact on lung DLCO and pulmonary vascular hemodynamic in HFrEF patient.

Methods

27 HFrEF patients (age 69 ± 9; LV EF 34 ± 6) underwent right heart catheterization, rest and exercise echocardiography, right ventricle 3D assessment and lung alveolo-capillary membrane DLCO. We identified 2 subgroups divided by normal (<3 WU, n= 20) or abnormal (>3 WU, n = 7) PVR.

Results

Abnormal PVR patients showed increased pulmonary artery pressures and TPG, reduced CO and pulmonary artery compliance. Total DLCO was not significantly different between groups. The membrane component (Dm) and the alveolar volume (Va) were significantly reduced in abnormal PVR group, while the capillary volume (VC) showed a strong trend toward higher values. Abnormal PVR group had a very high percentage of moderate-to-severe MR. The TASPE/SPAP ratio and the circumferential component of RV systolic function were significantly reduced in abnormal PVR group.

Conclusion

The presence of severe MR is associated with alveolar-capillary membrane remodeling (lower Dm), worse hemodynamic profile (higher PA pressures, lower PA compliance and higher PA resistance) and worse right ventricle to pulmonary circulation coupling (lower TAPSE/SPAP and lower 3D RV circumferential EF) in this cohort of HFrEF patients. These results confirm the adequacy of using therapeutic strategies aimed to solve valvular disease.
P967 Profile of arrhythmia in pregnant women with different WHO class is similar
Authors: Wisniowska-Smialek S , Lesniak-Sobelga A , Kostkiewicz M , Rubis P , Holcman K , Podolec P
Published: January 2020

Background

Arrhythmia is the most common cardiac complications during pregnancy especially in women with structural heart disease. Methods: Since January 2015 till December 2018 the consecutive 150 pregnant women with different maternal cardiovascular risk according to WHO classification: 100 in WHO I and II (gr 1);50 in WHO II-III, III, IV were enrolled. Each woman had 24-hour Holter- ECG monitoring during at least 2 trimester. Results: Except mild ventricular arrhythmia i.e ventricular extrasystole > 1000 per 24 hour, which occured more often in group1, we did not observe any significant differences in arrhythmic profile of pregnant women with different WHO risk classification (table 1). Delivery: Caesarean section was more frequent in gr 2 (86% vs 62%) but rate of stillbirths were similar among groups. Maternal death did not occurred, there was 2 (4%) foetal mortality in gr 2. Mean duration of pregnancy, children length and birthweight were significantly higher in gr 1(table1).Conclusion: Arrhythmias during pregnancy occurred particularly on the substrate of structural heart disease. According to our observation pregnant women with potentially higher risk of maternal cardiovascular events did not reveal significant arrhythmia including conduction disturbances in comparison to women in WHO class I or II.

Holter monitoring resultes Parameter Group 1; no 100 Group 2, no 50 P value Age 31(27-34) 31(28-33) 0,36 NYHA 1,34 1,32 0,76 SVE > 1000/d 2(2,15%) 2(5,88%) 0,28 VE > 1000/d 20(19,23%) 3(5,88%) 0,03 SVT 6(6,5%) 4(11,43%) 0,35 sVT 1(1%) 0 0,65 nsVT 8(8,79%) 3(8,57%) 0,96 AF/AT 0 2(4%) 0,54 AV I 5(5%) 3(6%) 0,32 AV II Mobitz I 1(1,1%) 1(2%) 0,53 AV III 0 1(2%) 0,41 Duration (weeks) 39(38-40) 37,1 0,017 Weight (grams) 3220+-641 2840+-767 g 0,02 Caesareon section 54(62%) 33(86%) 0,00 Stillbirths 22(21,57% 8(17,78%) 0,6
P968 Subcostal M-mode echocardiography of tricuspid annular motion helps recogntion of heart arrhythmias
Authors: Drinkovic N , Drinkovic Jr N
Published: January 2020

Recognition of supraventricular arrhythmias and differention between supraventricular and

ventricular rhythm abnormalities in ECG can sometimes be difficult due to indiscernible P

wave. 1D echocardiography of tricuspid annular motion can quickly and reliably detect atrial contraction (Picture 1, figure 1a.) which has a characteristic appearance for majority of supraventricular arrhythmias. Since subcostal approach is almost always reliable, it allows simple and rapid recognition and differentiation between supraventricular arrhythmias, e.g. atrial fibrillation (Picture 1, figure 1b.) from atrial flutter and nodal rhythm. Detection of atrial contractions enables recognition of AV dissociation in ECG, which helps in differentiation between supraventricular and ventricular arrhythmias. This technique is also useful in checking the function and mechanical efficiency of atrial pacing.

Figure 1a. Atrial contraction / sinus rhythm

RA = right atrium

A = atrial contraction

Figure 1b. Atrial fibrillation

RA = right atrium

a = fibrillary contractions

Abstract P968 Figure. Picture 1
P971 The echocardiographic phenotype in patients with cardiac amyloidosis and heart failure with preserved ejection fraction
Authors: Perez Gil M D M , Mora Llabata V , Saad A , Sorribes Alonso A , Faga V , Arbucci R , Bertolin Boronat J , Serrats Lopez R , Lowenstein J
Published: January 2020

BACKGROUND

New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural.

PURPOSE.

To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA).

METHODS.

Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF > 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º).

We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV.

RESULTS

There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA.

However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table).

CONCLUSIONS

In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV.

Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p < 0.001 < 0.01 0.46 0.46 < 0.01 < 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.
P977 CT phenotype of high-risk atherosclerotic plaques causing an acute coronary syndrome compared to silent vulnerable plaques
Authors: Hodas R I , Opincariu D , Rat N , Rodean I , Chitu M , Benedek I , Benedek T
Published: January 2020

Funding Acknowledgements

PlaqueImage.- research grant no. 103544/2016, contract number 26/01.09.2016 -

Background

Previous studies demonstrated that plaque morphology has a crucial role in the development of an acute coronary syndrome (ACS). However, not all vulnerable coronary plaques produce an ACS and the prediction power of various vulnerability features to predict an acute coronary event in a close future, has not been elucidated so far.

Objective

We aimed to use multi-slice computed tomography angiography (CTA) for assessment of morphological characteristics of culprit lesions producing an ACS in the next several months after CT assessment, in comparison with morphological characteristics of unstable coronary atherosclerotic plaques which did not trigger an ACS.

Material and methods

We analyzed 40 patients in whom CTA revealed presence of unstable coronary lesions, exhibiting at least one marker of vulnerability: napkin ring sign (NRS), spotty calcium (SC), positive remodeling (PR) or presence of low attenuation plaque (LAP), divided in 2 groups: group 1 - 20 patients who developed an ACS in the next 6 months following CTA examination, and group 2 – 20 patients matched for age, gender and risk factors, who did not present any cardiovascular event 6 month after CTA assessment. Post-processing of multi-slice CTA images was performed in order to assess morphological characteristics and CT-derived markers of atherosclerotic plaque instability.

Results

Similar mean values of plaque length (17.1 +/- 5.9 mm vs 16.9 +/- 3.4 mm; p = 0.6) and total atheroma volume (188.1 +/- 104.7 mm3vs 186.4 +/- 90.7 mm3; p = 0.8) were obtained for both groups. The mean number of vulnerability markers was 1.6 in group 1 vs 1.2 in group 2 (p = 0.07). However, atherosclerotic lesions in patients from group 1 presented significantly higher values of lipid-rich atheroma (9.8 +/- 10.8 mm3vs 2.6 +/- 1.0 mm3; p = 0.01) and remodeling index (1.14 +/- 0.3 in group 1 vs 0.89 +/- 0.19 in group 2, p = 0.04). At the same time, atheromatous plaques in patients who developed an ACS during the 6-months follow-up showed in a significantly higher proportion LAP (45% in group vs 10% in group 2, p = 0.03) and PR (15%in group 1 versus 5% in group 2, p = 0.04), but not NRS (30% vs 25%, p = ns) or SC (65% vs 40%, p = 0.2).

Conclusions

Atherosclerotic plaques producing an ACS exhibit a different phenotype than unstable plaques that remain silent. The CTA profile of atheromatous plaques producing an ACS includes the presence of low attenuation, positive remodeling, higher RI and lipid-rich atheroma. Presence of these features in high-risk coronary plaques identifies very high risk patients, who can benefit from adapted therapeutic strategy in order to prevent the development of an ACS.
P979 Subclinical left ventricular dysfunction and silent myocardial ischemia in asymptomatic middle-aged patients with type 2 diabetes mellitus
Authors: Kisko A , Lesko J , Dernarova L , Kishko N
Published: January 2020

Early detection of silent myocardial ischemia (SMI) in asymptomatic middle-aged patients (pts) with type 2 diabetes mellitus (T2DM) may be important due to the generally poor prognosis and early myocardial involvement in this specific subgroup of diabetic population.

Our goal was to evaluate whether subclinical left ventricular (LV) systolic dysfunction assessed by two-dimensional speckle-tracking echocardiography (2D-STE) is independently related to SMI detected by MPI (gated SPECT myocardial scintigraphy) and if it could provide incremental information over baseline characteristics to identify it. We have tested the hypothesis that the myocardial mechanics significantly differ in asymptomatic middle-aged diabetics, depending on the presence or absence of SMI.

In total, 60 consecutive middle-aged (<60 years; 42 males, 70.0%) asymptomatic T2DM pts were enrolled into the study. MPI was performed in one-day protocol according to the EANM procedural guidelines, and SMI was diagnosed consensually by two experts as myocardial perfusion abnormalities without associated symptoms. The T2DM pts were subdivided into two groups according to the results of MPI, namely SMI group (n = 11) and non-SMI group (n= 49) Global longitudinal peak systolic strain (GLPSS) was measured from two- and four-chamber views cines using Automated Function Imaging (Vivid S6, GE). Subclinical LV dysfunction was defined as GLPSS of > -20%.

Prevalence of SMI in T2DM pts was 18,3%. All pts in SMI group (n = 11) were of male gender, and disease duration ≥ 5 years. Pooled data from 2D-STE showed significant reduction in mean absolute GLPSS values (p<.001). Further more, pts in SMI group had more impaired GLPSS when compared with patients in non-SMI group (-16.1 ± 1.5% vs. -20.4 ± 1.8%, P < .01). At multivariate analysis, male gender, an amount of epicardial adipose tissue and erectile dysfunction in men were independently associated with SMI. The addition of the LV GLPSS values to other selected independent clinical variables significantly improved the ability to predict SMI in these patients (χ(2) = 48.62; P = .001).

Asymptomatic middle-aged T2DM pts with SMI showed a more impaired LV GLPSS compared with patients without silent ischemia. The presence of subclinical LV systolic dysfunction provides significant incremental value for the identification of SMI in asymptomatic middle-aged diabetics.
P987 Comprehensive systolic right ventricular longitudinal strain analysis in congenital heart disease patients with different right ventricular loading conditions
Authors: Van Berendoncks A , Bowen D J , Mcghie J , Cuypers J A , Kauling M , Roos-Hesselink J W , Van Den Bosch A E
Published: January 2020

Background

Right ventricular (RV) function is recognized as a prognostic factor in congenital heart disease (CHD). Speckle tracking analysis might reveal subclinical systolic dysfunction. Accurate assessment of global (GLS) and regional strain measurements of the RV remain challenging. We previously introduced a novel four-view approach with all RV walls visualized in their long axis from one apical view using 2D multi-plane-transthoracic echocardiographic (TTE) iRotate mode.

Aims

To extensive evaluate GLS of the entire RV using iRotate echocardiography in CHD patients with different RV loading conditions compared with healthy subjects.

Methods and Results

One-hundred forty-two CHD patients with different RV loading conditions were recruited from the outpatient clinic and compared with 89 age, gender and BSA matched healthy controls. CHD patients were divided in 5 groups: 42 patients with volume overloaded (VO)RV (at least moderate pulmonary or tricuspid regurgitation (TR) and/or an atrium septum defect), 16 patients with pressure overloaded (PO) RV (defined as TR velocity > 2.8 m/s), 34 patients who met both criteria for volume and pressure overloaded RV (P + VO), 30 patients with systemic RV and 27 with normal RV loading conditions. TAPSE and Fractional area change (FAC%) were significantly lower in all CHD subgroups vs healthy controls (p < 0.05). Within the CHD group, TAPSE, FAC% and TDI S` did not differentiate systemic RV from PO RV, whereas RV function was significantly better in RV VO and RV VO + PO compared with systemic RV.

GLS was significantly lower in patients with CHD compared with healthy subjects. Within the CHD groups, GLS values of systemic RV were lower (p < 0.05), but no significant difference could be observed between the other subpulmonic RV loading conditions (Figure).

Conclusion

Comprehensive RV function analysis reveals decreased RV function in all CHD subgroups compared with healthy subjects. GLS showed RV systolic function to be the worst in the systemic RV but however could not differentiate between subpulmonic RV groups confirming the load independent functional analysis capacity of GLS.

Abstract P987 Figure.
P988 The newly discovered congenital heart disease in grown-up patients: untimely diagnosis or echocardiographic casuistry?
Authors: Legkonogov A , Legkonogova L G
Published: January 2020

Purpose of the study. Evaluation of the reasons for the untimely diagnosis of congenital heart disease (CHD) in adults and elderly patients.

Material and methods. 30000 people over the age of 25 who underwent transthoracic and transesophageal echocardiography were examined.

Results

CHD for the first time were revealed in 417 of 30000 patients (1,39%) including 41 of 5346 patients over 60 years of age (0,77%). The most often CHD was atrial septal defect (ASD) – 179 patients, and ventricular septum defect (VSD) was significantly less diagnosed (48 cases). In 98 cases, an aortic valve bicuspidy was identified with hemodynamically significant aortic valve stenosis and / or insufficiency. Coarctation of the aorta was detected in 25 patients, in 16 cases it was combined with a bicuspid aortic valve. The diagnosis of Ebstein"s anomaly (AE) was established in 16 patients, patent ductus arteriosus (PDA) in 15 patients, isolated pulmonary artery stenosis - 12, congenitally corrected transposition of the great arteries (CCTGA) - 6, tetralogy of Fallot - 5, congenital aneurysm of the sinus of Valsalva (CASV) - 5, congenital aneurysm of the ascending part and the arch of the thoracic aorta - 4, Lutembacher syndrome - 2, congenital mitral insufficiency - 2, mesocardia - 2 cases. In patients with CHD over 60, secondary ASD prevailed (28 observations); less frequently were discovered VSD (4), CCTGA (3), CASV (4), PDA (1), AE (1).

Conclusion

Untimely detection and difficulties in primary diagnosis of CHD in adults and elderly patients can be due to established diagnostic stereotypes, when the results of clinical observation and instrumental examination were interpreted in favor of manifestations of coronary artery disease, arterial hypertension, chronic heart failure, acquired valvular heart disease, cardiomyopathies etc. In addition, overestimation of concomitant age-related structural and functional changes of the heart and improper medical monitoring may be important.
1024 Left ventricle myocardial deformation (strain) pattern in severe aortic valve stenosis. AMY-TAVI study
Authors: Bastos Fernandez M , Lopez Otero D , Lopez Pais J , Pubul Nunez V , Gude Sampedro F , Neiro Rey C , Trillo Nouche R , Martinez Monzonis A , Gonzalez Juanatey J R
Published: January 2020

OnBehalf

AMY-TAVI study

PURPOSE.

To study left ventricular (LV) myocardial deformation in patients with severe symptomatic aortic stenosis (AS), through the analysis of the Regional and Global Longitudinal Strain (GLS), as well as the phenotypic pattern of peak systolic longitudinal strain represented in the bull´s eye.

METHODS.

A total of 42 patients with severe symptomatic AS were prospectively and consecutively included. Conventional morphological and functional parameters were analyzed, along with LV strain parameters and the strain pattern phenotype using two-dimensional speckle-tracking echocardiography. Indices derived from strain accepted as suggestive of cardiac amyloidosis were calculated (RELAPS: relative apical sparing: defined using the equation (average apical LS/(average basal LS + mid-LS); ­­Eyection Fraction strain ratio (EFSR= LVEF/GLS). Scintigraphy with technetium pyrophosphate99 and blood protein electrophoresis were performed in all patients for the diagnosis / exclusion of cardiac amyloidosis.

RESULTS

The mean age was 80 ± 7 years, and 52% were women. The mean aortic valvular area was 0.6 ± 0.1 cm2 and the left ventricular ejection fraction (LVEF) was 56 ± 16%. 19 patients (45.2%) presented a pattern of relative apical sparing of LV longitudinal strain (RELAPS> 1); and 16 patients (38%) showed an EFSR> 4.1. Cardiac amyloidosis was excluded in all patients. In the univariate analysis, RELAPS> 1 was significantly associated with higher degree of LV hypertrophy, lower LV end-diastolic volume, and greater myocardial contraction fraction.

CONCLUSIONS.

In our series, patients with severe symptomatic AS have with high frequency a "relative apical sparing" longitudinal strain pattern and Eyection Fraction Strain Ratio similar to those described in cardiac amyloidosis. Our results suggest that the classic patterns of cardiac amyloidosis are common in patients with severe AS in the absence of said pathology, findings that we believe may have important clinical implications.

Abstract 1024 Figure. Peak systolic LS patterns in severe AS
1027 Mechanical dispersion of the left and right ventricle and the correlation with ventricular arrhythmias in hypertrophic cardiomyopathy
Authors: Popa-Fotea N M , Micheu M M , Dorobantu M
Published: January 2020

Funding Acknowledgements

CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF

Introduction

One important cause of sudden cardiac death in hypertrophic cardiomyopathy (HCM) are ventricular arrhythmias. In patients with HCM, non-sustained ventricular arrhythmias were analysed in relation with 2D speckle tracking mechanical dispersion of left ventricle (LVMD), but not in relation with mechanical dispersion of the right ventricle.

Purpose

To investigate the possible associations between mechanical dispersion and other echocardiographic parameters and the development of non-sustained ventricular tachycardias (NSVT) in HCM patients.

Methods

Clinical, 24 hours ECG-Holter, 2D and 3D echocardiography data were registered in HCM patients and in a healthy control group (with normal echocardiography). The 24 hours ECG-Holter was used for detecting NSVT. LVMD was calculated as the standard deviation of time to peak negative strain in the sixteenth segments of the left ventricle. The right ventricle mechanical dispersion (RVMD) was calculated on a three free wall segments model (FWMD), but also in six segments (three RV free wall segments plus three septal segments). Right and left ventricle function was evaluated by conventional echography and 2D speckle tracking imaging.

Results

Fifty-two patients with HCM and thirty-six age and sex matched subjects were included in the study. In HCM group, 6 patients (11,5%) associated biventricular hypertrophy, while 15 (28.8%) had NSVT on ECG monitoring (group HCM1). HCM1 patients had a much higher LVMD (77.38 ± 11.19 ms) compared with HCM patients without NSVT (group HCM2) (55.8 ± 23.85 ms, p = 0.001, CI:-33.9,-9.3) or compared with controls (43.07 ± 14.19 ms, p <0.001, CI: -44.68, -25.99). The 6 segments RVMD (60.23 ± 10.2 ms) was significantly higher in the CMH1 group compared with CMH2 (45.22 ± 9.8 ms, p = 0.01, CI: -32.1, -28.1) or with the control group (22 ±14 ms, p < 0.001,CI: -36.28, -30.12) independently of the existence of RV hypertrophy. Also, FWMD (55.2 ± 4.8 ms) was significantly higher in CMH1 group in comparation with CMH2 (42.3 ± 5.6 ms, p = 0.02, CI: -27.1, -8.2) or controls (32.1 ± 2.2 ms, p = 0.006, CI: -28.1, -12.1).

The presence of NSVT correlated with global longitudinal strain (GS) 2C (-0.442, p = 0.009), GS LAX (r=-0.373, p = 0.03), GS mean value (r=-0.345, p = 0.046), LVMD (r = 0.462, p = 0.006), FWMD (r = 0.51, p = 0.004), 6 segments RVMD (r = 0.46, p = 0.05), 2D and 3D left atrial volume (r = 0.446, p = 0.008 and respectively, r = 0.512, p = 0.002).

In a logistic regression, the only parameters associated with NSVT were LVMD (OR = 1.046, p = 0.05), FWMD (OR = 1.03, p = 0.05) and 6 segments MD (OR = 1.1, p = 0.04).

Conclusions

Increased mechanical dispersion of the left, but also right ventricle is associated with the risk of non-sustained ventricular tachycardias in HCM patients.
1037 Differences in reverse remodelling between ischemic and non-ischemic left ventricular segments as assessed by myocardial work after sacubitril-valsartan therapy
Authors: Valentim Goncalves A A , Galrinho A , Pereira-Da-Silva T , Moura Branco L , Rio P , Teresa Timoteo A , Abreu J , Soares R , Feliciano J , Ilhao Moreira R , Cruz Ferreira R
Published: January 2020

Introduction

Myocardial work (MW) is a new transthoracic echocardiographic (TTE) parameter that enhances the information provided through left ventricular (LV) global longitudinal strain (GLS), allowing to investigate LV performance even in cases of changes in afterload.

None is known about the effects of Sacubitril-Valsartan (LCZ696) therapy in MW parameters.

Purpose

Compare the changes in MW parameters between ischemic and non-ischemic segments after LCZ696 therapy.

Methods

The study was a prospective evaluation of chronic Heart Failure (HF) patients with optimized standard of care therapy and LV ejection fraction ≤40%, in which LCZ696 therapy was started and no other HF treatment was expected to change.

A TTE study was performed before and 6 months after LCZ696 therapy, using the GE Vivid E95 ultrasound system. A semiautomated analysis of GLS was performed after two-dimensional images were acquired in the standard apical 4-, 3- and 2 chamber views. MW and related indices were estimated using custom software.

Two groups were created according to the 17 segment model TTE study before LCZ696 therapy:

G1 (ischemic group): dyskinesia/akinesia/hypokinesia segments in patients with ischemic HF etiology;

G2 (non-ischemic group): normokinesia segments in patients with ischemic and all segments in patients with non-ischemic HF etiology;

Results

Of the 42 patients, 35 (83.3%) completed the six-months follow-up with LCZ696, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events. Mean age was 58.6 ± 11.1 years, with ischemic etiology in 15 (42.9%), resulting in a total of 26.5% segments for G1.

Baseline global MW index (GWI) had no statistical difference between G1 and G2 (566.1 VS 584.8mmHg%, p = 0.257), but baseline MW efficiency (GWE) were significantly lower in G1 (71.9 VS 78.8%, p < 0.001).

The table represents the mean values for MW parameters in G1 and G2 before and 6 months after LCZ696 therapy, with a significantly increase in GWI and GWE values in both groups. Despite no difference in the increase in GWE (p = 0.872), the increase in GWI were higher in G2 than G1 (p < 0.001).

Conclusion

MW seems to be a new tool providing signs of reverse remodelling and better cardiac performance in ischemic and non-ischemic segments after LCZ696 therapy.

Table 1 Time 0 6 months p GWI in ischemic segments (mmHg%) 566.1 ± 364.0 696.5 ± 445.2 <0.001 GWE in ischemic segments (%) 71.9 ± 25.0 78.9 ± 19.1 0.009 GWI in non-ischemic segments (mmHg%) 584.8 ± 434.3 812.3 ± 442.0 <0.001 GWE in non-ischemic segments (%) 78.8 ± 21.2 85.7 ± 15.8 0.004 MW data before and after six months of LCZ696 therapy