bluuebunny/crossref_metadata_2025 huggingface dataset:
415 Comparison between two methods for assessing ventricular-arterial coupling: the Chen single-beat method and carotid artery wave intensity
Authors: Antonini-Canterin F , Pepe A , Strazzanti M , Luzza G , Penzo M , Nicolosi E , Pagliani L , Rivaben D
Published: January 2020

Background

Ventricular arterial coupling (VAC) can be defined as the ratio of the arterial elastance (Ea) to the ventricular elastance (Ees). . The Ea/Ees ratio has been consistently demonstrated to be a reliable and effective measure of cardiovascular performance. The Chen single-beat method is the most used non-invasive method for this measurement. Carotid artery wave intensity (WI) is also considered a index of VAC, as the first peak (W1) represents the forward compression wave, reflecting left ventricle (LV) contractile function. However, data about the relationship between the two methods are nowadays scarce.

Purpose

Aim of the study was to compare carotid WI and Ventricular-Arterial Coupling (VAC) in a population of patient with heart failure.

Methods

We examined 50 consecutive patients with heart failure (9 females, 41 males, mean age 67 + 12 years, range 29-97 years, 34 ischemic, 16 not ischemic). Carotid artery wave intensity was achieved merging the echo-tracking of the vessel with its doppler signal. Simultaneous not-invasive oscillometric blood pressure was obtained. The VAC was assessed by the ratio between the arterial elastance (Ea) and the end-systolic ventricular elastance (Ees). Ea was calculated from stroke volume (SV) and end-systolic pressure (Ea=(Systolic BP x 0.9)/SV) and Ees was calculated by the modified single-beat Chen method, using an estimated normalized ventricular elastance at arterial end-diastole (ENd) Ees = [Diastolic BP-(ENd(est) x Systolic BP x 0.9)]/(ENd(est) x SV). Three subgroups were created according to the left ventricle ejection fraction values (LVEF ≤ 35%, LVEF >35% <50%, LVEF ≥ 50%, with 26, 14, 10 patients respectively).

Results

The correlation between Ea/Ees and W1 was significant (Pearson’s correlation r= -0.35, p 0.01). The W1 and VAC values of the three LVEF-sorted subgroups were processed with ANOVA test (p 0.054 and p 0.0002 respectively). W1 values resulted to be, as expected, reduced especially in the group of severe ventricular dysfunction (mean 4,97+- 3,29), as well as the ventricular-arterial coupling was increased (mean 2.04 +- 1.04). Interestingly W1 shows to be correlated with the Left atrial volume index (Pearson’s correlation r= -0,30 p = 0,037).

Conclusions

Carotid WI technique seems to be a reliable method to estimate the ventricular-arterial interplay. Larger studies are needed to evaluate the respective role of W1 and Ea/Ees in the prognostic evaluation.

Results EF ≤ 35 (n = 10) 35 < EF < 50 (n = 14) EF≥ 50 (n = 26) p value W1 4.97 ± 3.29 8.05 ± 3.79 7.85 ± 3.12 0.054 Ea/Ees 2.04 ± 1.04 1.39 ± 0.31 1.16 ± 0.3 0.0002

Abstract 415 Figure.
P714 Contradicting the most basic tenet of black holes: light can, indeed, escape
Authors: Sousa J P , Ribeiro J , Puga L , Lourenco C , Teixeira R , Goncalves L
Published: January 2020

A 69-year-old man with history of non-insulin-treated type 2 diabetes mellitus, arterial hypertension and mixed dyslipidemia presented to the emergency department with chest pain lasting for four days. Immediate twelve-lead electrocardiogram unveiled an inferior ST-segment elevation myocardial infarction (STEMI), prompting emergent coronary angiography, which, in turn, revealed two-vessel disease, specifically proximal ramus intermedius 60-70% stenosis and proximal right coronary artery acute occlusion. Culprit lesion was successfully managed with balloon angioplasty and a single drug-eluting stent implantation. Still, clinical course was noticeable for deterioration, under the form of cardiogenic shock, which required invasive ventilation and intravenous vasopressor support with norepinephrine. Despite biventricular systolic function relative preservation, transthoracic echocardiography disclosed inferior akinesis, right ventricle dilation, mild circumferential pericardial effusion and, particularly, a 2.3cm posteroinferior ventricular septal defect (VSD), in the setting of a 4.4cm2 pseudoaneurism, resulting in left-to-right shunting, quantified through maximal/mean trans-VSD pressure gradients of 84/44mmHg. Further imaging with transesophageal echocardiography and cardiac computed tomography angiography allowing the conception of a 3D-printed model was performed. Surgical correction of the defect followed, achieving partial anatomic success, namely with residual shunting, as of a left ventricular systolic pressure of 80mmHg and a right ventricular systolic pressure of 25mmHg. Patient survived, recovered and got discharged three weeks later. At one-year follow-up, he was hospitalized for acute decompensated heart failure (hemodynamic profile C) twice, with medication non-adherence reported as the main precipitating factor. In addition to a significant remaining left-to-right shunt (maximal velocity 3m/s), adverse cardiac remodeling was recognized, featuring left ventricular ejection fraction of 30-35%, severe functional mitral regurgitation, severe postcapillary pulmonary hypertension and de novo left bundle branch block (QRS duration of 197ms). Having been deemed clinically unsuitable for another surgical correction, patient underwent percutaneous VSD closure with both AmplatzerTM septal and muscular VSD occluders, with a suboptimal result. He is now on New York Heart Association class III heart failure and on the waiting list for both MitraClip and cardiac resynchronization therapy implantation.

Reflecting numerous breakthroughs in the management of acute myocardial infarction, incidence of mechanical complications is on the decline. Nevertheless, when they occur, morbidity and mortality remain high. Acquired ventricular septal defects are no exception, demanding the best care from a tertiary hospital heart team.

Abstract P714 Figure.
P962 The Remodeling Index risk stratifies patients with hypertensive left ventricular hypertrophy
Authors: Le T T , Bryant J , Ang B , Su B , Cook S , Chin CALVIN
Published: January 2020

Funding Acknowledgements

National Medical Research Council

BACKGROUND

Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. The authors previously developed the Remodeling Index (RI) that incorporated LV volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients.

PURPOSE

This study examined the mechanisms and prognostic potential of the RI in reference with current LVH classifications.

METHODS

Cardiovascular magnetic resonance (CMR) was performed in 400 asymptomatic hypertensive patients. The newly derived RI ([(EDV)^1/3]/t; where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients into 3 groups: without LVH, LVH with normal RI (LVH_Normal-RI) and LVH with low RI (LVH_Low-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes and decompensated heart failure.

RESULTS

LVH_Low-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), patients with LVH_Low-RI had more than a 5-fold increase in adverse events compared to those with LVH_Normal-RI (11.6 events/100patient-years versus 2.0 events/100 patient-years, respectively; log-rank P < 0.001; Figure A). The RI provided incremental prognostic value over and above a model consisting of clinical variables and LVH (P = 0.02). Conversely concentric and eccentric LVH were associated with adverse prognosis (4.5 events/100patient-years versus 6.0 events/100patient-years, respectively; log-rank P = 0.62) that was similar as the natural history of hypertensive LVH (5.1 events/100patient-years).

CONCLUSIONS

The RI provides mechanistic insights and prognostic value that improves risk-stratification of hypertensive LVH.

Abstract P962 Figure.
1039 Time course of left atrial performance in patients with paroxysmal atrial fibrillation undergoing radio-frequency catheter isolation of pulmonary veins
Authors: Katbeh A , Iliodromitis K , De Potter T , Geelen P , Balogh Z , Stefanidis E , Barbato E , Van Camp G , Penicka M
Published: January 2020

Background

Radio-frequency catheter isolation of pulmonary veins (RF-PVI) is associated with changes of left atrial (LA) structure and function. However, there is limited knowledge regarding the long-term impact of successful RF-PVI on the LA mechanics. The aim of the current study was to assess the time course of LA performance in patients with paroxysmal atrial fibrillation (pAF) undergoing RF-PVI.

Methods

The study population included 24 consecutive patients (age:62 ± 21 years; 66% male) with symptomatic pAF and preserved left ventricular ejection fraction (≥50%) undergoing the first RF-PVI and 23 healthy controls. A comprehensive echocardiographic examination was performed one day before and 1 day, 3- and 12- months after RF-PVI. The reservoir, conduit and contractile LA strain (LAS), strain rate (LASR) and mechanical dispersion (LAMD) were assessed using two-dimensional speckle tracking echocardiography in apical views.

Results

At baseline, patients with pAF showed a significant reduction of all three components of LAS and LASR compared with controls (all p < 0.01). At 1 day after RF-PVI, LAS and LASR showed significant decrease compared with baseline (all p < 0.05) (figure). At 3-month follow up, LAS and LASR recovered to baseline values while LAMD showed a significant improvement (77ms vs 58ms, p = 0.003). At 12-month follow up, both reservoir and contractile LAS showed further improvement compared to 3-month values (31% vs 27%, and 15% vs 13%, both p < 0.05). Yet, even after 12 months, LAS values remained significantly lower compared with healthy controls (p < 0.05). LA emptying fraction was restored and LA end-systolic (max) and end-diastolic (min) volume index showed a significant decrease compared to baseline and 3-month values (all p < 0.05).

Conclusion

Successful RF-PVI is associated with acute decrease in LAS, followed by recovery to baseline values within 3 months and further improvement during one year. Reservoir and contractile LAS appears to be the most clinically useful indices to monitor LA performance in patients with pAF undergoing RF-PVI.

Figure

Time course of LA reservoir and contractile strain, LA max and min volume index, and LA mechanical dispersion (Baseline, 1-day FUP, 3- and 12-month FUP).

Abstract 1039 Figure.
1095 Effective image-guided medical management in effusive constrictive pericarditis
Authors: Montes A , Cecconi A , Alvarado T , Vera A , Barrios A , Caballero P , Olivera M J , De Rueda C , Gonzalez E , De La Cuerda F , Jimenez C , Perich J , Gamarra A , Jimenez Borreguero L J , Alfonso F
Published: January 2020

A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started.

During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition.

Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D).

Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis.

Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery.

Abstract 1095 Figure.
1099 Constrictive pericarditis:a challenge in Cardiology
Authors: Kairis C , Stefanidis C , Saxpekidis B , Petridis C , Mosialos L , Stosic T , Tsinopoulos G , Koufou E
Published: January 2020

Funding Acknowledgements

none

A 50-year old woman had complained about dyspnea and leg swelling despite taking furosemide 80 mgr per day.

Her past medical history had included radiation therapy for Hodgkin"s lymphoma, prosthetic heart valves (mechanical MV, AV- INR = 3,2) and permanent pacemaker. Also her coronary vessels were normal.

On clinical examination she was non-febrile, the arterial pressure was 120/80mmHg,there was atrial fibrillation at 70 pulses/min at rest and oxygen saturation was 96%.

The chest x-ray finding was left pleural effusion. The patient also had ascites.

Kidney function was normal without proteinuria. The diagnostic paracentesis and biochemical analysis of ascitic fluid was indicative of transudative fluid.Cytologic analysis was negative for malignancy. Moreover,needle biopsy specimen was subjected to histopathology,which was negative for malignancy.

Echocardiography had revealed normal size and function of left ventricle ( LV = 46mm-EF = 60%). The mechanical valves had normal function, without paravalvular leak or masses. Also right ventricle was normal. The pulmonary artery pressure measured by echocardiography was in the normal range (RVSP = 35mmHg), but the inferior vena cava was dilated.There were also dilated hepatic veins and hepatic vein flow reversal.There was variation> 25% in triscupid inflow with respiration. TEE had confirmed the findings of transthoracic echo with regard of prosthetic valves.

CT of chest and abdomen findings were no pathologic lymphadenopathy,no pulmonary embolism and absence of tumor compressing inferior vena cava. Chest CT scan had demonstrated pericardium thickening,indicative of constrictive pericarditis. CMR was not performed because of permanent pacemaker.

The final step in diagnostic algorithm was cardiac catheterization:

a)the pulmonary artery systolic pressure measured during right heart catheterization was 35mmHg.

b)dip & plateau’ pattern or ‘square root sign of right ventricle, i.e. pattern of accentuated early dip in diastolic pressure, followed by plateauing in mid-late diastole.

c)prominent y wave of right atrium- absent x wave because of AF.

d)left ventriculography was not performed because of mechanical aortic valve.

At the end constrictive pericarditis was confirmed by the surgical report.

According to ESC guidelines a diagnosis of constrictive pericarditis is based on the association of signs and symptoms of right heart failure and impaired diastolic filling due to pericardial constriction by one or more imaging methods, including echocardiography, CT, CMR, and cardiac catheterization.

However,the most important step is the suspicion of constrictive pericarditis, especially in patients with history of radiation therapy and heart surgery.

Abstract 1099 Figure.
P1253 A case report of acromegalic cardiomyopathy with severe left ventricular hypertrophy
Authors: Kuklina M D , Melkozerov K V , Kalashnikov V Y
Published: January 2020

Introduction

Acromegaly is a rare disease, mostly caused by a growth hormone (GH)-secreting benign pituitary tumor, with an increased production of GH and insulin-like growth factor 1 (IGF-1). One hallmark feature of the disease is acromegalic cardiomyopathy, a syndrome of progressive cardiac dysfunction characterized by left ventricular hypertrophy, diastolic dysfunction, and combined systolic and diastolic dysfunction in the very advanced stage.

Clinical case

A 54-year-old male with history of arterial hypertension and abnormal electrocardiogram (ECG) for more than 10 years was diagnosed with active stage of acromegaly (IGF-1-1711ng/ml, cardiac magnetic resonance (CMR) – pituitary tumor). Surgical treatment was recommended. He was referred for preoperative cardiac evaluation preceding transsphenoidal resection of a pituitary adenoma. He denied syncope or any chest pain. The standard 12-lead ECG demonstrated sinus rhythm, left atrial enlargement and left ventricular (LV) hypertrophy with deep negative T waves in V3-V6 leads. Holter monitor demonstrated episodes of non-sustained ventricular tachycardia. Transthoracic echocardiography revealed severe asymmetric LV hypertrophy without LVOT obstruction at rest and maneuver Valsalva (max. grad. – 19mm. Hg) with mildly abnormal LV ejection fraction (48%, range ≥52%), severe reduced global longitudinal strain (-8,2%, range <-18%) and grade II diastolic dysfunction. CMR imaging was performed. According to CMR suggested hypertrophic cardiomyopathy (HCM) demonstrating area of myocardial fibrosis on extensive late gadolinium enhancement, maximal LV wall thickness of 40 mm, increased myocardial mass (index 277g/m2, range 68–103g/m2) and mildly reduced systolic LV function (LVEF - 54%, range 57-74%). Coronary angiography did not show significant stenosis. After cardiac examination, transsphenoidal adenomectomy was done. There are currently no algorithms sudden cardiac death (SCD) for patients with acromegalic cardiomyopathy, but he was recommended implantation of cardioverter defibrillator devices on a scale for HCM (Risc SCD – 4,17%). Acromegaly-induced cardiomyopathy can mimic HCM. He was also recommended genetic typing for HCM, considering the results of MRI.

Conclusion/Discussion: Reduction GLS might be expected to result in a fall in LVEF, however this is often not the case in hypertrophic LV diseases. It is important to note that measures of regional function such as myocardial strain may actually reflect global systolic function better than the ejection fraction. The results may improve our ability to provide a more accurate prognosis and better assessment of actual systolic function. Because cardiomyopathy is an important cause of mortality in acromegaly, diagnosis and appropriate management are critical to improve survival.

Abstract P1253 Figure.
P1269 Relationship between left ventricle mass index and abdominal obesity in patients with metabolic syndrome hospitalized due to acute coronary syndrome
Authors: Furman-Niedziejko A , Rostoff P , Palka I , Golonka M , Golinska-Grzybala K , Nessler J
Published: January 2020

Background

There is evidence that metabolic syndrome (MS), as a cluster of acute coronary syndrome (ACS) risk factors, is associated with increased left ventricle mass index (LVMI). According to the 2009 IDF criteria of MS diagnosis, elevated waist circumference (≥94 cm in M, ≥80 cm in F), as a determinant of abdominal obesity (AO), is not an obligatory component of MS. Little is known about the relation of abdominal obesity to LVMI in pts with ACS.

Purpose

The aim of this study was to evaluate the relationship between abdominal obesity and LVMI, determined as LVM/H2,7, in patients with MS hospitalized due to ACS.

Methods

444 consecutive pts were enrolled based on ACS diagnosis. The pts were divided into two groups depending on MS diagnosis: group A – 310 pts with MS and AO (205 M, mean age 63.3 ± 10.5 yrs), group B - 134 pts without MS (101 M, mean age 61,4 ± 12.7 yrs). The group A was divided to two subgroups depending on AO diagnosis: group A1 - 288 pts with MS and AO (185 M, mean age 63.4 ± 10.2 yrs and group A2 - 22 pts with MS without AO (19 M, mean age 62,6 ± 12.7 yrs). In all enrolled pts hypertension was diagnosed.

Results

A significant difference was found between group A and B with the respect to LVMI (68.4 ± 25.9 vs. 58.3 ± 16.5, p < 0.05). In the group B, a significant association was found between LVMI and waist circumference (r = 0.39, p < 0.05), weight (r = 0.22, p = 0.012), as well as BMI (r = 0.35, p < 0.05). In group A, LVMI was significantly correlated only with weight (r = 0.24, p < 0.05). No significant differences were found between pts with AO and without AO with respect to LVMI (68.9 ± 26.2 vs. 61.4 ± 20.9, p = 0.187).

Conclusion

1. In individuals without MS hospitalized due to acute coronary syndrome significant positive correlation was found between LVMI and waist circumference, weight as well as BMI. 2. There is significant difference between pts with MS and without MS with the respect to LVMI. 3. No significant differences were found in LVMI between pts with AO and without AO.
P1276 Excess mortality associated with atrial fibrillation complicating tricuspid regurgitation
Authors: Peri Y , Topilsky Y A N , Sadeh B E N , Merdler ILAN , Steinvil ARIE
Published: January 2020

Introduction

There is limited data regarding the prevalence of Atrial Fibrillation (AFib) in tricuspid regurgitation (TR) patients. In addition the influence on mortality of AFib on TR patients is not well studied. In the current study we aimed to examine whether the prevalence of AFib is related to the severity of TR and to assess effect of AFib on the mortality of TR patients.

Methods

The cohort included 397 patients (mean age 77.1 ± 15.2 Years; 36.3 % males) with TR of any cause that underwent quantitative prospective evaluation by the PISA method for regurgitant volume and effective regurgitant orifice (ERO). The primary outcome was all-cause mortality.

Results

251 (65.9%) of the patients were classified as mild to moderate TR (ERO < 0.4) and 130 (33.6%) patients classified as severe TR ( ERO≥ 0.4)

The prevalence of AFib in the total cohort was 56.4%. The prevalence of AFib in the mild to moderate TR patients was lower than in the severe TR group (52.5% vs. 63.9%; p = 0.03). In univariate Hazard analysis atrial fibrillation was associated with increased mortality (HR = 1.18, P < 0.04). In sub-group analysis atrial fibrillation was associated with excess mortality in the mild and moderate TR group (Log Rank Chi square = 3.11, p= 0.07) but not in the severe TR group.

Conclusions

The prevalence of AFIB among TR patients is high, and severe TR is associated with higher prevalence of AFIB compared to milder disease.

AFib is independently associated with mortality in patients with less than severe TR but not in the severe TR group.

Abstract P1276 Figure.
P1278 Budget impact of global longitudinal strain for the early detection of cardiotoxicity incorporation in the brazilian private healthcare system
Authors: Miglioranza M , Lucchetta R C , Barros Pena J L , Castillo J M , Oliveira Jr W P , Almeida A L C , De Resende M V C , Riveros B S , Rosim M P , Medeiros M , Dos Santos W M , Okumura L , Nita M E , Vieira M
Published: January 2020

Funding Acknowledgements

Department of Cardiovascular Imaging / Brazilian Society of Cardiology

Objective

To estimate the budget impact of incorporating global longitudinal strain (GLS) for the early detection of cardiotoxicity in patients under cancer treatment, compared to conventional echocardiographic measurements (ECO) in the Brazilian Private Healthcare System (PHS). Methods: The BI was calculated based on a Markov constructed with the following health states: no changes, cardiotoxicity, heart failure, reversibility and death, with annual cycles. Eligible population was estimated through an epidemiological approach, based on the prevalence of cancer, proportion of cancer patients treated with anthracyclines and proportion of patients covered by health plans. The time horizon was 5 years, with perspective of the PHS. One scenario was built considering only the cost of GLS and ECO, whereas the other scenario included direct medical costs related to the management of cardiotoxicity and heart failure. Probabilistic sensitivity analyses were performed to explore uncertainties. Results: The initial eligible population was estimated in 209,657 patients. The scenario considering only GLS and ECO procedures costs resulted in a positive BI, from BRL3.6 million in the first year to R$ 59 million in the fifth year. Considering total costs, the incorporation of GLS has the potential to result in savings to PHS from the fourth year of incorporation. In the fifth year the economy reaches about R$ 9 million. Deterministic results are corroborated by the probabilistic analyses. Conclusion: Cardiotoxicity has a major impact in cancer patients treated with anthracyclines, being associated with increased risk of heart failure and mortality. Since GLS has the potential of early detection of cardiotoxicity, allowing the rapid onset of treatment, the use of GLS has the potential to promote savings for the private healthcare system.

Abstract P1278 Figure. budget impact of GLS
P1282 Follow-up evaluation of right chambers mechanics is associated with prognosis in group 1 pulmonary arterial hypertension
Authors: Biondi F , Albani S , Lo Giudice F , Howard L , De Luca A , Tsampasian V , Pasanisi E G M , Sinagra G , Stolfo D
Published: January 2020

Background

Pulmonary arterial hypertension (PAH) is a severe disease that progressively leads to right ventricular (RV) failure and cardiovascular death. Evaluation of right heart mechanics by means of 2-dimensional speckle tracking echocardiography (2D-STE) has displayed to be a promising tool to estimate prognosis in PAH patients.

Purpose

To evaluate the association between right ventricular free wall longitudinal strain (RVFWLS) and right peak atrial longitudinal strain (RPALS) at follow-up after initiation of specific vasodilator therapy in PAH patients, with outcomes.

Methods

83 subjects diagnosed with PAH Group 1 at three University Hospitals (Hammersmith Hospital, London, United Kingdom; Trieste University Hospital, Trieste, Italy; FTGM, Pisa, Italy), who were naive from specific treatment for PAH at the time of diagnosis, were retrospectively enrolled in this study. Standard echocardiographic parameters were collected. Outcomes were defined as the combination of all-cause mortality, hospitalization for PAH and first prostanoid administration. We investigated the correlation between RVFWLS and RPALS with outcomes adjusting for validated echocardiographic parameters strongly associated with prognosis in PAH (right atrial area – RAA and pericardial effusion – PE) and patients’ haemodynamics.

Results

30 patients experienced outcomes during a median follow-up time of 33 months. Median RVFWLS at follow-up was -15.8% (IQR: -12.1%/- 21.1%). Median RPALS at follow-up was 25% (IQR: 17.9%/36.6%). In the multivariate analysis, RVFLWS at follow-up was independently associated with outcomes (95% confidence interval [CI]: 1.01 – 1.24, p = 0.04), irrespectively from RAA (95% CI: 0.98 – 1.20, p = 0.12) and pulmonary arterial systolic pressure (PASP, 95% CI: 0.99 – 1.06, p = 0.12). We also observed a trend towards superiority of RPALS at follow-up (95% CI 0.90 – 1.00, p = 0.07) over RAA (95% CI: 0.98 – 1.20, p = 0.14) and PASP (95% CI: 0.99 - 1.05, p= 0.31). Finally, RPALS (95% CI: 0.88 – 1.00, p = 0.05) was independently associated with outcomes over PE (95% CI: 0.14 – 1.89, p = 0.32) and RVFWLS (95% CI: 0.97 – 1.20, p = 0.16).

Conclusions

In PAH group 1, assessment of both RVFWLS and RPALS at follow-up is associated with outcomes, independently from standard echocardiographic parameters.
P1323 From a suspicion of pulmonary arterial hypertension to a rare form of Takayasu disease
Authors: Wrona K , Polak M , Mizia-Stec K
Published: January 2020

A 27-year-old female with a history of glomerulonephritis,with diagnosed systemic lupus

and retroperitoneal fibrosis was admitted due to fast worsening dyspnoea(NYHA class IV)

over the prior four weeks with suspicion for PA hypertension. In 2015, retroperitoneal fibrosis was diagnosed based on MR examination. With the methylprednisolone treatment a regression of changes was obtained. The patient was chronically treated with prednisone 7.5mg/day and mycophenolate

mofetil 2g/d.

When admitted to the ward, the patient was in a severe condition, with

symptoms of resting dyspnea and blood oxygen saturation up to 80%. A loud systolic

murmur was audible over the entire chest. In laboratory tests, the NT-proBNP values

(11,000 pg/ml) were significantly elevated, arterial blood gases showed tendency to alkalosis, hypoxemia (PO2 45mmHg)with hypocapnia. Parameters of inflammation were moderately elevated

(CRP 25mg/l, WBC 12,000/ul), with normal serum IgG4 concentrations. In TTE, significant dilatation of the right ventricle with left chamber compression were observed. Tricuspid ring dilation with no leaflets coaptation and a severe tricuspid regurgitation

(Vmax 5m/s, RVSP 100mmHg) were found. In addition, the critical proximal pulmonary artery

(PA) stenosis was revealed (left PA Vmax 3.3m/s, Pmax 42mmHg, right PA Vmax 5.2 m/s,

Pmax 110mmHg). Angio-CT confirmed critical proximal constriction of both PAs with a flow

channelup to 4 mm. Based on angio-CT and cardiac MR study the inflammatory

etiology of stenoses was suspected and an empiric diagnosis of the Takayahu disease of

pulmonary arteries was made. The patient was qualified for conservative treatment using prednisone and cyclophosphamide.

Over the course of two months,2.8 g of cyclophosphamide were administered intravenously in

three cycles with good response to the treatment. It resulted in regression of dyspnea and a

improvement in exercise tolerance - to the NYHA class II, normalization of

saturation. Laboratory tests showed reduction of NT-proBNP (1300 pg/ml). Control

TTE revealed reduction in the size of the right ventricle and regression of PAs stenoses

(left PA 11mm, right PA 7mm), also reduction of systolic flow gradients

(left PA Vmax 3.1 m / s, Pmax 39 mmHg, right PA 4.1 m/s, Pmax 68 mmHg).

Because of the significant improvement in patient’s condition,it was decided to continue the treatment.

Legend for the Fig.1 A angio-CT, critical proximal constriction of both PA B TTE, parasternal short axis view, imflammatory infiltration C TTE, continuous wave doppler, flow velocity pattern in the PA stenosis D TTE PLAX, dilatation of the right ventricle with left chamber compression fig. 1

Abstract P1323 Figure. Fig.1 artety pulmonary stenosis
P1409 Sizing of mitral annuloplasty rings using three-dimensional transoesophageal echocardiography
Authors: Yoshitani K , Fujii T , Ito S , Shimokawa A , Ohnishi Y
Published: January 2020

Funding Acknowledgements

Department funding

Background

Mitral valve repair is preferred to valve replacement in cases of degenerative mitral regurgitation (MR) due to the lower risk of valve-related complications and operative mortality. In mitral valve repair, annuloplasty is associated with better clinical outcomes. Sizing of the annuloplasty ring with a ring sizer, which should be performed in the end-systolic phase, is performed in diastole during hyperkalaemia cardioplegic arrest. Three-dimensional transoesophageal echocardiography (3D-TEE) allows measurement of the mitral valve while the heart is beating, which is beneficial since the mitral valve size changes throughout the cardiac cycle.

Purpose

To investigate whether 3D-TEE measurements of the mitral valve are effective for preventing recurrent mitral regurgitation (MR) in patients who undergo mitral valve repair for degenerative MR.

Methods

This study retrospectively reviewed 139 patients who underwent mitral annuloplasty for degenerative MR. After 47 patients were excluded, 92 patients were analysed. The inter-commissural (IC) distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systolic phase. The annuloplasty ring size and type were selected by surgeons using specific ring sizers. We investigated the association of the IC distance with the size of implanted annulus ring and differences between the size of implanted annulus ring and the IC distance. We also compared the IC distance, the A2 height, and the ratio of A2 height to IC distance between patients with and without recurrent mild-to-moderate MR for 36 months.

Results

There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance (R²=0.7023, p < 0.001). The variety between implanted annulus ring size and IC distance measured by 3D-TEE was shown in Figure1. Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). The A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059).

Conclusions

There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance. Our results demonstrated a higher ratio of A2 height to IC distance in patients with recurrent MR.

Abstract P1409 Figure1
P1485 multiple hindrances in and outside the heart : right ventricular outflow tract obstruction in a child with severe post-subclavian coarctation of aorta and ventricular septal defect
Authors: Naganur S
Published: January 2020

Funding Acknowledgements

Not applicable

OnBehalf

Not applicable

11 years boy with shortness of breath/easy fatigability. On examination obese, comfortable at rest, pulse : 80bpm, regular, normal JVP. Blood pressure : 170/100 in upper limb, 120/80 in lower limb. Mild cardiomegaly, normal S2, no S3/S4/click, harsh 4/6 ESM in left 3rd intercostal space, faint continuous murmur at the back. CXR : mild cardiomegaly, adequate pulmonary blood flow. ECG : sinus rhythm, normal QRS axis/intervals, biventricular hypertrophy. Echo : severe pulmonary stenosis (predominantly subvalvular, gradient 100mmHg) coarctation (gradient 50mmHg) preserved biventricular function. Cardiac CT : confirmed echo" findings, additional ? DCRV, anomalous RCA from left sinus. Cardiac MRI couldn"t yield more information. Hence, catheterization was performed. Pressure data : severe infundibular and mild valvular RVOT obstruction, normal PA pressure, severe coarctation. Oximetry : small L–>R shunt. RV angiogram : obstruction at sub-valvular/valvular levels, doming/reverse doming of pulmonary valve. LV angiogram : small subaortic VSD, L–>R. Aortic root angiogram : bicuspid aortic valve, no AR, anomalous RCA from left sinus, severe coarctation, no PDA. Plan : Single antihypertensive, surgical resection of infundibular RVOTO, pulmonary valvotomy, VSD closure, coarctation repair.

Cath data Pressure in mm of Hg Right atrium (mean) 8 Right ventricle (apex) systolic 100 end diastolic 12 Right ventricle (outflow) systolic 60 end diastolic 12 Main pulmonary artery 25/10 (15) Left ventricle systolic 158 end diastolic 14 Ascending aorta 165/75 (140) Descending aorta 116/80 (100) Right Femoral artery 117/76 (98) Oximetry Superior vena cava 68% Inferior vena cava 74% Pulmonary artery 82% Aorta 99% Pulmonary vein 100% Qp/ Qs 1.6:1

Abstract P1485 Figure. CT/MRI/Cath
P1510 Assessment of left ventricular relaxation time constant by noninvasive left ventricular pressure-strain loop: invasive validation
Authors: Meledin V , Haberman D , Gandelman G , Poles L , Goland G , George J , Gerafi A , Edri O , Shimoni S
Published: January 2020

Introduction

Left ventricular (LV) relaxation time constant, Tau (τ), is one of the best indexes to evaluate left ventricular diastolic function and is usually assessed invasively. Tau is the time constant of the exponential regression Pt =(P0-P∞)e-t/τ+P∞ that expresses left ventricular isovolumic pressure decay, where Pt is LV pressure (LVP) at time t, P0 is LVP at dP/dtmin and P∞ is the asymptotic pressure, to which relaxation would lead if completed without LV filling. Several noninvasive methods were developed to calculate Tau, however, they are time-consuming and complicated. Recently, a simple method regional left ventricular pressure–strain loops and myocardial work was introduced and validated. We hypothesize that left ventricular relaxation time constant can be derived and calculated from the LV pressure–strain loops.

Objective

To calculate noninvasively Tau using LV pressure–strain loops and compare it to invasive Tau assessment.

Methods

The study includes patients with preserved LV systolic function without significant valvular disease that were scheduled to elective coronary catheterization. During catheterization, a fluid-filled catheter was placed in the LV to measure pressure. Echocardiography was performed simultaneously with LV pressure recording. Three standard apical views were acquired and subsequently 2D strain analysis was performed using commercially available GE software and LV pressure–strain loops were calculated. Doppler signal was used for timing of valvular events. Tau was calculated by the equation τ =P/(-dP/dt) that is a derivative of the ventricular pressure decline P = P0e-t/τ+PB with respect to time. The pressure between peak negative dP/dt and the lowest LV pressure shortly after mitral valve opening was used for this calculation. The study was approved by the institutional ethics committee.

Results

Forty patients, (mean age 65.1 ± 10.9 years, 27 male, BSA1.93 ± 0.18 m2) were included in the study. Heart rate and the mean blood pressure at the time of catheterization were 69.9 ± 11.8 min-1 and 85.2 ± 18.8 mmHg, respectively. The mean LV end diastolic diameter was 44 ± 4 mm, the LV mass was 86.7 ± 25.2 g/m2, LVEF 58.4 ± 6.6% and GLS 21.0 ± 3.2%. Tau, calculated noninvasively using derivative method was significantly lower than invasively derived measurement (40.1 ± 13.4 vs 49.8 ± 7.7 msec, p = 0.002). However, a significant positive correlation was observed between the two methods (r =0.67, p <0.001, Figure).

Conclusions

This preliminary study demonstrates that Tau estimated by a noninvasive method using LV pressure–strain loops has a good correlation with Tau measured invasively. Therefore, Tau can be estimated noninvasively using novel left ventricular pressure–strain loop method.

Abstract P1510 Figure.
P1548 Changes in left ventricular deformation with weight loss in obese adolescents with intellectual and developmental delays (IDD)
Authors: Forsha D , Ptomey L , Johnson T , Goth N , Kuzava L , France R , Kathol M , Artman M , Donnelly J
Published: January 2020

Funding Acknowledgements

AHA Career Development grant

Background

Adolescents with IDD have twice the prevalence of obesity as their typically developed peers, leading to frequent early obesity-related subclinical cardiac dysfunction, detected by strain echo. The effects of weight loss on cardiac deformation are unknown in this population.

Purpose

To evaluate early cardiac dysfunction in overweight IDD adolescents before and after a 6-month caloric restriction-weight loss program.

Methods

Subjects with IDD co-enrolling in a weight loss program were consented for this strain imaging study, excluding those with congenital heart disease. An echo measuring LVEF (bullet), 2D speckle longitudinal LV global strain (GLS) and strain rate (GLSr) from 3 apical views and global circumferential strain from a parasternal short axis view at the paps (GCS) was performed at baseline and 6 months. Analysis included paired T-test and regression analysis, p ≤ 0.05 significant.

Results

Overweight (5) and obese (15) adolescents (40% female) had baseline LV strain measurements that were mildly diminished with increased baseline body weight predicting diminished GLS (P = 0.034) and GCS (P = 0.046) on regression modeling. After 6 months, weight and BMI decreased significantly with improvements in GLS and GCS and non-significant trends towards improvement in GLSr and early diastolic global strain rate. BMI change at 6 months predicted change in GLS (p = 0.015) and GCS (p = 0.0087) on regression modeling. At baseline, LVEF and LV end-diastolic volume were normal with no change over 6 months (p > 0.55).

Conclusions

Baseline abnormalities in LV deformation with preserved LVEF are present in this young, obese IDD population with improvements in BMI predicting those in GLS and GCS after a 6-month caloric restriction-weight loss program. These data provide compelling justification for larger studies in this population.

n Baseline (mean ± SD) 6-mo. follow up 0-6 mo. change p-value Age (years) 20 17.0 ± 2.0 17.5 ± 2.1 0.5 ± 0.1 Weight (kg) 20 86.9 ± 22.2 83.1 ± 22.7 -3.7 ± 5.9 0.014 BMI (kg/m²) 20 32.2 ± 5.3 30.4 ± 5.7 -1.8 ± 2.2 0.0031 GLS (%) 20 16.9 ± 1.6 19.2 ± 2.7 2.4 ± 2.0 0.00023 GLSr 20 1.15 ± 0.018 1.22 ± 0.18 0.06 ± 0.16 0.096 EaGLSr 20 1.83 ± 0.038 2.01 ± 0.46 0.18 ± 0.45 0.098 GCS (%) 20 19.1 ± 2.3 22.0 ± 2.6 2.82 ± 2.6 0.00019 LV deformation before and after weight loss. GLS, GLSr, and GCS are reported as positive values (absolute values). Body Mass Index (BMI); Early Diastolic Global Longitudinal Strain Rate (EaGLSr)
P1549 The quantitative value of PSI and time interval between AV closure and regional peak longitudinal strain in the assessment of CAD severity by the use of resting 2D ST_TTE
Authors: Farooq Al Kareem SAHAR , Ali Farhan Al Farhanal HASAN , Abdul Raheem YOUSIF
Published: January 2020

Background

Early detection of myocardial ischemia has important therapeutic and prognostic implications. Evidence of post-systolic shortening (PSS) on speckle tracking TTE is indicative of delayed myocardial contraction after aortic valve closure (AVC), and has been proposed to be a marker of myocardial ischemia. The pathologic post systolic strain index (PSI) only exists in patients with decreased systolic strain and thickening.

Purpose

To evaluate the PSI and time interval from AVC to regional PLS measured by using resting 2D speckle tracking TTE for detection of LV myocardial ischemic segments and lesion severity confirmed by coronary angiography.

Methods

A cross sectional study of patients with ischemic heart disease, underwent 2D speckle tracking TTE (Vivid E9, GE Healthcare) immediately before invasive coronary angiography. PSI, regional PLS and time interval from AVC to regional PLS in each LV segment were calculated.

Results

63 stable patients, the mean age 55.6 (± 10.95) years and male: female ratio (2: 1). Coronary angiographic lesion ≥ 50% was detected in (334) LV segments of corresponding coronary artery territory. There were significant differences between LV segments with <50% CA lesion severity and LV segments with ≥50% CA lesion severity regarding both the PSI and Time interval from AVC to regional PLS. To identify the LV segments of the corresponding CA territory with ≥50% lesion severity, the receiver operator characteristic (ROC) curves for PSI and the time interval had areas under the curve (AUC) values 0.82 and 0.63 respectively which were statistically significant with best cut-off points of PSI was 15% (sensitivity 84%, specificity 68%) and for the Time interval was 85msec (sensitivity 68%, specificity 55%).

Conclusion

In ischemic patients with ≥50% coronary artery stenosis, as confirmed by invasive coronary angiography, the measurement of PSI and the time interval simultaneously on resting 2D ST_TTE, enabled the identification of LV segments of the corresponding coronary artery territory with pathologic (ischemic) PSS by using each appropriate threshold for PSI and time interval with excellent diagnostic accuracy. When both measures were significant, the sensitivity and specificity being (49 %, 69.8%) respectively which is better than using one measure alone.

Best cut-off point of PSI & Time interva variable cut-off point sensitivity specificity PSI 15% 84% 68% Time Interval 68% 55% PSI & Time Interval 15% , 85 msec 49% 69.8%
P1576 Exercise echocardiography in asymptomatic or mildly symptomatic patients with moderate or severe aortic stenosis
Authors: Peteiro Vazquez J C , Bouzas-Mosquera A , Varela-Cancelo A , Broullon J , Vazquez-Rodriguez J M
Published: January 2020

Exercise testing is recommended in current guidelines for discovering symptoms in patients with aortic stenosis (AS) and equivocal or no symptoms at all. The additive value of imaging is controversial. We sought to assess the value of exercise echocardiographic (ExE) parameters in this setting, particularly increase in blood pressure, increase in LV ejection fraction and increase in gradients with exercise.

Methods

Retrospective analyses of prospectively collected data on 157 patients (83 males, age 70 ± 12 years) with moderate or severe AS and normal LV function (LVEF ≥ 50%) who were asymptomatic or who have equivocal symptoms. The end point was a combined event composed of overall mortality and aortic valve replacement.

Results

No complications were reported during the exercise testing. Ischemia was reported in 63 patients (40%) whereas 10 subjects had resting regional wall motion abnormalities (6%). During a median follow-up of 21 months (25th-75th percentil 7-60 months) there were 129 events, including 64 deaths. After multivariate adjustment, treatment with digoxine (hazard ratio [HR] = 4.65, 95% Confidence Interval [CI]= 1.97-10.94, p < 0.001), treatment with nitrates (HR = 1.52, 95%CI = 1.00-2.32, p = 0.049) maximal age-predicted achieved heart rate (HR = 0.16, 95% CI = 0.03-0.70, p = 0.02), and increase in blood pressure with exercise (HR = 0.99, 95% CI = 0.98-1.00, p = 0.002) were predictors of the combined event. Increase in LVEF and increase in gradients conferred protection by univariate analyses but were not predictors after adjustment.

In conclusion

ExE is safe in patients with AS. A significant number of patients have abnormal imaging results. Most of the patients with AS and a clinically indicated ExE have events in a median follow-up time interval. Although increase in gradients and increase in LVEF were associated to less events, the "exercise part" of the ExE seems to be more powerful for predicting outcome.
Differential visible spectral influence on carbon metabolism in heterotrophic marine flavobacteria
Authors: Hameed Asif , Lai Wei-An , Shahina Mariyam , Stothard Paul , Young Li-Sen , Lin Shih-Yao , Sridhar Kandikere Ramaiah , Young Chiu-Chung
Published: January 2020

The visible spectrum of solar radiation is known to stimulate photoheterotrophic bacterial carbon metabolism. However, its impact on ‘strictly’ heterotrophic bacteria remains less explored. Here, we show that heterotrophic flavobacteria exhibit enhanced uptake and mineralization of dissolved organic carbon with increasing wavelengths of visible light, without employing any ‘known’ light-harvesting mechanisms. RNA sequencing identified blue light as a major constraint in the extracellular enzymatic hydrolysis of polymeric carbohydrates and acquisition of sugars, despite acting as a stimulus for inorganic carbon sequestration. In contrast, green–red and continuous full-spectrum lights activated diverse hydrolytic enzymes and sugar transporters, but obstructed inorganic carbon fixation. This ‘metabolic switching’ was apparent through limited nutrient uptake, suppressed light-sensitivity, oxidative stress response and promotion of inorganic carbon sequestration pathways under blue light. The visible light impact on metabolism may be of significant ecological relevance as it appears to promote cell-mediated mineralization of organic carbon in ‘green-colored’ chlorophyll-rich copiotrophic coastal seawater and inorganic carbon sequestration in ‘blue-colored’ oligotrophic open ocean. Thus, a novel regulatory role played by light on heterotrophic metabolism and a hidden potential of flavobacteria to sense and respond differentially to monochromatic lights influencing marine carbon cycling were unraveled.