bluuebunny/crossref_metadata_2025 huggingface dataset:
P1407 Three dimensional echocardiography in cardiac myxomas
Authors: Galzerano D , Di Michele S , Elmahi I , Al Shaihid M , Al Amri M , Arshi F , Vriz O , Colivicchi F , Al Buraiki J
Published: January 2020

The majority of cardiac myxomas (75–80%) are located within the left atrium, characteristically originating from the mid-portion of the atrial septum by a narrow stalk; The detection of such a feature has paramount importance for the diagnosis of myxoma ; in fact other anatomical findings as sessile implantation or other locations may be common to other cadiac tumors. Two dimensional (2D) transthoracic (TT) and transesophageal(TE) echocardiography E and cardiac magnetic resonance imaging (MRI) are mainstay in the diagnosis; It has been reported that Three dimensional(3D) E and in particular the 2D orthogonal cross sectional planes generated by electronically sectioning the 3D volume, could correctly identify the attachment and the peduncle sometimes missed by other imaging modality and therefore lead to a correct diagnosis.

Purpose of our study was to assess the usefulness of 3DE in the detection of the mainstay anatomical features of the cardiac myxomas;

We retrospectively reviewed all the case of the myxomas with pathology confirmation that underwent 2D TEE, 3D TEE and MRI in the past 5 years in order to assess the ability of the techniques in identifying the following anatomical features: site of attachment (mid atrial septum, other locations ) , modality of attachment (pedunculated or sessile); Every study was reviewed by an expert reader.

Our study group is comprised by 7 patients, 6 female, mean age 48.8 ±9.7 with 12 myxomas ; 8 located in the left atrium 3 in the right atrium ; In 6 case was the first diagnosis , in one patient was a recurrence. 9 mixomas were in the left atrium , 3 in the right atrium. & were pedunculated, 5 sessile.

There was an agreement in detecting the anatomical features except in two patients

in a one patients the attachment by a peduncle in the atrial septum close to the opening of the left upper pulmonary vein was seen only by 3DE ; in a second patient a small myxoma close to the left atrial appendage was detected only by TEE ;

Until now few reports have described the uselfuness of three dimensional echocardiography in detecting the anatomical features of cardiac myxomas. Even though MRI is the only technique able to detect perfusion of a mass otherwise it is not able to distinguish among different tumors; therefore the visualization of the anatomical features may lead a more correct diagnosis that can help in a better therapeutical and surgical plan. In our study 3DE was the only technique able to correctly depict the mainstay anatomical features of cardiac myxomas. It was possible in particular by using the 2D cross sectional planes generated by electronically sectioning the 3D volume in a case of a small peduncle attached in an uncommon location of the interatrial septum.

All the techniques are reliable in assessing the anatomical features of myxomas however 3DE could have an additional value in particular in not common location and will compliment 2D imaging in cardiac myxoma diagnosis
P1416 Clinical importance of consecutive transthoracic echocardiography in the patients with hypertrophic cardiomyopathy
Authors: Kim K , Kim H R , Kang M G , Park H Y , Koh J S , Hwang S J , Hwang J Y , Park J R
Published: January 2020

Funding Acknowledgements

nothing

OnBehalf

nothing

Background

prediction of outcomes Hypertrophic cardiomyopathy (HCM) have been robustly analyzed with echocardiography. However, there is limited data of serial follow-up (FU) transthoracic echocardiography (TTE) to predict outcomes in patients with HCM.

Objectives

This study aim is to discover clinical predictors associated with consecutive TTE follow-up in patients with HCM.

Methods

From 2010 to 2016, 162 patients with HCM were enrolled retrospectively. Concentric LVH and others systolic disease related to wall thickness were excluded. Index TTE (baseline) was measured when firstly admitted in our hospital. FU TTE was analyzed at the end of follow-up, defined as the last recorded value in patients who did not develop events or the last recorded value before events developed.

Results

The average of FU TTE and clinical FU period was 3.7 ± 2.0 years. Clinical outcomes were defined as stroke, syncope, heart failure, arrhythmia and death. Interestingly, only baseline TR V max was a predictor for clinical outcome whereas the others echo parameters were not associated with events (Table 1). KM curve showed the TR Vmax ≥2.5m/s was also significant (log rank = 0.008, Fig 1.)

Conclusions Our study showed short-term FU TTE did not bring clinician with clinical benefits in the aspect of prediction for events. Only baseline TR V max was good correlation with cardiovascular outcomes and even in the survival analysis.

Serial TTE and changed values Total N = 162 index TTE (baseline) FU TTE Change of FU per year event no event p-value event no event p-value event no event p-value IVDd, mm 14 ± 4 15 ± 5 0.500 15 ± 5 14 ± 5 0.758 0.23 ± 0.51 -0.07 ± 1.27 0.200 LVIDd, mm 47 ± 5 48 ± 6 0.256 47 ± 7 48 ± 6 0.560 -0.22 ± 2.79 0.10 ± 2.27 0.444 LVEF, % 62 ± 5 61 ± 7 0.379 61 ± 6 61 ± 10 0.927 -0.43 ± 3.10 -0.04 ± 4.94 0.620 LAVI 43 ± 9 43 ± 8 0.879 57 ± 27 58 ± 23 0.849 0.53 ± 14.5 3.11 ± 7.2 0.134 EA ratio 0.9 ± 0.6 0.9 ± 0.6 0.782 1.0 ± 0.8 0.9 ± 0.6 0.595 -0.02 ± 0.76 0.003 ± 0.027 0.594 DT,ms 196 ± 58 201 ± 62 0.603 203 ± 91 217 ± 89 0.370 17 ± 57 5 ± 40 0.154 septal e` 4.4 ± 2.1 4.2 ± 1.6 0.585 4.4 ± 1.6 4.6 ± 1.7 0.438 0.24 ± 0.91 0.05 ± 0.65 0.190 E of e` 17 ± 11 17 ± 23 0.993 15 ± 9 15 ± 6 0.726 -0.48 ± 4.42 -1.66 ± 22.78 0.728 TR velocity 2.6 ± 0.5 2.4 ± 0.4 0.012 2.7 ± 0.6 2.6 ± 0.4 0.604 0.05 ± 0.30 0.04 ± 0.18 0.905 Max wall thickness 17 ± 3 18 ± 3 0.137 17 ± 4 17 ± 3 0.888 -0.01 ± 2.19 -0.18 ± 1.14 0.522

Abstract P1416 Figure. TR Vmax and CV outcomes in the KM curve
P1429 B-Type natriuretic peptide prediction of right catheterization parameters in the first year after heart transplant
Authors: Valentim Goncalves A A , Pereira-Da-Silva T , Soares R , De Sousa L , Ilhao Moreira R , Rio P , Feliciano J , Cruz Coutinho M , Reis J , Mano T , Mendonca T , Cruz Ferreira R
Published: January 2020

Introduction

Despite being the gold-standard for hemodynamic assessment, right heart catheterization (RHC) was overcome by plasma B-Type Natriuretic Peptide (BNP) levels in daily clinical routine. However, in the first year after heart transplantation (HT), the relationship between BNP and adverse hemodynamics have yielded conflicting results.

Purpose

The aim of this study was to evaluate whether BNP values can be used to estimate adverse hemodynamics in the first year after HT.

Methods

Prospective study of consecutive RHC performed in the first year after HT (according to the endomyocardial biopsies program). Plasma BNP levels were measured at the same day.

The area under the curve (AUC) was analysed to find the BNP values with higher sensitivity and specificity to detect adverse hemodynamics.

Results

From 2017 to 2018, 50 RHC were performed. Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml.

Prediction of adverse hemodynamics by AUC results are represented in the table. BNP values were significantly increased in patients with pulmonary capillary wedge pressure (PCWP) >12mmHg (p < 0.001), cardiac index <2.5L/min/m2 (p = 0.001), mean pulmonary artery pressure (mPAP) ≥25mmHg (p < 0.001), pulmonary vascular resistance > 1,5WU (p = 0.044) and right atrial pressure >5mmHg (p = 0.003).

BNP >500pg/ml had a sensitivity of 78.3% and 87.5% and a specificity of 76.0% and 67.7% to detect PCWP >12mmHg and mPAP ≥25mmHg, respectively.

Conclusion Significant associations were found between BNP values and adverse hemodynamics in RHC, supporting the clinical utility of BNP in the first year after HT.

BNP prediction AUC values SR HEMODYNAMIC PARAMETERS AUC p 95% CI Best BNP value Sensitivity Specificity Pulmonary capillary wedge pressure (PCWP) > 12mmHg 0.798 <0.001 0.671-0.925 > 500pg/ml 78.3% 76.0% Mean pulmonary artery pressure (mPAP) ≥ 25mmHg 0.830 <0.001 0.714-0.946 > 500pg/ml 87.5% 67.7% Cardiac output < 4L/min 0.833 0.002 0.667-1.000 > 1500pg/ml 77.8% 87.5% Cardiac index (CI) < 2.5L/min/m2 0.810 0.001 0.663-0.957 > 1150pg/ml 76.9% 86.1% Pulmonary vascular resistance (PVR) > 1,5WU 0.678 0.044 0.509-0.848 > 200pg/ml 83.3% 47.1% Right atrial pressure (RAP) > 5mmHg 0.744 0.003 0.607-0.880 > 500pg/ml 70.8% 65.4% BNP prediction
P1433 Antiarrhythmic effects of sacubitril-valsartan therapy assessed by mechanical dispersion index
Authors: Valentim Goncalves A A , Galrinho A , Pereira-Da-Silva T , Moura Branco L , Rio P , Teresa Timoteo A , Abreu J , Soares R , Ilhao Moreira R , Mendonca T , Coutinho Cruz M , Reis J , Mano T , Cruz Ferreira R
Published: January 2020

Introduction

Sacubitril/Valsartan (LCZ696) significantly reduced sudden cardiac death in the PARADIGM-HF trial. However, there is little published data regarding the possible explanations for the antiarrhythmic effects found with LCZ696 therapy.

Previous trials have shown that mechanical dispersion by strain echocardiography can predict arrhythmic events in Heart Failure (HF) patients.

The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index with left ventricular (LV) global longitudinal strain (GLS) analysis before and after LCZ696 therapy.

Methods

Prospective evaluation of chronic HF patients with LV ejection fraction ≤ 40% despite optimized standard of care therapy, in which LCZ696 therapy was started and no additional HF treatment was expected to change.

ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 therapy and 6 months after therapy. A semiautomated analysis of LV GLS was made and mechanical dispersion index was defined as the standard deviation from the 16 time intervals corresponding to each LV segment.

Results

Of the 42 patients, 35 (83.3%) completed the 6 months of follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6 ± 11.1 years.

QTc interval (451.9 vs 426.0msec, p < 0.001) and QRS interval (125.1 vs 120.8msec, p = 0.033) were reduced after 6 months of LCZ696 therapy. Mechanical dispersion index (88.4 vs 78.1msec, p = 0.036) was also significantly reduced after therapy.

Conclusion

LCZ696 therapy is associated with antiarrhythmic effects with a reduction in QTc and QRS intervals in ECG and a reduction in mechanical dispersion index as assessed by LV GLS.

Abstract P1433 Figure.
P1439 Familial dilated cardiomyopathy: assessment of left ventricular systolic and diastolic function by echocardiogram in asymptomatic patients
Authors: Quezada M , Ramos M , Ayala R , Calderon- Dominguez M , Guerrero De La Riva P , Villa Benayas Z , Munoz Carrasco M , Toro R
Published: January 2020

Funding Acknowledgements

Alfonso X El Sabio University

Introduction

Familial dilated cardiomyopathy (fDCM) represents 20% to 30% of idiopathic DCM (iDCM) ethiology. The assessment of cardiac function of these patients is awfully complex. Usually, myocardial fiber damages can not be detected in the early DCM stages. In this sense echocardiogram could be useful to detect incipient changes.

Purpose

The aim of this study was to characterize the systolic function of asymptomatic fDCM, compared within iDCM and control patients.

Material and methods

This study was carried out in 33 fDCM patients. A total of 4 fDCM families with LMNA gene mutation and 3 fDCM families with BLC2-associated athanogene 3 (BAG3) mutation were recruited. Moreover, a total of 30 iDCM and 66 healthy matched controls were enrolled in the study.

Results

58.14% were male. The average age was 45.3 ± 17 years. 72% showed sinus rhythm. Left bundle branch block (LBBB) was observed in 7.8% of patients. The LV ejection fraction (LVEF), sphericity index and mitral annular plane systolic excursion (MAPSE), were significantly improved in the fDCM patients compared to iDCM subjects. However, these parameters were aggravated compared with healthy controls. LVEF was enhanced in fDCM in contrast to iDCM (56% versus 35%; P < 0.001). Nevertheless, LVEF value was deteriorated in fDCM compared to healthy controls (56% versus 65%; P < 0.001). The values of septal and lateral annulus early diastolic velocity measured by DTI, were also diminished. All results are presented in Table 1.

Conclusions

Asymptomatic fDCM shown an intermediate value of LVEF between the iDCM and the control group. This ventricular remodeling process could be the consequence of a slight increase in the end-systolic diameter.

Patients Characteristics Patients Characteristics iDCM 30 patients fDCM 33 patients Control Group 66 Healthy P LVEF 32 (29.78-40) 56.0 (39.7-64.2) 65 (62-69.5) 0.001 EDD 62.5 (59.2-65.7) 53.7 (45.7-57.6) 45.50 (43-48.8) 0.001 ESD 53 (47-58.75) 36 (30.9-54.2) 27.9 (24-31) 0.001 MAPSE 11 (10-12.50) 14 (14-18) 19 (17-20) 0.001 Sphericity index 0.70 (0.66–0.79) 0.69 (0.66-0.79) 0.53 (0.48-58) 0.001 LA volume 61.5 (57-75.1) 32 (23-46.5) 17 (14.2-20) NS Septal annulus Early diastolic Velocity (cm/s) DTI 3.5 (3-4.2) 7.5 (1.6-8.8) 9 (7.9-11) 0.001 Lateral annulus Early diastolic Velocity (cm/s) DT 7.2 (5-8.9) 9.5 (1.8-11.8) 13 (10.37-15) 0.001 Table1. Echocardiografic findings in patients. LVEF: left ventricular ejection fraction; EDD: end-diastolic diameter; ESD: end systolic diameter; MAPSE:mitral annular plane systoluc excursion; LA: left atrium; TDI: Tissue Doppler imagin.

Abstract P1439 Figure. Familial dilated cardiomyopathy
P1445 DORv and window: a case of an uncorrected double outlet right ventricle with d-transposition of great arteries with concomitant aortopulmonary window in a 31-year-old female
Authors: Enero R , Obillos S , Yao P , Dizon E , Choa V , Go L , Cheng A , Carreon A
Published: January 2020

Funding Acknowledgements

none

Double outlet right ventricle (DORV) is a rare type of ventriculo-arterial connection occurring in about 1-3% of congenital heart defects. Moreover, transposition of the great arteries, wherein the aorta is anterior and to the right of the pulmonary artery (D-TGA), accounts for only 26% of cases of DORV. An aortopulmonary window, on the other hand, represents approximately only 0.2% of all congenital cardiac lesions. A case of DORV with D-TGA and pulmonary stenosis with a concomitant aortopulmonary window has never been reported, particularly in an adult in the third decade of life and without any history of surgical repair.

We present the case of a 31-year-old female who had sought consult for left-sided weakness. On physical examination, a grade IV/VI systolic murmur was heard at the left anterior chest and cyanosis of the digits of the upper and lower extremities were noted. Transthoracic echocardiogram revealed a non-restrictive ventricular septal defect (VSD) and segmental approach showed atrial and visceral situs solitus, levocardia, and atrioventricular concordance. However, there was ventriculoarterial discordance with fusiform aneurysmal dilatation of the aorta, which was noted to be at the right of and anterior to the pulmonary artery. Both great vessels arose from the right ventricle. Other echocardiographic findings included dilated right atrium, dilated and hypertrophied right ventricle with volume and pressure overload, global left ventricular hypokinesia with mild systolic dysfunction, and moderate to severe aortic regurgitation. The above complex congenital anomalies were confirmed via transesophageal echocardiogram and cardiac magnetic resonance imaging (MRI). Furthermore, pulmonary valve stenosis and aortopulmonary window, that was 3.5 centimeters in length located at the level of the proximal ascending aorta and main pulmonary artery, were seen on the MRI.

Various cardiac imaging modalities aided in cinching the diagnosis for this very rare complex congenital case in an adult reaching the third decade of life. Palliative care was deemed best for this patient due to the severity of her cardiac condition.

Abstract P1445 Figure 1.
P1466 Pacman heart documented by multimodality echocardiographic techniques
Authors: Cardoso Torres S , Sousa C , Rodrigues J , Nunes A , Araujo P , Grilo P , Resende C X , Macedo F , Maciel M J
Published: January 2020

We report a case of a 78-year old female with hypertension, dyslipidemia, atrial fibrillation under warfarin therapy and previously diagnosed HFpEF. She also had a history of recurrent episodes of bilateral inferior limb acute ischemia requiring urgent embolectomy and one previous cardioembolic stroke. She had no history of ischemic heart disease.

She was admitted to our center due to acute decompensated heart failure (NYHA class III). On physical examination there was evidence of pulmonary congestion with bilateral crackles, without heart murmurs. ECG showed AF rhythm, without any other significant changes.

The transthoracic echocardiogram (TTE) showed moderate biventricular hypertrophy with apical predominance and good systolic function. A partial loss of myocardial tissue in the mid segment of the interventricular septum was noticed, with no left-to-right shunt on color Doppler, apparently without interventricular communication (figure A).

For further elucidation of this finding a contrast-enhanced TTE was performed, revealing a serpiginous route through the septum to a small contained cavity within it (figure B). 3D TTE en face views additionally clarified the semilunar shape of this septal defect and its movement during the cardiac cycle, closing during systole and opening during diastole (figure C).

At this point, clinical history and previous diagnostic exams were reviewed. A thoracic CT conducted 3 years before in another clinical context showed that the ventricular septal defect was already present, with similar characteristics (figure D).

As doubts persisted about the existence of interventricular communication, cardiac catheterization with oximetry and ventriculography was performed and interventricular shunt was excluded. There was no evidence of coronary artery disease. Cardiac MRI was not possible due to lack of patient collaboration.

Final diagnosis was a partial ventricular septal defect (PVSD), probably congenital. The patient was discharged under optimized medical therapy.

PVSDs, which are rarely reported in the literature, are thought to be congenital (sporadic or familial) or a consequence of myocardial infarction. They have been described as "Pacman" heart due to the shape changes during the cardiac cycle, becoming slit-like or even absent during systole, like an opening/closing mouth, resembling the Pacman video game. Related complications include conduction disturbances, rupture and disturbed systolic function.

We describe a rare case of a partial ventricular septal defect, documented by multimodality echocardiographic techniques: 2D TTE first showed an incomplete defect of the mid interventricular septum; contrast-enhanced TTE revealed its serpiginous route to a small cavity; 3D TTE en face views further illustrated its semilunar shape and characteristic movement during the cardiac cycle.

Abstract P1466 Figure.
P1476 Percutaneous paravalvular leak closure after transcatheter aortic valve replacement expedited with multimodality imaging
Authors: Ozden Tok O , Abdelnabi M , Bingol G , Almaghraby A , Goktekin O , Piazza N
Published: January 2020

A 75-year-old male admitted to our hospital with decompansated heart failure symptoms. He had a history of 3 vessel coronary artery bypass grafting 10 years ago and a 29 mm Evolut R bioprosthetic transcatheter aortic valve replacement (TAVR) history 2 months ago. His physical examination revealed a 3/6 diastolic murmur on the aortic valve area. We performed a transeosophagel echocardiography (TOE) as the transthoracic echocardiography (TTE) images were not so clear and didn’t guide enough for the procedure . TOE showed a severe paravalvular leak .

After we found out from his medical reports that postprocedural ad-hoc post dilatation was performed but didn’t work, we decided to close this paravalvular leak percutanaously . According to TOE, the paravalvular leak was at 12 o’clock position. We identified the corresponding location of the leak on previous CT images which was scanned pre-TAVR for selection of the valve size and planning of the procedure. We recognized that the leak location was corresponding to a very calcified part of the aortic annulus and the reason of the severe PVL seemed to be due to this nodular extensive calcification.

We planned the procedure according to TOE-CT integrated analysis and selected the optimal flouroscopic viewing angle.The defect was found and crossed in 20 seconds after the wire passed through arcus aorta.The selected VSD Occluder(No:12) was deployed precisely by extending the device throughout the defect. Succesful complete closure was confirmed with TOE.

In the past 1o years, TAVR has become the treatment of choice for patients with severe aortic stenosis with a higher operative risk. Different studies have depicted a higher incidence of PVR in patients who undergo TAVR compared to SAVR.

Percutaneous postTAVR PVL closure is a technically challenging procedure. Echocardiography remains the primary imaging modality for assessing PVR immediately following TAVR. Finding and crossing the PVL defect is one of the most difficult and time-consuming parts of the procedure. The reason of this difficulty can be different anatomies, bad quality imaging and lack of common language between interventional cardiologist and cardiac imaging expert. To facilitate this part of the procedure integration of echocardiograohy and CT and finding the best angulation for flouroscopy seems to be quite promising.

Abstract P1476 Figure. Step by step approach to PostTAVR
P1477 Features of structural and functional parameters of the right and left heart and their relationship with the spirometry parameters in patients with CHF of ischemic genesis with COPD
Authors: Evdokimov V , Evdokimova A , Yushchuk E , Ivanova S
Published: January 2020

Purpose

Сomparative analysis of structural and functional parameters of the heart, the state of external respiration in patients with CHF II-III FC of ischemic genesis in the absence and in combination with moderate to severe COPD.

Material and methods

The study included patients aged 65.6 ± 3.9 years with LVEF ≤ 45% (according to Simpson). The first group consisted of 87 patients with CHF of ischemic genesis, and the second group - 385 patients with CHF of ischemic genesis and coexisted COPD. All patients were evaluated for clinical condition, TTE, the study of respiratory function with bronchodilation test.

Results

Patients of both groups were comparable by sex, age, FC CHF (NYHA). In patients with COPD, linear and volumetric LV parameters exceeded the normal values and were significantly higher than in CHF patients without COPD. LVIMM, LV sphericity index were significantly higher in the group of patients with COPD, which is associated with more pronounced remodeling of the left heart.

Correlation analysis showed direct moderate and reliable relationships between the RVIDd (internal end-diastolic diameter) and MPAP (r = 0.68, p < 0.01), RVIDd and LVSV (stroke volume) and FEV1 (r = 0.38, p < 0.05), FEV1 and LVMMI (r = 0.33, p < 0.05), FVC and LVMMI (r = 0.34, p < 0.05), LVEF and FEV1 (r = 0.44, p < 0.05) and VC (lung vital capacity) (r = 0.36, p < 0.05). Negative correlations were found between low-level FEV1 and RVIDd (r=-0.29, p < 0.05), FEV1 and SatO2 (r = 0.28, p < 0.05), and a strong degree between MPAP and FEV1 (r=-0.55, p < 0.05), moderate between MPAP and FEF75 (r=-0.57, p < 0.05).

In patients with COPD more pronounced significant increases in RVIDd, MPAP, RA dimension were noted. In patients of this group (n = 385), the IVRT and time of deceleration during the early diastolic filling (DTE) of RV increased more significantly.

RV diastolic dysfunction in patients with CHF with COPD may be due to slower relaxation of the right ventricular hypertrophy and an increase in afterload (evidenced by the relationship between the velocity of early diastolic filling (E) of the RV and the thickness of the anterior wall of the RV; the velocity of late filling (A) of the RV and MPAP (r= 0.3, p < 0.05)).

Conclusion

In patients with CHF of ischemic genesis with COPD, a more pronounced remodeling of the left and right parts of the heart was noted, reliable interrelationships of respiratory function indicators and structural and functional parameters of both the left and right ventricles of the heart were revealed.
P1479 Prognostic value of integrated cardiopulmonary ultrasound in heart failure patients with reduced and preserved ejection fraction
Authors: Gargani L , Pugliese N , Frassi F , Masi S , Landi P , Taddei S , Sicari R
Published: January 2020

Background

Lung-ultrasound B-lines are the sonographic sign of pulmonary congestion and are present in patients with heart failure (HF). Their role as a diagnostic marker is quite established since they can be used for the differential diagnosis of dyspnea to both rule in or rule out HF, whereas their prognostic value at admission is less known.

Purpose

To assess the prognostic value of B-lines at admission in patients admitted to a Cardiology Department with a diagnosis of HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction.

Methods

We enrolled a total of 310 consecutive in-patients (aged 69 ± 12 years, 751 males) who underwent on admission a two-dimensional and Doppler echocardiographic evaluation coupled with lung ultrasound assessment of B-lines, according to standardised protocols. The total number of B-line was obtained by summing the number of B-lines from 28 scanning sites on the anterior and lateral right and left hemithorax, as previously described.

Results

All patients were followed-up for a median period of 15 (interquartile range: 5-28) months for death and HF readmission. During the follow-up, 79 events occurred. Among standard echocardiographic parameters, ejection fraction (EF) <50%, tricuspid annular plane systolic excursion (TAPSE) < 17 mm, pulmonary artery systolic pressure (PASP) ³35 mmHg, inferior vena cava diameter >21 mm and total B-lines ³30 were predictors of events at univariate analysis, whereas only B-lines ³30 (hazard ratio [HR] 2.06; 95% conﬁdence interval [CI] 1.04-4.10) and TAPSE <17 mm (HR 0.53; CI 0.29-0.97) were independent predictors at multivariate analysis. When analysing separately HFpEF patients (105 patients, 33.9%), B-lines ³30 was the only independent predictor of events (HR 6.11; CI 1.49-25.05) (Figure).

Conclusions

B-lines are a simple, user-friendly, bedside echographic sign of pulmonary congestion, that provides useful information not only for the diagnosis but also for the prognosis of HF patients. Their added value among standard echocardiographic parameters is stronger in patients with HFpEF compared to HFrEF. An integrated cardiopulmonary ultrasound assessment at HF admission provides excellent value for both diagnostic and prognostic stratification.

Abstract P1479 Figure
P1481 Embolic infarct in a known coronary artery disease patient
Authors: Ali A H , Alnuaimi U , Lacau S I , Badiu C , Popescu A C
Published: January 2020

A 60 y/o diabetic and hypertensive lady with previous anterior infarction treated by primary PCI with stenting of the proximal LAD (2011) and CABG for stent thrombosis, presented for chest pain. Admission ECG showed ST segment elevation in II, III aVF, ST segment depression in V1-V2 (A). Urgent coronary angiography was performed. It showed non-significant lesions on RCA and LCX, occlusion of the proximal LAD stent, patent LIMA to LAD and first diagonal with non-significant stenosis of the distal anastomosis (B). Transthoracic echocardiography (C) showed calcific mass involving the mitral annulus and posterior mitral leaflet, moderate mitral regurgitation, hipokinesia of the basal segment of the inferior wall with preserved LV ejection fraction. Transesophageal echocardiography (D) confirmed the calcified mass involving the mitral annulus and the posterior mitral leaflet. There was no significant mitral stenosis, and mitral regurgitation was moderate. Thoracic CT showed massive mitral calcification and a possible thrombus attached to it. (E)

Myocardial infarction was confirmed by troponin rise and fall. The patient was discharged on dual antiplatelet therapy, ACE-I, betablocker and statin. At one month follow-up transthoracic echocardiography the central area of the mitral mass became hypoechogenic, and a bilobated hypermobile structure was seen attached to the ventricular side of the mass (F). Blood cultures were negative and there was no inflammatory syndrome. Cardiac magnetic resonance (H) confirmed myocardial infarction and showed massive calcification of the posterior mitral annulus. TEE performed after another month showed a very long hypermobile structure attached to the mitral annulus calcification, which was entering the left ventricular outflow tract reaching the plane of the aortic valve (G). The patient underwent surgical mitral valve replacement and redo CABG and the mass was excised. The pathologic aspect of the excised material was cazeous and friable (I).

The initial presentation was presumably an embolic infarct with cazeous material.

Abstract P1481 Figure.
P1483 Noninvasive multimodality imaging in diagnosis and management of cardiac sarcoidosis (CS)
Authors: Breskvar U , Zupan Meznar A , Kajdic N , Antolic B , Zizek D
Published: January 2020

Introduction

The clinical presentation of cardiac sarcoidosis (CS) ranges from an incidentally discovered condition to heart failure with risk of sudden cardiac death (SCD). As there is no single reliable test for detecting CS, noninvasive multimodality imaging plays a crucial role in establishing the diagnosis and SCD risk-stratification. We present a case of a young patient diagnosed with CS in whom, on the basis of multiple imaging results, dual-chamber ICD for primary prevention was implanted outside practice guidelines.

Case

A 37-year-old woman was admitted to our hospital due to occasional palpitations and incidentally recorded nonsustained monomorphic ventricular tachycardia (VT). One year ago she was diagnosed with pulmonary sarcoidosis and was put on methylprednisolone; ECG, 24-h Holter monitoring and echocardiogram were normal. In the present admission control echocardiogram, with the exception of decreased longitudinal deformation of the basal and mid segments of the infero- and anterolateral left ventricle (LV) wall, was unremarkable. However, cardiac magnetic resonance (CMR) showed sub-epicardial late gadolinium enhancement (LGE) along the lower third of the antero- and inferolateral LV free wall and in the apical lateral segment of LV. Apart from some focal metabolically active lesions in the lungs and liver, fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) displayed increased metabolic activity in the apical half of the antero- and infero-lateral segments of the LV. On the basis of this results CS was confirmed. Given the age, reduced longitudinal strain, notable LV LGE presence and increased cardiac metabolic activity, dual-chamber ICD to prevent SCD and possible bradycardia risk was implanted. The patient continued with immunosupressive therapy; 8 mg of methylprednisolone every other day.

Conclusion

In our case, integrated multimodality imaging played a crucial role in establishing CS diagnosis and SCD risk stratification. A comprehensive evaluation of patients with CS is vital for making the best clinical decisions.
P1484 Unusual manifestation of constrictive pericarditis
Authors: Golinska Grzybala K , Gackowski A
Published: January 2020

Introduction

The objective of this case report is to highlight the difficulties in establishing the proper management in some patients with chronic constrictive pericarditis (CCP).

Case Description

A 67 year-old-man with a long history of COPD (stage D), coronary heart disease, diabetes mellitus type 2, prostate cancer treated with local radiotherapy and hormonotherapy, was admitted due to progressive fatigue and dyspnoea on exertion,. Three months before he was hospitalised in pulmonary ward because of sudden onset of severe dyspnoea with mild leg oedema, and unusually weak response for typical COPD treatment was observed. At this time local lab test revealed moderately elevated CRP (43.6 mg/l), ESR (36 mm) and NT-proBNP (483 pg/ml). CT scan was performed to exclude pulmonary embolism. No pericardial calcifications were noted.

Physical examination showed obesity (33 kg/m2), heato-jugular reflux and mild ankle oedema. Chest auscultation revealed normal lungs sounds and muffled heart sounds. Pleural effusion was excluded and no ascites nor hepatomegaly was found.

Echocardiography revealed typical changes for CCP

prominent septal bounce during inspiration, annulus reversus (TDI e` lat 16 cm/sek; e` med 18 cm/sek), annulus paradoxus (E/e` 8), normal LV function, dilated vena cava inferior (VCI).

MRI showed thickened pericardium (5mm) particularly near the right ventricle (RV) and thick layer of fatty tissue (15 mm) localised in pericardium, next to the RV free wall. RV was compressed (fig.1). LVEF was 63%, EDV 117 ml, SV 74 ml, SVi 33 ml/m2, LV mass 78 g; RV EF 71%, EDV 72 ml/m2, right atrium enlargement was found (38 cm2), while left atrium was of normal size (22 cm2). VCI and hepatic veins were dilated (29 mm and 13mm respectively.

Fig 1. MRI – thickened pericardium containing thick fatty tissue causin with RV compression

After diuretic uptitration, the dyspnoea improved to NYHA I/II. Due to clinical improvement heart team decided to continue medical treatment. Due to comorbidities (DM, COPD, obesity), the risk of pericardiectomy was considered high. Three month later the patient was hospitalized due to sudden dyspnoea and subsequent cardiac arrest. Despite cardiopulmonary resuscitation the patient died in ICU. CCP was confirmed in autopsy.

Discussion

The diagnosis of CCP remains challenging. In this case the presentation was not fully typical. There was no clear precipitating factor, the history was relatively short and the symptoms and signs mild. CT scan did not show pericardial calcifications. Although TTE revealed typical features of CCP and MRI confirmed compression of the right ventricle, the heart team did not confirm the need for pericardiectomy, which is treatment of choice in progressive CCP.

Abstract P1484 Figure. Fig.1
P1509 Obesity and diastolic function of the left ventricle by echocardiography in a Mediterranean child population
Authors: Aristizabal Duque C , Fernandez Cabeza J , Blancas Sanchez I M , Ruiz Ortiz M , Delgado Ortega M , Rodriguez Almodovar A , Romo Pena E , Fonseca Del Pozo F J , Romero Sardana M , Pan Alvarez Osorio M , Mesa Rubio D
Published: January 2020

Background

The prevalence of overweight in childhood is 26% and obesity is 12.6% in Spain. Diastolic function assessed with echocardiography shows significant worsening in obese adults compared to non-obese adults. However, few studies describe the association between obesity and diastolic function in the pediatric population.

Aim

To investigate the relationship between obesity and diastolic function in a Mediterranean pediatric population.

Methods

A random sample of children and adolescents of primary and secondary education was selected, stratifying by age, gender and educational centers in a rural town of 2864 inhabitants of southern Spain. Children between 6 and 17 years old were included. A transthoracic echocardiogram was performed to evaluate diastolic function.

Results

A total of 212 children were studied (10.9 ± 3.0 years old and 51.9% males): 163 (76.9%) were not obese and 49 (23.1%) were obese. Age and sex were similar in both groups. Results are shown in the table. Obesity was related to a larger left atrial volume, a higher A-wave velocity, a lower lateral e "wave velocity, a higher average E/e ratio, and a higher pressure gradient between the atrium and the right ventricle.

Conclusions

Obesity in childhood is associated to worsening of diastolic function parameters commonly measured in echocardiography.

Obese Vs non-Obese non-obese obese p Age 10,8 ± 3,0 11,0 ± 2,8 0,63 Male (%) 50,1% 57,1% 0,4 A-wave velocity (cm/s) 58,7 ± 13,1 64,8 ± 13,8 0,005 E/A 1,89 ± 0,45 1,75 ± 0,41 0,05 lateral e" velocity (cm/s) 21,26 ± 4,61 19,58 ± 3,97 0,02 average E/e" 6,4 ± 1,1 7,0 ± 1,2 0,001 left atrial volume (mL) 20,8 ± 6,8 27,9 ± 7,4 <0,0005 pressure gradient (mmHg) 15,5 ± 4,5 18,0 ± 4,9 0,02
P1514 Increased myocardial oxygen demand is associated with impaired left ventricular strain in patients with morbid obesity referred for bariatric surgery
Authors: Grymyr L M , Nadirpour S , Gerdts E , Nedreboe B G , Hjertaas J J , Matre K , Cramariuc D
Published: January 2020

Background

Obesity predisposes for left ventricular (LV) hypertrophy and systolic dysfunction. Higher myocardial oxygen demand in LV hypertrophy is associated with higher risk for cardiovascular events, while the association with LV systolic function has been less explored.

Purpose

To assess the association of myocardial oxygen demand with LV systolic function in morbidly obese subjects without known heart disease.

Methods

Clinical and echocardiographic data from 110 obese subjects referred for gastric bypass surgery (mean age 42 ± 11 years, 74% women, mean body mass index [BMI] 41.9 ± 4.8 kg/m², 33% with hypertension, 15% with diabetes) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV function was assessed by ejection fraction (EF) by Simpson"s biplane method and endocardial global longitudinal strain (GLS) by 2D vector velocity imaging using a 16-segment model (Image Arena 4.6, Tomtec, Unterschleissheim, Germany). Myocardial oxygen demand was estimated from LV mass - wall stress - heart rate product according to a previously validated formula.

Results

Myocardial oxygen demand was higher in men (1884 vs. 1579 x 10³ g x kdyne/cm² x bpm, p < 0.05), and associated with higher BMI (r = 0.24) and pulse pressure (r = 0.28), and with lower EF (r = -0.22) and lower GLS (r = 0.26, all p < 0.05). In multiple regression analysis, higher myocardial oxygen demand was associated with lower LV GLS (Beta = 0.21, p < 0.05) independent of age, gender, BMI, pulse pressure, diabetes, and EF (Table).

Conclusion

In obese patients without known heart disease referred for bariatric surgery, higher myocardial oxygen demand was associated with lower LV systolic function measured by GLS independent of confounders.

Covariates of lower GLS in multivariable Variable β correlation coefficient p LV mass - wall stress - heart rate product (g x kdyne/cm² x bpm x 10³) 0.21 0.04 Age (years) -0.12 0.22 Gender 0.34 <0.01 BMI (kg/m²) 0.25 <0.01 Pulse pressure (mmHg) -0.04 0.71 Diabetes -0.17 0.09 LV EF (%) -0.01 0.90
P1516 Detecting right ventricular systolic dysfunction in patients with acute ST-elevation myocardial infarction: echocardiography is good enough
Authors: Pickure Z , Kalinin A , Pickurs K , Zakharova E , Alekhin M , Lejnieks A
Published: January 2020

Background

Many recent years" studies confirm the impact of the right ventricle (RV) dysfunction on morbidity and mortality in patients with an acute ST segment elevation myocardial infarction (STEMI). Earlier echocardiography (Echo) was not accurate enough in detecting RV dysfunction. The newest Echo methods allow to directly and accurately assess the RV systolic function.

Purpose

The aim of this study was to estimate the frequency of both RV segmental and global dysfunction in patients with STEMI using three-dimensional (3D) Echo and myocardial longitudinal strain (LS).

Methods

A group of 73 patients with first-time acute STEMI of different localization was selected. A control group of 32 people was formed of healthy individuals. As a standard for determining RV systolic dysfunction, changes in the traditional Echo parameters of the RV were accepted. In our study RV 3D ejection fraction (EF) less than 49% (AUC = 0.88, p < 0.001, sens 73%, spec 78%, PPV 50%, NPV 91%) and RV free wall LS less than 24.5% (AUC = 0.95, p < 0.001, sens 88%, spec 89%, PPV 74%, NPV 96%) best predicted RV involvement in STEMI. RV involvement frequency in STEMI was analyzed in 4 levels: 1 - visual estimation only (RV segmental or global dysfunction); 2 – visually + pathologically changed conventional Echo parameters; 3 – visually + pathological conventional Echo parameters + pathological RV EF and RV LS defined by current guidelines; 4 - visually + pathological conventional Echo parameters + new pathological 3D RV EF and RV LS cut-off levels, defined in our study.

Results

RV involvement in patients with STEMI was found in 26%, if estimation was only visual (presence of segmental and/or global dysfunction). By adding in algorithm pathologically changed conventional Echo parameters, RV dysfunction was detected already in 36% of cases. New Echo parameters (3D RV EF and RV LS) added 6% more to RV involvement cases, resulting in 42% in total, if current guideline-recommended pathological cut-off levels were used. But the highest number of RV involvement cases - 62%, was reached, if visual evaluation and conventional Echo parameters were combined with 3D RV EF and RV LS, using higher pathology cut-off levels, defined in our study. This number is much closer to the data, provided by cardiac magnetic resonance and autopsy.

Conclusion

Modern echocardiography can provide greatly improved RV dysfunction diagnostics. In the case of STEMI current echocardiography methods show much closer results to the gold standard – cardiac magnetic resonance imaging and autopsy data, detecting RV involvement in more than 60% cases of acute STEMI.
P1525 Residual functional mitral regurgitation post-MitraClip is associated with worse hemodynamics and predicts poor outcome at 2-year follow-up
Authors: Van De Heyning C M , Debonnaire P , Bertrand P B , Mortelmans P , Deferm S , Paelinck B P , De Bock D , Coussement P , Vandervoort P M , Claeys M J
Published: January 2020

Background

Percutaneous mitral valve repair using MitraClip offers symptomatic benefit and improves rest and exercise hemodynamics in patients with severe functional mitral regurgitation (MR). Recent randomized trials have shown contradictory results regarding the impact of MitraClip on mid-term survival in functional MR. It is unknown whether improved hemodynamics are related to patients" outcome.

Purpose

To assess whether residual MR and altered resting and exercise hemodynamics are predictors of outcome in patients with functional MR treated with MitraClip.

Methods

Consecutive patients (n = 45, 72 ± 10years, left ventricular ejection fraction (LVEF) 34 ± 9%) with symptomatic severe functional MR were prospectively evaluated by Doppler echocardiography at rest and during symptom-limited exercise on a semi-supine bicycle pre- and 6 months post-MitraClip procedure. LVEF, MR severity, cardiac output (CO), systolic pulmonary artery pressure (SPAP) and a flow-corrected SPAP/CO ratio were assessed at rest and peak exercise. 2-year follow-up clinical data were collected from patient records.

Results

During 2-year follow-up post-MitraClip, 15 patients (33%) experienced major cardiac events (hospitalization for heart failure (n = 14) and/or cardiac death (n = 5)). Age, gender, a history of coronary artery disease, diabetes, baseline MR severity and baseline SPAP/CO ratio at rest and during exercise were not related to a worse event-free survival. In contrast, patients with events at 2-year follow up had more often a history of hospitalization for heart failure (73 vs. 37%, p = 0.029), lower baseline LVEF (30 ± 8 vs. 36 ± 10%, p = 0.041), more residual MR at 6 months post-MitraClip (MR jet area/left atrial area 27 ± 14 vs. 15 ± 10%, p = 0.004) and higher SPAP/CO ratios at rest and during exercise 6 months post-MitraClip (13.9 ± 5.3 vs. 9.9 ± 3.4mmHg/L/min, p = 0.007 and 13.6 ± 4.9 vs. 9.4 ± 4.6mmHg/L/min, p = 0.009, respectively). When corrected for baseline LVEF, residual MR 6 months post-MitraClip remained an independent predictor for worse 2-year outcome. Residual MR was moderately correlated to a worse SPAP/CO ratio 6 months post-MitraClip (Pearson Rho 0.518, p < 0.001).

Conclusions

In patients with functional MR treated with MitraClip, residual MR at 6-month follow-up is associated with impaired hemodynamics, and is an independent predictor of cardiac events at 2-year follow-up.
P1543 The assessment of regional myocardial strain in classifying amyloid cardiomyopathy
Authors: Geenty P , Shivapathan S , Deshmukh T , Brown P , Boyd A , Taylor M , Kwok F , Altman M , Richards D , Stewart G , Thomas L
Published: January 2020

Background

An infiltrative cardiomyopathy is a common manifestation of AL-amyloidosis, with cardiac involvement associated with a poor prognosis. Wild-type transthyretin amyloidosis (wt-TTR), is a distinct clinical entity occurring predominantly in men > 65 yrs, that has gained interest recently due to novel treatment options. Regional strain analysis has been shown to discriminate both forms of cardiac amyloidosis from other causes of concentric left ventricular hypertrophy, with a characteristic pattern of ‘apical sparing’. Due to the significant difference in both the course of the disease and treatment options between groups, a non-invasive echocardiographic method of determining subtype would be valuable.

Aim/Method: We sought to compare traditional and novel echocardiographic parameters in a cohort of AL ( n = 80) and wild type (wt-TTR) amyloid ( n = 32) patients. All amyloid patients underwent comprehensive transthoracic echocardiography, including both conventional parameters and LV longitudinal strain. Further novel parameters were computed including the ratio of global longitudinal strain (GLS) to LV ejection fraction (LVEF), as well as GLS to indexed LV mass.

Results

wt-TTR patients had significantly greater LV mass (176 ± 59g/m2vs118 ± 37g/m2, p < 0.001), and worse diastolic dysfunction as expressed as E/E’ (21.5 ± 11vs17 ± 8, p = 0.04). LVEF was significantly lower in wt-TTR patients however remained in the normal range in both groups (53 ± 6%vs57 ± 6%, p = 0.001), whilst GLS was significantly reduced compared to AL-amyloid patients (11.5 ± 3.4%vs16.2 ± 4.6%, p < 0.001). LVEF:GLS was significantly higher in wt-TTR patients (4.93 ± 1.4vs3.87 ± 1.3, p = 0.001) reflecting a more profound reduction in strain with a relatively preserved ejection fraction. Similarly, the ratio of GLS to LV mass was significantly lower in wt-TTR amyloidosis (0.078 ± 0.05vs0.155 ± 0.07, p < 0.001), reflecting a more significant reduction in strain for a given wall thickness in wt-TTR patients. GLS:LV mass was the strongest discriminator between subtypes (AUC 0.82), with a cutoff of 0.09 giving a sensitivity and specificity of 71% and 80% respectively, for detecting wt-TTR.

Conclusion

In this cohort, patients with wt-TTR had significantly greater increase in LV wall thickness and diastolic dysfunction, which may in part reflect their increased age (77vs62). However, GLS was also significantly reduced compared to AL-amyloid, even when accounting for LV ejection fraction and LV mass, suggesting these composite parameters may have value in determining the subtype of cardiac amyloidosis.