bluuebunny/crossref_metadata_2025 huggingface dataset:
P845 Deep vein thrombosis, pulmonary embolism and patent foramen ovale: a lethal mix
Authors: Vera Sainz A , Garcia Guimaraes M , Jimenez C , De La Cuerda F , Gonzalez E , Montes A , De Rueda C , Rojas A , Cecconi A , Diego G , Benedicto A , Dominguez L , Monguio E , Jimenez Borreguero L J , Alfonso F
Published: January 2020

A 50-year-old woman without remarkable medical history was admitted at the Emergency Department for acute dyspnoea. The patient had been recently submitted to C5-C6 microdiscectomy. She was tachypneic and oxygen saturation was 88%. CT angiography showed bilateral pulmonary embolism (PE) (Figure 1A, yellow arrowheads) with signs of right ventricle overload. Bilateral deep vein thrombosis was also confirmed. The patient was admitted at the Intensive Care Unit, clinically stable. Few hours later, she presented sudden hemodynamic and respiratory deterioration, requiring invasive mechanical ventilation and vasopressors. Due to recent cervical surgery, systemic fibrinolysis was ruled out. Decision for percutaneous thrombectomy and inferior vena cava filter placement was made. Nevertheless, percutaneous thrombectomy was unsuccessful due to the impossibility to catheterize pulmonary artery. Contrast injection demonstrated that the guiding catheter was located in the left atrium (Figure 1B), suggesting a patent foramen ovale (PFO). Transoesophageal echocardiogram confirmed the presence of a 5x6 mm PFO with right-to-left shunt (Figures 1C – yellow arrows, and 1D). In addition, a 4 cm mobile mass attached to the aortic valve and protruding throughout the left ventricle outflow tract was visualized, suggesting paradoxical embolism (Figure 1E – white arrows). Accordingly, open surgical approach with pulmonary thrombectomy, PFO closure and removal of the left-sided thrombus was decided. Unfortunately, despite careful cannulation, thrombus was not found when aortic valve was inspected. Worst suspicions were confirmed, when the patient presented non-reactive mydriatic pupils. A brain CT showed signs of an extensive bihemisferic ischemic stroke (Figure 1F) presumably related to cerebral embolization of aortic thrombus. The patient finally died. Autopsy study was not consented.

PFO has been associated with paradoxical embolisms and risk of stroke in PE. This case strikingly illustrates that treatment of these patients may be challenging in spite of an adequate diagnosis and management.

Abstract P845 Figure.
P858 Cardiovascular toxicity induced by immunotherapy and tyrosine kinase inhibitors
Authors: Calcullo D , Di Lisi D , Iacopelli P , Nugara C , Bronte E , Evola V , Iacono F , Immordino F , Lunetta M , Novo S , Russo A , Novo G
Published: January 2020

Background

in the recent years, survival of cancer patients increased enormously through the use of new anticancer drugs such as molecular target drugs (tyrosine kinase inhibitors- TKIs, immunotherapy). Immunotherapy includes anti-BRAF and anti-MEK drugs (although evidences are scarce, these drugs seem to be capable of causing cardiovascular toxicity too); TKIs includes inhibitors of VEGF, VEGFR and other kinases.

Purpose

to assess cardiovascular toxic effects of TKIs and immunotherapy, to identify early signs of cardiac and vascular toxicity using speckle tracking echocardiography and arterial stiffness measurement.

Methods

a prospective study was carried out evaluating 45 patients treated with immunotherapy or TKIs. Population was divided into 2 groups: Group A (17 patients with melanoma treated with anti- BRAF and anti-MEK) and Group B (28 patients with solid cancer treated with TKIs-anti VEGF). Cardiological evaluation including electrocardiogram, conventional echocardiogram with tissue Doppler imaging (TDI) and left ventricular global longitudinal strain (GLS) measurement and carotid ultrasound scan was carried out before starting therapy and at a follow-up time of 6 and 12 months. Cardiovascular events such as heart failure, arterial hypertension, arrhythmias, Qtc interval prolongation, stroke, arterial and venous thrombosis were assessed during follow-up.

Results

mean follow-up was 7 months for anti-BRAF and 13 months for TKI. Neither cardiovascular adverse events nor significant reductions in LVEF or other echocardiographic parameters during follow-up were observed in Group A: we did not observe significant changes in GLS (-18,4 [RI -19,9 a -15,8] vs. -18,3 [RI -18,9 a -16,1] or in vascular parameters (PWV 7,3 ± 1,4 vs. 6,7 ± 1,5, β mean wave 8,5 [RI 6,3-12] vs. 7,4 [RI 4,9-9,4]; α mean wave 6,8 [RI 3,1-6,2] vs. 9,6 [RI 2,4-4,6]). As regards Group B, new onset of arterial hypertension in 35% of population but no significant changes in LVEF or other echocardiographic parameters including GLS ( -18,6 ± 2,3 vs. -18,3 ± 3,3) were observed. Significant changes were furthermore found in vascular parameters with increased arterial stiffness during follow-up (PWV 7,82 ± 1,23 vs. 10,02 ± 2,73; p = 0,04, β mean wave 5,33 ± 1,98 vs. 8,43 ± 3,03; p = 0,02, α mean wave 10,79 ± 4,03 vs.16,82 ± 6,38; p = 0,03).

Conclusions

according to the literature data, immunotherapy seems to have a safe cardiovascular profile. Anti-VEGF drugs seem to predominantly cause vascular damage, early identifiable through arterial stiffness measurement.
P866 Mitraaortic intervalvular fibrosa pseudoaneurysm with aortic paravalvular regurgitation in a marfan-like syndrome patient diagnosed with multimodality imaging
Authors: Ozden Tok O , Abdelnabi M , Almaghraby A , Bingol G , Bakan S , Guden M , Goktekin O
Published: January 2020

Introduction

The fibrous area. between the mitral and aortic valves described as the mitral-aortic intervalvular fibrosa (MAIF). The MAIF can be damaged by endocarditis, degenerative calcification or mitral and aortic valve surgery . Damage caused by replacement of the aortic valve can lead to the formation of pseudoaneurysms (MAIF) or other complications

Case

A 64-year-old male admitted to our outpatient department with complaints of dyspnea fatique and atypical chest pain. He has Marfan like syndrome and had a history of mechanical aortic valve replacement 16 years ago and upon dysfunciton of the prosthetic valve and significant ascending aorta aneurysm he had undergone a second Bentall operation 6 years after the first operation.

We performed a transthoracic echocardiography and a transesophageal echocariography to clarify the underlying pathology. Transesophageal echocardiography revealed a moderate to severe paravalvular regurgitation, a mitraaortic intervalvular fibrosa pseudoaneurysm and a functional moderate-severe mitral regurgitation. The echocardiographic appearence of MAIF pseudoaneurysm cavity demontrates marked pulsatilty with systolic expansion and diastolic collapse.

In order to show the pathology truly and exclude a coronary artery disease, we decided to perform a cardiac CT (CCT). Cardiac CT confirmed mitraaortic intervalvular fibrosa pseudoaneurysm and paravalvular defect clearly with patent coronary arteries.

After our heart team meeting, we decided to give the patient to the cardiovascular surgery for the complete treatment of aortic valve, pseudoaneurysm and mitral valve. The patient underwent his 3rd surgery succesfully with a new bioprosthetic aortic valve replacement, repair of the pseudoaneurysm and mitral valve and his potoperative course was uneventful.

Conclusion

Combination of MAIVF pseudoaneurysm and paravalvular leak together in a connective tissue disorder patient is quite rare. TEE is more sensitive than TTE in accurately predicting this complication but to combine TOE with cardiac CT facilitates the diagnosis and gives a more accurate anatomic description of the defects to cardiologists and cardiovascular surgeons which is very helpful in terms of orientation.

Abstract P866 Figure. 2D,3D TOE and CCT images of MAFP and PVL
P876 I may still steal you : huge coronary cameral fistula (non-dominant right coronary artery to right ventricle) in a neonate causing heart failure
Authors: Naganur S
Published: January 2020

Funding Acknowledgements

Not applicable

OnBehalf

Not applicable

A 25 days old neonate, weighing 2.8kg was brought with complaints of feeding difficulties, not gaining birth weight and rapid breathing. The parents had not noticed any cyanosis. He was further referred to us as the treating paediatrician heard a pansystolic murmur over the left sternal border.

When examined, baby was afebrile, tachypnoea (70 per minute), regularly tachycardia(180bpm). We did not appreciate any dysmorphism. On cardiovascular examination we found a mild cardiomegaly, RV S3, mild hepatomegaly with no signs of active infection. Systemic saturations were 98% in all limbs. Other systemic examinations were essentially normal.

12 lead ECG showed, physiological RV dominance, with no signs of LV volume overload.

Chest radiograph showed cardiomegaly of RV type with adequate PBF.

2 D echocardiogram : The intra-cardiac structures were found to be normal. A huge coronary-cameral fistula originating from RCA, traversing in right AV groove and draining into the RV with mild RV enlargement. No signs of PAH. Biventricular function was preserved.

CT coronary angiogram : CT confirmed the presence and anatomy of the RCA—RV fistulous tract seen on echocardiography. The fistula measured ∼ 6mm at the origin and 3.5mm at the point of entry into RV. As we could not see any PDA arising from RCA and a twig from LCX traversing in interventricular groove, we thought it’s a left dominant coronary circulation.

Hemodynamics in the index case

The symptoms of heart failure in the index neonate is due to the volume overload on the RV. The non-dominance of RCA is probably a blessing in disguise for this baby in preventing coronary steal. The "steal phenomenon" will be apparent once the physiological (high) PVR comes down.

Plan

Baby is on diuretics and nutritional support, under weekly follow up. We will be performing catheter study (around 12 weeks of life or as per clinical indications) to look for dominance and need/feasibility of device closure.

Abstract P876 Figure.
P886 Shoots from the whip: catheter tip migration and tromboembolic comlications of ventriculoatrial shunt for hydrocephalus in von Hippel Lindau disease - multimodality findings
Authors: Gosciniak P , Larysz B , Kurzyna M
Published: January 2020

We report a rare nowadays case of 35 yo patient with von Hippel Lindau (VHL) disease and pulmonary hypertension as a severe complication of ventriculo-atrial (VA) shunt insertion in the treatment of hydrocephalus.

The patient was admitted to our department with signs of heart failure such as large decrease in exercise tolerance, increasing dyspnea, fatigue, ankle swelling manifested since few months.

In the past, the patient was diagnosed with multiple cerebral hemangiomas of the cerebellum and the spinal cord and increased intracranial pressure due to obstructive hydrocephalus as a sequel to a mass effect from haemangioblastoma. He underwent surgery of the posterior cranial cavity tumor and ventriculo-atrial shunting.

Electrocardiogram showed sinus tachycardia, right axis deviation, and right ventricle hypertrophy.

Particular transthoracic and 3D transesophageal echocardiography showed enlarged right chambers with right overload (A) and severe tricuspid regurgitation (B) with pulmonary hypertension. The distal end of the VA shunt was seen in the right atrium (C). The tip was migrating in some cycles of the heart into the right ventricle inflow tract (D). It moved like a cracking whip and was knocking against the tricuspid leaflets.

A pulmonary scan (230 MBq of the Tc99m intravenously) was then undertaken to confirm the presence of the pulmonary embolism and showed in both lungs numerous segmental and subsegmental perfusion deficits.

Multidetector CT pulmonary angiogram revealed marked mosaic attenuation in bilateral lung fields as well as abridgment of subsegmental pulmonary arteries (E).

Conventional pulmonary angiography showed on the right side arteries A9 and A10 obstructed, A4 amputated, A6 bifurcation at division into subsegmental branches (F).

All the diagnostic tests confirmed CTEPH and medical therapy, including anticoagulation, was started. Removal of the catheter was planned. After 3 months The patient was qualified for pulmonary artery angioplasty.

In conclusion, however, VA shunts inserted for the treatment of hydrocephalus are known to be a risk factor for pulmonary hypertension the pathogenetic process that causes pulmonary hypertension after shunt insertion is unclear. Therefore routine echocardiography and/or lung scanning is necessary for early diagnosis and treatment.

Abstract P886 FIGURES A-F
P899 Reduced right ventricular longitudinal function in patients with chronic left ventricular disease can be due to left ventricular forward failure and not right ventricular dysfunction
Authors: Fredholm M , Ricksten S E , Karason K , Bartfay S E , Dellgren G , Bech-Hanssen O
Published: January 2020

Background and aim

The occurrence of right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important therapeutic and prognostic consequences. Echocardiography (Echo) parameters describing the RV longitudinal function (tricuspid annular plane systolic excursion, TAPSE; peak systolic free wall longitudinal strain, RV-Str; tricuspid annulus peak systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesised that these parameters are load dependent.

Methods

We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC) and Echo within 48 hours. RHC was performed as part of diagnostic- or pre-transplant work-up. Fifty-six patients (85%) had left ventricular ejection fraction < 40%. From RHC data the patients were divided into three groups: Patients with RV decompensation and increased right atrial pressure (RAP) ≥10 mmHg (iRAP, n = 21), with normal RAP but reduced stroke volume index (SVI < 35 mL/m2) (rSVI, n = 21) and with normal RAP and normal SVI (nSVI, n = 24).

Results

Patients with iRAP had compared with rSVI/nSVI more advanced LHD with higher PAMP, PCWP and larger RV diastolic area (RVdA). TAPSE, RV-Str and FAC did not differ between iRAP and rSVI patients. The ratio RVdA/RV-Str was significantly higher in iRAP patients compared with rSVI and nSVI. The rSVI and nSVI patients did not differ regarding RAP response during supine exercise (P = 0.84).

Conclusions

Reduced RV longitudinal function in patients with chronic LHD and normal RAP can be due to left ventricular forward failure and not RV systolic dysfunction.

iRAP (n = 21) rSVI (n = 21) nSVI (n = 24) Overall P-value iRAP vs rSVI iRAP vs nSVI rSVI vs nSVI RAP (mmHg) 13 ± 2 5 ± 3 4 ± 2 <0.001 <0.001 <0.001 0.34 PAMP (mmHg) 33 ± 8 24 ± 8 22±] <0.001 0.001 <0.001 0.34 PCWP (mmHg) 22 ± 5 16 ± 8 11 ± 6 <0.001 0.003 <0.001 0.025 CI (l/min/m2) 2.2 ± 0.4 2.2 ± 0.4 2.8 ± 0.5 <0.001 0.75 <0.001 <0.001 PVR (Wood unit) 2.6 ± 1.2 1.5 ± 1.6 1.9 ± 1.0 0.032 0.022 0.035 0.60 RVdA (cm2) 26 ± 7 21 ± 7 21 ± 5 0.012 0.007 0.017 0.63 TAPSE (mm) 12 ± 3 13 ± 3 18 ± 6 <0.001 0.28 <0.001 0.001 TAPSm (cm/s) 8 ± 2 8 ± 2 10 ± 4 0.06 - - - RV-str (%) -15 ± 5 -17 ± 5 -21 ± 6 0.002 0.11 0.001 0.028 FAC (%) 28 ± 9 29 ± 11 39 ± 11 <0.001 0.72 0.001 0.003 RVdA/RV-str (cm2/%) 2.2 ± 1.3 1.3 ± 0.7 1.1 ± 0.6 <0.001 0.013 0.001 0.27
P906 Are all severe Tricuspid Regurgitation the same?
Authors: Vieitez Florez J M , Monteagudo J M , Mahia P , Perez L , Lopez T , Marco I , Carrasco F , Adeba A , De La Hera J M , Hinojar R , Fernandez-Golfin C , Zamorano J L
Published: January 2020

Introduction

Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, both clinical profile of the patients as well as right chambers morphologic and functional changes have not been described compared to the severe TR patients.

Methods

Consecutive patients undergoing an echocardiographic study in 9 Spanish hospitals within a three-month period with at least moderate TR were prospectively included. All studies with severe TR were selected for analysis. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR severity grades was performed according to Hanh & Zamorano new published classification. Two cohorts were made: patients with severe TR and patients with massive or torrential TR.

Results

A total of 644 patients with severe or bigger TR were analysed. Severe TR was present in 540 (84%), massive was present in 83 (13%) and torrential in 21 (3%) Baseline characteristics of the study population are shown in table 1.

No differences were found in NYHA class or atrial fibrillation incidence between groups. Pacemaker was more frequent in massive/torrential group (30% vs 19%; 0,014).

Patients with massive/torrential TR presented worst RV remodelling data:

-RV was dilated (RV telediastolic basal diameter >42mm) in 84.2% of patients with massive/torrential TR vs 57% of patients with severe TR (p < 0.001).

-Right atrium was bigger in patients with massive/torrential TR (21 ± 0.8 cm2/m2 vs 17.2 ± 0,3 cm2/m2; p < 0.001)

-Tricuspid annulus diameter was bigger between massive/torrential TR patients (26.7 ± 0.6 cm/m2 vs 23.6 ± 0.3 cm/m2; p > 0.001).

No significant differences in prevalence of RV function (TAPSE < 17 mm) were noted 39% vs 33%, p = 0,273.

Conclusions

In this large multicentre cohort of patients, the presence of massive/torrential TR seems to be associated with a differential RV and RA remodelling, reflecting the greater volume overload seen in these patients. Further studies are needed to define prognosis implication of our findings and its role in clinical decision making.

Table 1 Variable Severe (n = 540) Massive/Torrential (n = 104) Body mass index 26,6 (±0,3) 26.4(±0,6) 0.350 Woman 336 (62%) 69 (66%) 0.438 Atrial firilation 298(55%) 61(59%) 0.514 Age (years) 76,5 (±0,5) 77,5(±1,1) 0.209
P923 Ultrasound follow-up of left atrial appendage occlusion devices
Authors: Molinero D , Cabeza P , Hernandez N , Delgado W , Silva E
Published: January 2020

Background

Left atrial appendage (LAA) occlusion devices represent an important alternative to anticoagulation in patients with atrial fibrillation (AF) with high risk of bleeding and who have suffered any hemorrhagic event. At first, a transesophageal ultrasound is performed to examine cardiac cavities, take measures of LAA and discharge the presence of thrombi. We redo a new transesophageal ultrasound as a control three months later after having installed the device. The purpose of this article is to show our experience in ultrasound follow up of LAA occlusion.

Methodology

All measures of LAA were taken with the transoesophageal ultrasound device by the same operator. According to the size acquired from the appendage of each patient, they were divided into a first group with the implementation of the Watchman device (23 patients) and Amplatzer (6 patients). A transthoracic echocardiography control was performed on each patient to rule out the presence of complications after the intervention, before to be discharged from hospital. After three months, a new transoesophageal study was repeated to assess the correct position of the device and to rule out the presence of any disfunctions or clot formation.

Results

A total of 29 patients with AF (CHADSVASC 4.09 HASBLED 2.96) with a high risk of bleeding and after having suffered any complications (41% brain bleeding, 31% major gastrointestinal bleeding, 27% advanced chronic kidney disease) were presented for the implantation of a LAA closure device. Firstly, LAA size was confirm and the presence of a thrombi was rule out. No patient suffered complications during the procedure that was confirmed with transthoracic echocardiography (discharging the presence of perforation, pericardial effusion or tamponade). At three months later, we performed a new transoesophageal as a control for the assessment of the place and presence of GAPs, if any (80% correct-placed, 15% placed with a gap of 2-4 mm with passage of flow throughout). In a 10-month follow-up, it was found that practically 93% of patients were still without anticoagulation, except two patients, one of them (CHADSVASC 4 HASBLED 2) had to reintroduce oral anticoagulation due to the fact of the clot formation on the device. The second one (CHADSVASC 4 HASBLED 2) had to reintroduce temporarily fractionated heparin due to stent thrombosis in the femoral artery. None of them presented any ischemic complications or new haemorrhagic events.

Conclusions

LAA occlusion devices are an effective and safe alternative to anticoagulation in patients with atrial fibrillation with predisposition to bleeding where ultrasound techniques play an essential role in all stages of procedure (prior to implantation of the device, during and at the follow-up).
P925 An analysis of the impact of etiology vs. impact of hemodynamic variables on the right ventricular free wall deformation in patients with pulmonary hypertension
Authors: Ojrzynska N , Kowalik E , Kowalski M , Klisiewicz A , Demkow M , Witkowski A , Grzybowski J
Published: January 2020

Purpose

Pulmonary hypertension (PH) is a deadly disease leading to right ventricular (RV) failure. The aim of this study was to establish whether aetiology of PH has a greater impact on RV longitudinal deformation than cardiac catherization parameters.

Methods

We retrospectively analyzed echocardiographic studies and cardiac catherization parameters of 25 patients with pulmonary hypertension : 13 pts with precapillary PH associated with atrial/ventricular septum defect and 12 pts with postcapillary PH due to dilated cardiomyopathy. We measured regional strain and regional systolic and diastolic strain rates (SR) in right ventricular free wall in basal, mid and apical segments.

Results

Aside from TAPSE, echocardiographic parameters indicate no difference. Even though mean pulmonary arterial pressure and pulmonary vascular residence significantly higher in patients with precapillary PH, strain was significantly decreased in patients with postcapillary PH. Statistically significant differences were observed between pre- and postcapillary PH patients" strain in apical and mid myocardial segments. Early diastolic strain rate (SR) in apical RV segment in precapillary PH patients was significantly higher than in patients with postcapillary PH. In other myocardial segments there were no differences between systolic, early diastolic and late diastolic SR.

Conclusion

Our study suggests that RV free wall strain in patients with PH moderately correlate with aetiology of PH. We did not find correlation between higher RA pressure or PVR and worsening of RV function in PH of different aetiologies.

Precapillary PH Postcapillary PH p value PA mean pressure (mmHG) 75,2 ± 17,7 42,0 ± 7,3 <0,05 PWR (WU) 15,8 ± 6,7 4,7 ± 2,6 <0,05 RV wall thickenss (mm) 11,0 ± 2,5 5,5 ± 1,0 NS RVIT (mm) 42,7 ± 10,4 42,8 ± 8,1 NS TAPSE (mm) 19,2 ± 4,2 15,6 ± 4,9 <0,05 S" 10,8 ± 2,0 9,4 ± 2,1 NS basal segment strain -16 ± 7 -17 ± 5 NS mid segment strain -18 ± 8 -15 ± 4 <0,05 apical segment strain -19 ± 8 -14 ± 4 <0,05
P937 Left atrial longitudinal strain as a marker of acute cellular rejection in heart transplant recipients: impact of intervendor variability
Authors: Carnero Montoro L , Ruiz Ortiz M , Rodriguez Diego S , Delgado Ortega M , Rodriguez Almodovar A M , Paredes Hurtado N , Oneto Fernandez M J , Luque Moreno A , Gonzalez Manzanares R , Pericet Rodriguez C , Fernandez Ruiz A , Arizon Del Prado J M , Lopez Granados A , Pan Alvarez-Ossorio M , Mesa Rubio M D
Published: January 2020

Introduction and purpose

Preliminary reports suggests that left atrial longitudinal strain (LALS) variables are a sensitive marker of acute cellular rejection (ACR) in heart transplant recipients (HTxR), discriminating between those studies without rejection and those with any grade of rejection. Intervendor variability is a concern in the widespread use of this technique. Our objective was to compare the LALS evaluated by two different softwares.

Methods

From September 2014 to October 2016 we performed, in 18 consecutive adult HTxR in their first year posttransplantation, serial echocardiographic exams within 3 hours of the routine surveillance endomyocardial biopsies (EMB), in a single centre. Peak average longitudinal strain, and strain rate were measured in the left atrium in the apical four chambers view in all studies, using both softwares, its association with the presence of ACR was investigated, and intervendor variability was evaluated.

Results

a total of 147 pairs of EMB and echo exams were performed, 65 with no rejection (grade 0R), 82 with any grade of ejection (grades 1R and 2R). Intraclass correlation coeficients for intervendor reproducibility for LALS and LALSR were 0.4 (95%CI 0.26 - 0.57) and 0.3 (95%CI -0.06 - 0.52) respectively. The number of segments evaluable by each software was significantly different. Association of LALS with rejection is shown in the table.

Conclusions

In this monocentric prospective study, left atrial longitudinal strain variables were found to be a sensitive marker of acute cellular rejection in heart transplant recipients. Although intervendor reproducibility was poor, these results were consistent between both software.

Results Software n/N (%)* Variable No ACR ACR≥1 p value Siemens 114/147 (77.5) Peak atrial LS 19.4 ± 7.4 15.5 ± 6.3 0.006 114/147 (77.5) Peak atrial LSR 1.5 ± 0.4 1.3 ± 0.5 0.005 TomTec 131/147 (89.1) Peak atrial LS 19.1 ± 6.2 14.1 ± 5.4 <0.005 131/147 (89.1) Peal atrial LSR 1.0 ± 0.4 0.8 ± 0.3 <0.005 n: number of exams evaluable by each software. N: total numbers of exams. *p = 0.01 for comparison between the proportion of exams evaluable by each software.
P941 Evaluation of right ventricular contractile reserve with exercise stress echocardiography
Authors: Missana A , Azzolini Jacquin M , David C , Baudouy D , Sartre B , Sanfiorenzo C , Wehrlin C , Sermesant M , Ferrari E , Moceri P
Published: January 2020

INTRODUCTION

Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls.

METHODS

We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary TVI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients.

RESULTS

Our patient group was composed by PAH patients, 61.5 ± 14.8 years; mean age of our control group was 29.33 ± 5.5 years. PAH patients achieved an exercise with a mean workload of 69.17 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (p = 0.17), whereas change in pulmonary TVI, pulmonary output and RV peak systolic strain was highly discriminant (respectively p = 0.03, p = 0.009 and p = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (p = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (p = 0.005, p= 0.0008, p = 0004).

CONCLUSION

Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve.

echocardiographic parameters PAH (n = 12) Healthy Controls (n = 12) p value sPAP at rest (mmHg) 40.91 ± 10.7 15.42 ± 4.1 <0.001 sPAP at peak (mmHg) 82.50 ± 21.7 42.50 ± 17.8 <0.001 TAPSE at rest/sPAP at rest (mm/mmHg) 0.62 ± 0.2 1.72 ± 0.6 <0.001 TAPSE at peak /sPAP at peak 0.36 ± 0.1 0.80 ± 0.2 <0.001 ΔStrain (%) 3.43 ± 3.1 8.08 ± 2.8 <0.001 Δ(peak Strain/sPAP) -0.17 ± 0.2 -0.77 ± 0.4 <0.001 Δpulmonary TVI (cm) 3.88 ± 4.0 7.46 ± 3.5 0.03 Δ(RVEF/sPAP) -0.34 ± 0.4 -2.06 ± 1.7 <0.001

Abstract P941 Figure. echography (rest/peak) PAH patient
P946 Right atrial volumetric and functional analysis by three-dimensional speckle-tracking echocardiography in acromegaly
Authors: Kormanyos A , Kalapos A , Domsik P , Gyenes N , Ambrus N , Valkusz Z , Lengyel C , Forster T , Nemes A
Published: January 2020

Introduction

Acromegaly is a chronic, rare hormonal disease associated with major cardiovascular comorbidities. The disease, in the majority of the cases, is caused by a benign human growth hormone secreting adenoma. Cardiovascular involvement is especially common in acromegaly patients from the most common hypertension to cardiomyopathy. It was set out to quantify right atrial (RA) morphology and function in a group of acromegaly patients using three-dimensional (3D) speckle-tracking echocardiography (3DSTE).

Methods

The study comprised 30 patients from which 8 patients were excluded due to inadequate image quality. Mean age of the remaining acromegaly patients were 53.7 ± 14.5 years (7 males). Ten patients were in active phase, while 12 subjects had inactive acromegaly. In the control group 40 healthy adults were enrolled (mean age: 52.3 ± 8.2 years, 15 males). In each case, complete two-dimensional Doppler echocardiography was performed followed by 3DSTE.

Results

Maximum (54.5 ± 14.4 ml vs. 47.2 ± 11.6 ml, p <0.05) and minimum (35.5 ± 10.2 ml vs. 29.2 ± 9.1 ml, p <0.05) RA volumes and RA volume before atrial contraction (45.1 ± 11.1 ml vs. 38.2 ± 10.3 ml, p <0.05) were significantly higher in case of acromegaly compared to the healthy controls. Both global and mean segmental peak 3D strain (-11.94 ± 7.52% vs. -8.07 ± 5.03%, p <0.05 and -17.16 ± 6.13% vs. -13.78 ± 5.35%, p <0.05) were higher in the acromegaly group compared to the controls. At atrial contraction, mean segmental radial strain (-13.22 ± 6.45% vs. -9.74 ± 4.58%, p <0.05) was significantly higher and mean segmental 3D strain (-9.78 ± 5.44% vs. -13.78 ± 5.35%, p <0.05) was significantly lower in the acromegaly group compared to the controls. Between the active and inactive group of acromegaly patients, mean segmental longitudinal strain (28.17 ± 4.89% vs. 35.34 ± 9.75%, p <0.05) was significantly different. Numerous independent strain parameters had significant correlations with different hormonal variables in the active acromegaly group. These correlations were not present in the inactive acromegaly subgroup.

Conclusion

Acromegaly is associated with significant RA volumetric and functional abnormalities.
P958 Back to basis? Feasibility of standard and novel echocardiographic measurements after breast cancer surgery
Authors: Orstad E , Steine K , Nerdrum T
Published: January 2020

Background

It is recommended that breast cancer patients should undergo cardiac follow-up during chemotherapy, with clinical assessment and echocardiogram. Standard measurements are robust and reproducible, but novel echocardiography methods as global longitudinal strain (GLS) and three-dimensional (3D) echocardiography are recommended due to their superior sensitivity. These methods require high-quality images. Breast cancer surgery may lead to reduced echocardiographic image quality in this population, in addition to age, obesity and smoking.

Purpose

We wanted to explore the feasibility of standard and novel echo methods in an unselected breast cancer population.

Methods

The present study included consecutive, unselected patients referred to baseline echocardiogram at the cardio oncology outpatient clinic in a large university hospital prior to start of adjuvant chemotherapy. Data on surgery, smoking habits, age and body mass index were collected. Feasibility was defined as the presence or absence to carry out meaningful measurements of left ventricular (LV) systolic function, from standard mitral annular plane systolic excursion (MAPSE) and two-dimensional LV ejection fraction (EF), to novel GLS and 3D LVEF. Multivariable logistic regression was performed to assess the impact of relevant variables on image quality.

Results

116 female patients were included. 21 % of these patients had insufficient images for novel analyses. Left sided breast implant (OR 5,77; P 0,04), age (OR 3,89; P 0,02) and daily smoking (OR 3,57; P 0,03) were found to be independently associated with insufficient image quality. Standard analyses like two-dimensional EF and MAPSE were obtainable in 99 and 97 % of the examinations, respectively.

Conclusion

One of five in a postoperative breast cancer population cannot undergo follow-up using novel, sensitive echocardiographic measurements. Standard measurements, however, are obtainable in almost all patients. It is therefore important that these measurements are included in cardiac follow-up during chemotherapy.
P961 Diagnostic use of proportion between ascending aorta and left atrium in patients referred for coronary artery calcium scoring
Authors: Sosnowski M , Czekaj A , Mlynarski R , Chromik K , Tendera M , Wojakowski W
Published: January 2020

Background

Non-contrast-enhanced cardiac computed tomography (NCE-CCT) is currently used for coronary artery calcium (CAC) scoring. Meanwhile, other cardiac, vascular and extra-cardiac structures can be evaluated. Data about ascending aorta (AA) and left atrium (LA) has been quantified separately in a few studies. Their mutual proportion has not been examined, as yet.

Aim. We hypothesize that mutual proportion between AA and LA size might help for diagnosing their enlargement before absolute cut-off values are reached.

Method

Among 7950 patients who had NCE-CCT with a 64 raw scanner (Aquillion, Toshiba) within the last decade in our center, in 797 persons the AA diameter (at the level of pulmonary artery bifurcation) and LA diameter and area (highest value) were measured. Raw AAD values were qualified as abnormal if exceeded upper normal limit UNL) for age and height. Weight, BMI and BSA has not been used in order to avoid falsified results in obese patients. The ratio AAD:LAD was quantified as low (<0.8), normal (0.8-1.2) and high (>1.2).

Results

There were 45 patients (5.6%) who had AAD higher than age-height predicted UNL, including 24 patients with a raw AAD >43mm (3.0%). The other 752 has their AAD within limits. The means of AAD were 42.9 ± 3.2mm and 33.6 ± 3.6mm (p < 0.001). LA size differed significantly, both in diameters 38.5 ± 7.4 vs 34.2 ± 5.6mm (p < 0.001) and areas 2138 ± 593 vs 1837 ± 481 mm2 (p < 0.001). Data regarding mutual relationship are shown in the fig.1. It is seen that normal mutual proportion (AOLARel =1) in patients with high AAD means that LAD was also increased (left graph, red open square). In 603 patients with normal AAD corresponded with normal LAD. The AAD:LAD >1.2 in 845 subjects might suggest increased AAD in spite to normal raw diameter. Similar rules were found in respect to the LA area.

Conclusions

Ascending aorta and left atrium enlargement are infrequently recognized in patients referred to CAC scoring. Mutual proportion between AA and LA size might complement diagnostic approach of their abnormalities.
P969 Functional classification of extrasystolic arrhythmia
Authors: Germanova O , Germanov A
Published: January 2020

Introduction

Exstrasystoles" classifications mostly are based on ectopic centers localization and frequency per time. These classifications are not focus on the functional importance of extrasystolic and first post-extrasystolic reductions.

Aim. To make functional classification of extrasystoles based on hemodynamics and kinetics of main arteries.

Methods

233 patients were observed with supraventricular and ventricular extrasystoles, which appeared in the phase of isovolumic decrease of intraventricular pressure before the mitral valve opening and in fast or slow ventricules filling phase in cardiocycle. We performed doppler - ultrasound of carotid, radial, ulnaris, posterior tibia, arch of foot arteries and sphygmograms of these arteries. The volume of cardiac output and transmitral blood flow were measured by echocardiography. To know the moment of extrasystoles appearance in cardio cycle and ectopic center localization we used apex-cardiography and electrocardiography. We determined the parameters of heart biomechanics and main arteries kinetics: speed, acceleration, capacity and work in each phase of heart cycle in systole and diastole, and also the periods of dominance of outflow over inflow. We analyzed the peak speed direct blood flow, blood flow volume.

Results

The increasing of main parameters (speed, acceleration, capacity and work) was observed in first-extrasystolic contraction with the tendency: if earlier extrasystole appeared in cardiocycle than more changes were observed. We can quantitatively characterize different types of extrasystoles which are principally different in the degree of participation of resulting blood flow. We measured the contribution of extrasystolic and first post-extrasystolic reduction. So we classified extrasystoles due to its functional importance:

1. Exstrasystoles before the mitral valve opening.

2. Exstrasystoles in phase of fast ventricules filling before the peak of transmitral blood flow.

3. Exstrasystoles in phase of fast ventricules filling after the peak of transmitral blood flow.

4. Exstrasystoles in slow ventricules filling phase.

5. Coupled and group extrasystoles.

Conclusion

The main important thing for hemodynamic measuring is the moment of extrasystoles’ appearance in cardiocycle and the ability of the first post-exstrasystolic reduction to reestablish an adequate resulting blood flow. The treatment and cupping of extrasystoles is determined by the degree of hemodinamic disturbance in each variant of arrhythmia. The most changes of blood flow are with extrasystoles before the mitral valve opening. The first poist-extrasystolic reduction causes the significant increase of cardiac output, arteries diameter and non-stability of atheromas.
P980 RV longitudinal dysfunction predicts outcomes in anterior ST elevation myocardial infarction treated by primary PCI
Authors: Zamfir D , Onciul S , Scarlatescu A , Guzu C , Pascal A , Cojocaru I , Stoian M , Petre I , Iancovici S , Bataila V , Dorobantu M
Published: January 2020

Funding Acknowledgements

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

Background

The prognostic value of LV function in the setting of an acute ST elevation myocardial infarction (STEMI) is well established, but data regarding the association between RV function and adverse events in this population of patients are still scarce, especially for the cases with anterior wall localization of necrosis. Two-dimensional speckle tracking echocardiography (STE) is able to detect subclinical changes in local or regional RV function.

AIMS

To evaluate the relation between STE parameters of RV global and regional function recorded 24 hours after admission and the occurrence of major non-fatal cardiovascular adverse events (MACE) in anterior STEMI patients treated by primary percutaneous intervention (PCI)

Methods

We have prospectively analyzed a cohort of 80 consecutive patients (mean age 61.17 years, 68.8% males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary disease were excluded. All patients underwent conventional echocardiography and STE, 24 hours after the index event. RV strain was assessed as RV free wall strain (RVFWS) representing the average of peak strain values encountered in three segments of the RV free wall and RV global longitudinal strain (RVGLS) obtained by averaging peak strain values in six segments including RV free wall and interventricular septum . The mean follow-up duration was 8.2 ± 0.69 months.The combined endpoint of non fatal MACE was defined as recurrent myocardial infarction, need for repeat revascularization, hospitalization for heart failure or stroke.

Results

In the study population 45 patients (56%) had the culprit lesion on the anterior descendent artery. In this group we observed that RVGLS was predictive for non fatal MACE independent of LVEF or extension of necrosis expressed by wall motion score index with OR 0.89 95 % CI 0.7-0.9, p = 0.042, with a ROC curve with a sensitivity 73% and specificity 53%, AUC =0.7. In addition, in anterior STEMI complicated by LVEF <40 % , a RVFWS absolute value lower than -14.3 % has proved to be an additional parameter of negative prognosis with a sensitivity of 91 %, and a specificity of 40% (AUC 0.68, CI 95%: 0.3-0.7)

Conclusions

In anterior STEMI patients treated by primary PCI, global RV longitudinal dysfunction assessed by STE early after the index event is predictive for non fatal MACE independently of LV function or the infarct size. In addition, RV regional longitudinal dysfunction provides incremental prognostic information in patients with anterior STEMI with moderate or severe LV systolic dysfunction. These data highlight the importance of the assessment of subclinical RV dysfunction in this setting.
1032 Evaluation viability in patients with ventricular dysfunction by 2D speckle tracking echocardiography: the impact of low dose dobutamine. A meta-analysis of prospective trials
Authors: Ballo H , Doghman F , Saraste A , Knuuti J
Published: January 2020

Background

2D-Speckle tracking echocardiography (2DSTE) has been used for the assessment of myocardial viability in patients with artery disease and left ventricular (LV) dysfunction.

Aim

The purpose of this analysis was to evaluate the diagnostic accuracy of 2DSTE using longitudinal (LS) and rest circumferential strain (CS) in this setting with or without low dose dobutamine (LDD) infusion.

Methods

A systematic review of MEDLINE, Cochrane, and Embase for all the prospective trials using 2DSTE to assess myocardial viability until January 2019 was done. Studies that utilized 2DSTE before coronary revascularisation and used the wall motion evaluation in the long term after the revascularisation as a reference were included. A standard approach of meta-analysis for diagnostic tests and a bivariate analysis of sensitivity, specificity, positive likelihood ratio(+LR), and negative likelihood (-LR) were performed. In addition, direct comparison analysis was done to only studies that compared the tests in the same patients.

Results

A total of 24 studies of 2DSTE evaluating myocardial viability with 1173 patients (mean age 66 years, 72% male, and mean left ventricular ejection fraction was 45%) fulfilled the inclusion criteria. Eight studies used LS, 8 studies used CS, 4 studies used LS with LDD, and 4 studies used CS with LDD. LS and CS with LDD provided higher +LR ( 4.2 and 4, respectively) as well as a best specificity when compared with LS and CS (81% CI: 65- 92% vs 68% CI: 60- 75%, p = 0.04, and 81% CI: 64-91% vs 66% CI: 59-72%, p= 0.02, respectively) for predicting improved segmental LV contractile function after revascularization. The sensitivities of different 2DSTE tests for detection the viability were not statistically different. The direct comparison of the studies with the same patients yielded similar results.

Conclusions

Using LDD with LS and CS analysis significantly improve specificity of the tests. Therefore, the use of a low dose of the dobutamine can be recommended to improve the accuracy of the 2DSTE for detection of viable myocardium following myocardial infarction.

Abstract 1032 Figure. Summary ROC Curves
1041 Early detection of biventricular mechanical dysfunction in PLN R14del mutation carriers
Authors: Taha K , Te Rijdt W P , De Bruin-Bon H A C M , Cramer M J M , Asselbergs F W , Bouma B J , Van Den Berg M P , Teske A J
Published: January 2020

Funding Acknowledgements

PLN Genetic Heart Disease Foundation

Background

Carriers of the phospholamban (PLN) R14del founder mutation may develop an arrhythmogenic and/or dilated cardiomyopathy. Overt disease is preceded by a pre-symptomatic phase of variable length in which structural abnormalities seem to be absent.

Purpose

We aimed to explore echocardiographic characteristics of PLN R14del mutation carriers, particularly in early disease stages.

Methods

We included 120 PLN R14del mutation carriers and classified them to the pre-symptomatic stage (no symptoms and no structural disease, n = 60), the arrhythmic stage (arrhythmic symptoms and left ventricular ejection fraction (LVEF) ≥50%, n = 30) or the structural stage (LVEF <50%, n = 30). We included 60 healthy control subjects who were age- and gender matched with pre-symptomatic mutation carriers. All subjects underwent comprehensive echocardiographic analysis, including deformation imaging.

Results

Values are provided in the abstract table. Patients in the structural stage had significantly impaired left/right ventricular (LV/RV) function and increased LV/RV size when compared to the other mutation carriers (p < 0.001). In the pre-symptomatic and arrhythmic stage, LV function and volumes did not differ significantly from controls by conventional measurements. However, LV global longitudinal strain (GLS) and LV mechanical dispersion (MD) were already significantly impaired in the pre-symptomatic and arrhythmic stage when compared to controls (p < 0.001). RV function by conventional measurements was lower in arrhythmic subjects than in controls (p = 0.016). A strong linear correlation was found between LV GLS and RV GLS (r = 0.8, p < 0.001).

Conclusion

Echocardiographic deformation imaging reveals biventricular mechanical alterations in PLN R14del mutation carriers before arrhythmic symptoms and overt structural disease. Longitudinal studies are needed to determine the incremental prognostic value of these findings.

Control subjects (n = 60) Pre-symptomatic (n = 60) Arrhythmic (n = 30) Strucutral (n = 30) LVEF(%) 60.3 ± 4.2 58.6 ± 4.2 57.1 ± 5.3 38.8 ± 10.6* LVEDV (ml/m2) 54.6 ± 10.0 53.7 ± 9.5 56.1 ± 11.6 70.1 ± 25.8* LV GLS (%) 21.5 ± 1.8 19.5 ± 1.5* 19.1 ± 1.7* 12.7 ± 3.8* LV MD (msec) 24.4 ± 5.9 33.1 ± 9.5* 48.2 ± 13.3* 60.8 ± 17.1* RV FAC (%) 46.4 ± 4.9 44.7 ± 5.0 42.6 ± 7.4* 33.2 ± 8.0* RV GLS (%) 26.5 ± 3.7 24.2 ± 2.9* 22.5 ± 4.2* 15.1 ± 5.7* FAC = Fractional area change; GLS = Global longitudinal strain; LV/RV = Left/right ventricular; LVEDV = Left ventricular end-diastolic volume; LVEF = Left ventricular ejection fraction; MD = Mechanical dispersion. *p < 0.05 when compared to control subjects.

Abstract 1041 Figure. Clinical stages in PLN mutation carriers