bluuebunny/crossref_metadata_2025 huggingface dataset:
P739 Patients with Crohn’s disease with intestinal failure have less active disease than patients with Crohn’s disease without intestinal failure
Authors: Bouri S , Willsmore J , Geldof J , Gabe S , Donnelly S , Hart A
Published: January 2020

Background

Intestinal failure (IF) is an uncommon complication of severe Crohn’s disease (CD) due to extensive or recurrent resections or complications. It is observed that disease activity might remit once IF develops. This is unexpected given the previous disease course. The aim of this study is to compare the number of patients in deep remission with CD–intestinal failure (CD-IF) to CD without IF.

Methods

A single tertiary centre retrospective analysis was performed on CD-IF patients on parenteral nutrition due to short bowel vs. patients with small bowel CD. CD patients were selected from consecutive hospital clinics if they lived in the local catchment area. Deep remission was defined by the lack of objective indicators of inflammation during the year prior to their latest clinic; including imaging, endoscopy and faecal calprotectin.

Results

94 CD-IF and 94 CD patients were included. The proportion of female patients was 56.4% (CD-IF) and 46.8% (CD); mean age was 51.2 (CD-IF) and 41.5 years (CD); mean duration of disease 24 (CD-IF) and 16 years (CD); proportion with a stoma 73.4% (CD-IF) and 7.4% (CD). In the CD-IF group, 80.9% were in deep remission compared with 37.2% in the CD group (p < 0.0001) (Table 1). Medication requirements were higher in the CD group. 45/94 (47.9%) (CD-IF) vs. 27/94 (28.7%) (CD) (p = 0.005) were not on medications Biologics were required by 23/94 (24.5%) (CD-IF) vs. 48/94 (51.1%) (CD) (p = 0.0003). Combination therapy (immunomodulator and a biologic) was required by 6/94 (6.4%) (CD-IF) vs. 26/94 (27.7%) (CD) (p = 0.0003) (Table 2). 17 of the 27 CD patients not on medications were in remission and 10 had active disease (of whom 2 refused treatment, 1 was pregnant and 7 had stable mild disease with no major symptoms). 38 of the 45 CD-IF patients off medications were in remission and 7 had active disease (of whom 2 had surgery, 2 are due to start biologics, 1 died and 2 had stable mild disease).

Conclusion

CD-IF patients were more often in remission than those with CD; they required less medications and less biologics. Plausible reasons for this observation could include that there is less bowel which can inflame; perhaps parenteral nutrition or an altered diet has a protective effect via modulation of the microbiota.
P745 Perianal disease in Crohn’s disease is associated with higher rate of hospitalisation and mortality despite a higher utilisation of biologics: Report from the epiIIRN cohort
Authors: ATIA O , Asayag N , Focht G , Cahan A , Dotan I , Balicer R , Gavish M , Feldman B , Brufman I , Haklai Z , Turner D
Published: January 2020

Background

Perianal disease is a disabling complication of Crohn’s disease (CD). In this study, we aimed to explore the incidence of fistulising perianal CD (PCD) and its association with treatment pattern and disease outcomes, within the validated epiIIRN cohort which includes all IBD patients in Israel (n = 45,074). We also aimed to differentiate simple from complicated PCD.

Methods

The current analysis was performed on data from the two largest Health Maintenance Organisations (HMOs), covering 75% of the Israeli population. First, we developed and validated algorithms to identify fistulising PCD patients and differentiate simple from complex disease, by establishing two reference cohorts of true positive PCD patients (TP, patients with perianal abscess/fistula) classified into simple or complicated PCD, and true negatives (TN) of CD patients without perianal disease (validated by chart reviews). We then applied the algorithms on the complete epiIIRN IBD cohort. Random charts were reviewed to validate again PCD diagnosis.

Results

The chosen algorithm included patients with at least one perianal-related diagnosis, procedure or surgery (sensitivity/specificity 75%/96% for identifying PCD, and 70%/79% for differentiating complicated vs. simple PCD). Of the total 26,440 CD patients, 4237 (16%) had fistulising PCD, of whom 1004 (4% of the total) had complicated PCD. Those with complicated PCD were diagnosed with IBD at a younger age than simple PCD and non-PCD (29.2 ± 13.6 vs. 32.2 ± 16 and 32.8 ± 16.7 years, respectively) (p < 0.001). PCD patients were treated more often with biologics (32% in non-PCD compared with 47% in simple PCD and 70% in complicated PCD, p = 0.01), steroids (74%, 78% and 83%, respectively; p < 0.001) and immunomodulators (56%, 64% and 67%, respectively; p < 0.001). Despite this, PCD patients had more hospitalisations (median 0 (IQR 0–2), 5 (2–11) and 13 (7–22) in non PCD, simple PCD and complicated PCD, respectively, p < 0.001), more colon surgery (5%, 18% and 52% in non PCD, respectively, p < 0.001) and higher mortality compared with CD patients without perianal disease (p < 0.001).

Conclusion

Conclusion: Despite the higher utilisation of immunomodulators and biologics, patients with PCD are at higher risk of hospitalisation and surgical resection, higher need for steroids and higher mortality. PCD is a strong predictor of disease course and thus should prompt early intensified treatment and close monitoring.

This study was supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.
P763 Epstein–Barr virus serological status in paediatric patients with inflammatory bowel disease
Authors: Feo-Ortega S , Pujol Muncunill G , Minguez-Rodríguez B , Álvarez-Carnero L , Guevara-Caviedes L N , Coronel-Arismendi M B , Vila-Miravet V , Martin De Carpi F J
Published: January 2020

Background

The impact of Epstein–Barr virus (EBV) infection on the clinical outcomes of children and adolescents with inflammatory bowel disease (IBD) is not well known. The aim of the study is to evaluate the seroprevalence, seroconversion rate and complications associated with EBV infection in a cohort of paediatric IBD (PIBD) patients at a tertiary care hospital.

Methods

A descriptive study was performed collecting demographic, clinical and treatment data from medical records as well as EBV serological status of paediatric IBD patients from 2012 to 2018. In seronegative patients, seroconversion rate was evaluated. Complications associated with primary EBV infection were described. Since September 2016, EBV serology was included into the initial work-up for PIBD patients. For those patients who did not have EBV study at IBD onset, it was performed during follow-up.

Results

A total of 307 patients with PIBD were diagnosed between 2012 and 2018. EBV status was available for 131 patients (43%). Of those, 57% had Crohn’s Disease, 41% Ulcerative Colitis, and 2% IBD unclassified (66% males; median age at IBD diagnosis: 13.2 years (IQR: 0.8–17.8)). In 102 patients serological EBV status was determined at IBD onset; while in 17 patients it was performed during the follow-up. Overall, EBV seroprevalence was 67%, and no differences were observed regarding age (over or under 10 years-old). EBV seroprevalence was higher in females than in males (80% vs. 60.5%, p = 0.02). Regarding IBD treatment, 84% had received immunosuppressive treatment [thiopurines (32%), anti-TNF (9%) and combined treatment (59%)], without differences in the seroprevalence rate according to the treatment modality. Forty-three patients were seronegative, and 12 of them had a second determination during follow-up. Overall, 5 patients showed seroconversion (42%) after a mean follow-up of 24 months (IQR: 22–26). All these patients had received treatment with thiopurines: 2 patients presented symptomatic mononucleosis with neutropenia, requiring hospital admission and withdrawal of immunosuppressive treatment and 3 patients had asymptomatic primary infection.

Conclusion

EBV seroprevalence in our paediatric IBD cohort is similar as previously described in the literature. EBV status study in patients with IBD, especially prior to initiation of thiopurines, may be useful to plan subsequent follow-up since a non-negligible percentage of them could present with complicactions of primary EBV infection under immunosuppressive treatment.
P767 Prevalence and incidence rates of inflammatory bowel disease among First Nations: Population-based evidence from Saskatchewan, Canada
Authors: Peña-Sánchez J N , Jennings D , Osei J A , Andkhoie M , Brass C , Bukassa Kazadi G , Fowler S , Johnson-Jennings M , Lu X , Marques Santos J D , Porter L , Porter R , Quintin C L , Sanderson R , Teucher U
Published: January 2020

Background

Worldwide, the epidemiology of inflammatory bowel disease (IBD) has been widely studied in the general population; however, there is limited-to-no evidence about IBD among Indigenous peoples, specifically among First Nations (FNs). Saskatchewan (SK) is a province in western Canada with a population of 1.1 million, 11% of whom are FNs. We aimed to estimate the prevalence, incidence, and trends of IBD among FNs in SK since 1999.

Methods

As part of a patient-oriented research project, we conducted a retrospective population-based study between 1999 and 2016 fiscal years using administrative data for the province of SK. A previously validated algorithm that required multiple health care contacts was applied to identify IBD cases (Crohn’s disease [CD] and ulcerative colitis [UC]). The ‘self-declared FN status’ variable in the Person Health Registration System was used to determine FNs meeting the IBD case definition and the population at risk. Generalised linear models (GLMs) with generalised estimated equations and a negative binomial distribution were used to estimate the annual prevalence of IBD, CD, and UC. Incidence rates and their corresponding 95% confidence intervals (95%CI) were estimated using GLMs with a negative binomial distribution. The GLMs were used to test trends overtime.

Results

The annual prevalence of IBD among FNs in SK increased from 64 (95%CI 62–66) per 100,000 people in 1999 to 142 (95%CI 140–144) per 100,000 population in 2016. Also, the prevalence of CD and UC increased during the study period, with 53/100,000 (95%CI 52–55) for CD and 87/100,000 (95%CI 86–89) for UC in 2016. The average increase in the prevalence of IBD was 4.2% (95%CI 3.2–5.2) per year, with similar trends observed in CD (4.1% [95%CI 3.3–4.9]) and UC (3.4% [95%CI 2.3–4.6]). The incidence rates of IBD among FNs were 11 (95%CI 5–25) per 100,000 people in 1999 and 3 (95%CI 1–11) per 100,000 population in 2016. No statistically significant changes were observed in the incidence rates over time (p = 0.09).

Conclusion

This study is the first epidemiological work providing detailed evidence of IBD among FNs. We identified that FNs have increasing trends in the prevalence of IBD, which has also been described in the Canadian general population. In contrast to the general population of Canada and other developed countries that have shown decreasing trends, the incidence rates of IBD among FNs appear to be stable over time. Also, among FNs, UC appears to be more prevalent than CD; this pattern has been observed in the general populations of developing countries. These results illuminate the need to advocate for better health care and wellness for FNs living with IBD.
P782 Immune status to viral infectious diseases and associated factors in Korean patients with inflammatory bowel diseases
Authors: Hong H S , Jung J , Park S H , Noh S M , Oh E H , Kim J Y , Kim J , Hwang S W , Yang D H , Byeon J S , Myung S J , Yang S K , Ye B D
Published: January 2020

Background

Data on the protective immune status against measles, mumps, rubella, varicella zoster virus (VZV), hepatitis A virus (HAV) and Epstein–Barr virus (EBV) infection among inflammatory bowel disease (IBD) patients is still lacking. Therefore, we investigated seropositivity to viral infectious diseases and associated factors in Korean IBD patients.

Methods

In this retrospective cohort study, serum immunoglobulin G (IgG) antibody positivity against measles virus, mumps virus, rubella virus, VZV, HAV and EBV viral capsid antigen (VCA) were measured in consecutive patients with Crohn’s disease (CD) or ulcerative colitis (UC) who first visited the IBD clinic of Asan Medical Centre, Seoul, Korea. Seropositivities and their associated factors were analysed.

Results

Of 263 study subjects, one hundred sixty seven (67.3%) were males. Median age at diagnosis of IBD and median age at serologic tests were 28 years (interquartile range [IQR], 20–41) and 30 years (IQR, 22–46), respectively. UC patients were 50.9% (n = 134) and median disease duration at serologic tests were 6 months (IQR, 0–59). One hundred eighty two patients (69.2%) were not under any immunosuppressive therapy. Seropositivity rates were 84.0% for measles, 85.2% for mumps and 66.5% for rubella. IgG anti-VZV positivity rates were 87.4%, but only half (50.0%) were positive for IgG anti-HAV. IgG against EBV VCA was positive in 93.6%. Younger age at IBD diagnosis (<40 years) was independently associated with non-protection status against measles (odds ratio [OR], 8.76; 95% confidence interval [CI], 2.06–37.30). Younger age (<40 years) at serologic test was independently associated with non-protection status against rubella (OR, 2.08; 95% CI, 1.16–3.73) and HAV (OR, 9.07; 95% CI, 4.51–18.24). Among 182 patients who were not under any immunosuppressive therapy, seropositivity rates were 83.0% for measles, 85.2% for mumps, 67.6% for rubella, 88.9% for VZV, 52.5% for HAV and 92.0% for EBV VCA, respectively. Younger age at IBD diagnosis (<40 years) was independently associated with non-protection status against measles (OR, 14.41; 95% CI, 1.91–108.78) and HAV (OR, 14.52; 95% CI, 4.85–43.49). IBD type, UC was independently associated with seroprotection status against HAV (OR, 2.55; 95% CI, 1.28–5.09) among patients who were not under immunosuppressive therapy.

Conclusion

Seroprotection rates for common vaccine-preventable diseases and EBV among Korean IBD patients with or without immunosuppressive therapy were similar to those of the general Korean population. In the young age group under 40 years old, immunity to measles, rubella and HAV is needed to be checked together with proper vaccination as needed.
N16 Inflammatory bowel disease (IBD) Nurses’ role and level of practice in Ireland: a National online survey
Authors: Keogh A M , Farrell D
Published: January 2020

Background

The role of the IBD nurse is evolving in Ireland. While Ireland has a sound base of expertise and infrastructure for providing IBD services, the lack of a dedicated specialist nurse was found to be the most significant barrier to delivering best care (ISG, 2016). There is currently no data on the role and level of practice of IBD nurse nationally.

Methods

A cross-sectional, descriptive online survey was undertaken. The 72-item survey was adapted from the tool used in the National UK IBD standards survey (Mason et al 2012) and underpinned by the Standards and Requirements for Clinical Nurse Specialists (NMBI, 2008). The survey was distributed to all members (n = 50) of the inflammatory bowel disease Nurses Association of Ireland (IBDNAI) and members were also invited to share the survey with colleagues not on the database.

Results

A total of 35 nurses working in IBD services across 22 hospitals nationally completed the survey, including IBD Clinical Nurse Specialists (CNS) (24%), IBD Clinical Nurse Managers II (CNM) (18%), IBD Nurses (12%), IBD Research Nurses (12%), Staff Nurses (9%); Infusion Nurses (6%), and IBD Advanced Nurse Practitioners (6%). The majority of respondents worked in adult IBD services (94%), with most working in their IBD role between 3 to 6 years and within gastroenterology up to 10 years. Only 44% of respondents work exclusively in IBD. The highest level of education reported was masters (40%), degree (40%); however, 75% of respondents have not completed a postgraduate diploma in gastroenterology. Services provided by nurses included patient education (94%), telephone advice line (81%), coordinating biologic service (69%), screening patients prior to administrating biologics (66%), email service for patients (59%), development of initiative for the IBD service (56%), coordinating care of inpatients (53%), follow-up (53%) and rapid access clinics (53%). Over half of respondents (61%) reported working unpaid overtime (typically 1–2 hours per week), with service suspended in their absence (45%). 36% of participants conducted original research and 48% conduct audits on their service.

Conclusion

IBD nurse’s role and level of practice varies greatly in Ireland. Many nurses are working in diverse roles with a wide variety of titles providing an extensive service to patients, often at a higher level than is recognised within their role title. IBD nurses are highly educated and well experienced; however the lack of specialist education has resulted in nearly as many IBD CNM’s as CNS’s which is causing variation in the title of the IBD nurse. There is a need for the development of a postgraduate programme in gastroenterology to include IBD and more IBD nurse specialists to deliver a quality, evidence-based service.
40 Long-term clinical outcome of functional tricuspid regurgitation
Authors: Mutlak D , Lessick J , Agmon Y , Aronson D
Published: January 2020

Background

Significant functional tricuspid regurgitation (TR) has been associated with higher risk for adverse cardiovascular outcomes. Left-sided heart disease (LHD) is a potentially important confounder of this association because it is strongly linked to both TR and to clinical outcome.

Methods

We studied 5886 patients who were followed for a period of 10-years after the index echocardiographic examination. The relationship between TR severity and the composite endpoint of admission for heart failure or cardiovascular mortality was analyzed using a Cox model. An additional analysis included a propensity-score-matching. To simplify the modeling of the severity of LHD, we calculated an additive score summing the number of LHD components as follows: reduced LVEF, LA enlargement ≥moderate, aortic or mitral valve disease (regurgitation or stenosis ≥moderate) and PASP≥50 mmHg.

Results

Higher TR grade was associated with markers of LHD including left ventricular systolic dysfunction, valvular heart disease ≥moderate, left atrial enlargement and pulmonary hypertension (All P < 0.001). There was a significant interaction between TR and the presence of LHD with regard to the endpoint of heart failure in the model for admission for heart failure (P = 0.01) and the combined endpoint of heart failure and cardiovascular mortality (P = 0.02). In both models, moderate/severe TR was associated with higher risk for heart failure (hazard ratio [HR] 3.13; 95% CI 2.49–3.93, P < 0.0001) and the combined endpoint of heart failure or cardiovascular mortality (HR 2.61; 95% CI 1.33–5.13, P = 0.005) only in patients without LHD. The interaction plot (Figure) demonstrates that when LHD is present, TR is not a predictor of clinical outcome.

Propensity score matching yielded 350 patient pairs, of which 88% had LHD. The HR for heart failure or cardiovascular mortality at 10-years was 0.78 (95% CI 0.56–1.08, P = 0.14) in the moderate/severe TR as compared with the trivial/mild TR.

Conclusions

Moderate or severe functional TR portends an increased risk for heart failure and cardiovascular mortality only when isolated, without concomitant LHD.

Abstract 40 Figure. Interaction plot
100 Association of age-related left atrial remodeling with ischemic stroke in patients with normal sinus rhythm
Authors: Bianco F , De Caterina R , Chandra A , Goncalves A , Aquila I , Solomon S D , Chen L Y
Published: January 2020

OnBehalf

The ARIC Study

Background

Age-related left atrial (LA) structural/functional abnormalities in elderly patients with normal sinus rhythm and preserved ejection fraction may precede the development of overt atrial fibrillation, and also may be related to stroke.

Purpose

To evaluate the association of 3-dimensional echocardiographic (3DE) atrial contractility parameters with subclinical cerebral infarcts (SCIs), as assessed by brain MRI, and clinically diagnosed stroke

Methods

We studied 407 participants (mean age 76 ± 5 years, 40.5% male) from the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) without AF and who underwent a brain MRI and a 3DE examination in 2011-13. We defined 3 groups: those with no cerebral infarcts on brain MRI (NCIs, N = 315); those with MRI-diagnosed SCIs (N = 58); and those with clinically diagnosed stroke (N = 34).

Results

While still within the normal range, LA indexed volume significantly increased across the 3 groups (P-trend = 0.01).This was accompanied by an increase in the LA global longitudinal strain (GLS), an echocardiographic index of LA reservoir function (P-trend = 0.004). E/e’ divided by LA GLS—index of atrial stiffness—worsened across groups (P-trend = 0.005) and was independently associated with SCIs and Stroke, pooled together, [OR per 1 %-1, 1.97; 95% CI (1.24, 3.11), P = 0.004], and Stroke [OR per 1 %-1, 2.30; 95% CI (1.23, 4.30), P = 0.009]. LA GLS was marginally associated with an increased odd of SCIs [OR per 1 %, 1.07; 95% CI (1.01, 1.13), P = 0.014].

Conclusions

Among elderly participants with normal sinus rhythm and preserved ejection fraction in a large cohort study, markers of LA function and stiffness are associated with increased odds of subclinical infarcts and stroke. These data suggest that even subtle LA dysfunction, which may contribute to LA stasis, may predispose to subclinical cerebral infarcts and stroke.
155 Myocardial work in hypertension and mitral regurgitation- insights from non-invasive assessment of left ventricular pressure-strain relations
Authors: Loncaric F , Marciniak M , Nunno L , Fernandes J F , Mimbrero M , Tirapu L , Fabijanovic D , Sanchis L , Doltra A , Cikes M , Lamata P , Bijnens B , Sitges M
Published: January 2020

Funding Acknowledgements

Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310)

Background and aim

Non-invasive left ventricular (LV) pressure estimates and speckle-tracking deformation curves can be used to quantify an index of myocardial work (MWI) which may offer insight into the early changes and work distribution in hypertension (HTN) and mitral regurgitation (MR) – cardiac diseases related to pressure and volume overload. The aim is to assess segmental strain and MW indices in patients with HTN, MR, and in healthy controls.

Methods

An echocardiogram was performed in 73 participants: 31 patients with a diagnosis of long-standing HTN with signs of LV hypertrophy, 22 patients with MR without hypertension, and 20 healthy age- and sex-matched controls. LV speckle-tracking was performed in 4C, 2C, and 3C apical views. MWI was calculated between mitral valve closing and opening. Average regional values of strain and MW indices were calculated by averaging the 4C, 3C, and 2C basal, mid, and apical segments, as based on the 18-segment model of the LV. Total MW per minute (MWI/min) was calculated by multiplying global MWI by the heart rate.

Results

LV ejection fraction and global longitudinal strain (GLS) were preserved and similar in all groups (GLS, controls vs. mild/moderate MR vs. severe MR vs. HTN: -21.28 ± 2.36 vs. -21.30 ± 1.49 vs. -20.93 ± 2.46 vs. -20.93 ± 2.46, p = 0.602). MR was classified as mild or moderate in 45% (n = 10) and severe in 55% (n = 12). A strong trend of higher global MWI (controls vs. mild/moderate MR vs. severe MR vs. HTN: 2098 ± 373 vs. 2036 ± 341 vs. 2237 ± 351 vs. 2297 ± 427 mmHg%, p = 0.171), as well as MWI/min could be noted in patients with hypertension and severe MR. Averaged regional deformation values showed a gradient increasing from base to apex in all groups, significantly more pronounced in the HTN patients. This deformation pattern was reflected in myocardial work distribution. In HTN, the basal region performed a lower percentage of total work, with the apex performing an increased workload. In the MR subgroups, the work was distributed similarly to the healthy controls Results are shown in Figure 1.

Conclusion

Non-invasive pressure strain relations offer additional information on cardiac function in HTN and MR with preserved LVEF and GLS. In HTN, MW is elevated and redistributed in the LV with an apex-to-base gradient signaling an apical compensation of basal impairment in the setting of increased afterload. Mild and moderate MR is associated with a compensated state of normal global MWI and work distribution, however, MWI/min in severe MR reveals an overall increase in workload - potentially predicting further LV remodeling in these patients over time.

Abstract 155 Figure 1
P197 Assesment of cardiac function during trastuzumab therapy in HER2 positive breast cancer patients
Authors: Krstic I , Deljanin Ilic M , Pejcic I , Vrbic S , Marinkovic D
Published: January 2020

Background

Although trastuzumab has benefits in treatment of HER2 positive breast cancer, it also carries the risk of cardiotoxicity. It is very important to evaluate the cardiac status before and after therapy with trastuzumab, as well as monitoring of electrocardiografic and echocardiographic parameters.

The aim of this study was to assess of cardiac function during trastuzumab therapy in HER2 positive breast cancer patients.

Method

Ninety six HER2 positive female breast cancer patients (mean age, 59.57 ± 9.6 years) were enrolled in the study. At the time, they were on sequential therapy with anthracyclines (IV to VI cycles) within the FAC regimen (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2) on day 22, and after that trastuzumab therapy (6 mg/kg of body weight on day 21, for the period of one year). In all patients (pts) blood pressure (BP), heart rate (HR), electrocardiografic and echocardiographic parameters (left ventricular ejection fraction–LVEF(%); fractional shortening–FS(%); end-diastolic diameter–EDD(mm); left ventricular mass – LVM (g)) were assesed at the beginning and after the therapy with trastuzumab.

Results

There was no significant changes in arterial BP before and after trastuzumab in examined pts (systolic BP119.90 ± 16.04 mmHg vs 121.30 ± 13.06 mmHg; diastolic BP 75.89 ±7.25 mmHg vs 76.30 ± 7.65 mmHg) ns and HR (68.78 ± 7.69/min vs 67.92 ± 7.90/min) ns. All pts at the beginning and after the last therapy with trastuzumab on the electrocardiogram (ECG) were in sinus rhythm, one pts has LBBB and one RBBB. During therapy ectopic beats were registred in 11 pts, SVES in 7 (7.29%), VES in 4(4.16%). In the most of this patients with PSR in the middle of treatment period with trastuzumab sinus tachycardia was recorded as well. At the end of trastuzumab therapy in examined group LVEF was decreased by 1.73% (from 65.49 ± 5.82% to 63.76 ± 6.43%; p = 0.007), FS by 0.86% (from 36.18 ± 5.10% to 35.32 ± 4.91%; p = 0.123) ns, EDD increased by 1.26 mm (from 47.53 ± 4.48 mm to 48.80 ± 5.19 mm; p = 0.005) and LVM increased by 173.68 g (from 161.55 ± 43.76 g to171.15 ± 47.88 g; p = 0.031). Cardiotoxicity is registred in 4 (4.17%) patients, according to the criteria of EACVI and ASE.

Results

Tratsuzumab has not significant effect on BP and ECG changes.The rate of cardiotoxicity after trastuzumab therapy was low and was expressed through reduction of left ventricle ejection fraction, the increase in the end-diastolic diameter and the left ventricular mass.
P204 Recovery of left atrial function after restoration of sinus rhythm in patients with atrial fibrillation
Authors: Kupczynska K , Michalski B , Miskowiec D , Wejner-Mik P , Wierzbowska-Drabik K , Lipiec P , Kasprzak J D
Published: January 2020

Background

Atrial fibrillation (AF) is associated with impaired mechanical function of the atria. The restoration of sinus rhythm (SR) leads to improvement of mechanics, however the onset of those changes is not established yet.

Purpose

To analyse changes in left atrial (LA) mechanical function after conversion to SR.

Methods

Forty patients (mean age 65 ± 12 years, 63% male) with nonvalvular AF underwent successful electrical cardioversion. Transthoracic echocardiography with speckle tracking analysis (STE) of LA was performed in AF and within 24 hours after cardioversion, in SR. We analysed standard parameters of left ventricle (LV) and LA. By the use of STE we assessed peak atrial longitudinal strain (PALS), time to PALS indexed to RR interval (TT-PALS/RR) and intra-atrial asynchrony.

Results

Heart rate during echocardiography was higher before cardioversion - median (IQR) 90 beats per minute (80-110) vs 61 (56-72); p < 0.0001. The mean LV ejection fraction in our study group was 48 ± 11%. We noticed significant improvement in LA STE measurements and in early diastolic (E’) mitral annular velocity. There were no significant changes in systolic (S’) mitral annular velocity and in the ratio of transmitral Doppler early filling velocity to E’ (E/E’). Detailed results are present in the table.

Conclusions

Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR.

Atrial fibrillation Sinus rhythm p S" (cm/s) 6 (5-6.5) 6 (5-6.6) NS E" (cm/s) 10 (7.5-13) 9.5 (6.8-10.5) 0.0008 E/E" 8.2 (6.3-12.3) 9.3 (7.5-13) NS PALS (%) 9.9 ± 4.6 14.5 ± 6 <0.0001 TTP-PALS/RR (%) 51 (44-58) 42 (38-45) 0.0001 LA asynchrony 15 (11-19) 9 (8-14) 0.0007
P1580 Global regurgitant volume - approaching the critical mass in valvular-driven heart failure
Authors: Spinka G , Bartko P , Arfsten H , Heitzinger G , Pavo N , Kastl S , Prausmueller S , Strunk G , Mascherbauer J , Hengstenberg C , Huelsmann M , Goliasch G
Published: January 2020

Aims

Recent progress in the diagnosis of functional valve regurgitation forms a coherent perception of severity thresholds by quantitative assessment. However, thresholds focused on either valve in isolation -not accounting for the global hemodynamic burden arising from concomitant functional regurgitation of the mitral and tricuspid valves. We sought to determine whether the global regurgitant volume is associated with adverse cardiac remodeling and mortality.

Methods and results

This long-term observational study included 414 patients on guideline-directed medical therapy. Baseline global regurgitant load defined as the sum of mitral and tricuspid regurgitant volume was assessed by the proximal flow convergence method. All-cause mortality during five years follow-up served as the primary endpoint. The median global regurgitant load was 30ml (IQR 15-49) with 67% accounting for mitral and 33% accounting for tricuspid regurgitant volume. The global regurgitant load had significant impact on outcome with a crude HR of 1.46 (1.28-1.66; P < 0.001) for a 1-SD increase in global regurgitant volume, results that remained virtually unchanged after bootstrap or clinical confounder-based adjustment (P < 0.001 for adjusted models). Spline curve analysis showed a linearly increasing risk with a threshold of 50ml and sustained increasing risk thereafter.

Conclusions

The present study demonstrates the detrimental effect of the global regurgitant load in patients with HFrEF. The threshold where heart failure is driven by the valve lesions is a global regurgitant volume of 50ml with continuously increasing risk beyond that threshold. Future studies need to address whether an attempt to reduce the global regurgitant volume can improve outcome.

Abstract P1580 Figure 1 - Global RegVol
P1757 Novel echocardiographic markers as predictors for left ventricular reverse remodeling one year after edge-to-edge mitral valve repair in patients with functional mitral regurgitation
Authors: Papadopoulos K , Ikonomidis I , Chrissoheris M , Chalapas A , Kourkoveli P , Vardas P , Spargias K
Published: January 2020

Background

Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe treatment option for high surgical risk patients with severe functional mitral regurgitation (FMR). Recent trials have proven this method’s efficiency but novel echocardiographic markers such as deformation imaging have never been analyzed in this subgroup of patients.

Purpose

The purpose of this study is to analyze novel echocardiographic parameters in patients treated for FMR and identify predictors of response in patients undergoing PMVR.

Methods

We retrospectively analyzed 79 consecutive high surgical risk patients (logistic EuroSCORE 21.8 ± 15.2%), with ischemic or dilated cardiomyopathy, reduced EF (31.0 ± 8.5%) and severe functional MR (FMR). Effective regurgitant orifice area (EROA) was measured at 28.8 ± 15.1mm2 and regurgitant volume (RV) at 41.7 ± 18.3ml. At baseline and 1-year after PMVR or optimal medical treatment (OMT) we assessed echocardiographic parameters such as LV global longitudinal strain (LVGLS) and peak left atrial longitudinal strain (PALS), LV end-systolic and end-diastolic volumes (LVESV, LVEDV), LA volume, MR severity along with BNP levels, NYHA class and 6 minute walking distance (6MWT).

Results

One year after PMVR there was a significant reduction of MR (3.7 ± 0.4 vs 1.7 ± 0.8) and BNP levels (980 ± 1027pg/ml vs 420 ± 338pg/ml, p = 0.005), improvement of NYHA class (3.20 ± 0.55 to 2.0 ± 0.6, P < 0.05) and increase of 6MWD (240 ± 137 to 298 ± 139m, P < 0.01). LA volume and LVEDV were reduced (141 ± 79ml to 114 ± 74ml and 221 ± 74 to 193 ± 62ml respectively) (P < 0.01 for all comparisons). On the other hand, patients treated with OMT didn’t have any change of their MR (3.4 ± 0.5 vs 3.4 ± 0.9), BNP levels (601 ± 652 vs 610 ± 748) or NYHA class status (2.6 ± 0.6 vs 2.4 ± 0.6). Additionally, LA and LV volumes were approximately the same (134 ± 69 vs 141 ± 61ml and 222 ± 64 vs 222 ± 56ml respectively) (p < 0.05 for all comparisons). Baseline LVGLS slightly increased post intervention (-8.5 ± 4.1% vs -9.1 ± 3.7%, r = 0.76, P < 0.01), and was associated with the absolute (r=-0.46, p = 0.01) and percentage difference in LVEDV (r= -0.61, P < 0.01). ROC curve analysis identified a cut-off value for GLS of -7.45% (AUC 0.815, 95% CI: 0.647-0.983; p = 0.007) associated with more than 15% LV reverse remodeling, with a sensitivity and specificity of 71% and 75% respectively.

Conclusions

Edge-to-edge repair is a safe and effective method for treating patients with functional MR and has a positive clinical impact in patients at one year follow up. A preserved LVGLS seems to be a good predictor of LV reverse modeling post intervention.
P251 Right ventricular free wall dissection clearly detected and recorded by echocardiography: a fatal complication after inferior myocardial infarction
Authors: Kawada Y , Yamada A , Hoshino N , Hoshino M , Yamabe S , Takada K , Sakaguchi E , Ozaki Y
Published: January 2020

An 81-year-old man was transferred to our institution by ambulance because of poor feeding, general fatigue and slight disorientation lasting for a week. On arrival, he was awake and able to speak, however, his blood pressure was low at 61/43 mmHg in spite of his medical history of hypertension. His ECG showed abnormal Q waves and ST elevation in II, III, aVF leads. The echo exam detected severe hypokinesis in the left ventricular inferior wall and reduced ejection fraction at 30%. Pericardial effusion was not observed in the first echo exam. The patient was diagnosed as cardiogenic shock due to recent inferior myocardial infarction. Coronary angiography was performed, which detected total occlusion of mid right coronary artery, followed by a successful percutaneous coronary intervention (PCI) with a drug-eluting stent under the support of intra-aortic balloon pumping. Nevertheless, his blood pressure remained low and intravenous adrenaline administration was necessary during and even after PCI. To detect the cause of prolonged low blood pressure, echo was performed again immediately after PCI. The echo exam detected new findings: right ventricular posterior free wall was dissected and abnormal shunt flows were obviously observed from left ventricle to right atrium through the dissection cavity during systole. An urgent surgical repair was considered as the only option for his survival, however, his family did not accept it because the operation itself was too risky. On the next day of his admission, he passed away. Right ventricular free wall dissection is a very rare but fatal complication after inferior myocardial infarction, nevertheless, we could detect it by echocardiography with clearly recorded images.

Abstract P251 Figure.
P1766 Comparison of left ventricular stroke volume in healthy adults among regions around the world: results from the World Alliance of Societies of Echocardiography (WASE) Normal Values Study
Authors: Miyoshi T , Addetia K , Blitz A , Lang R , Asch F
Published: January 2020

Funding Acknowledgements

WASE Normal Values Study is sponsored by American Society Echocardiography Foundation.

OnBehalf

the WASE Investigators

Background

The American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) chamber quantification guidelines provide normal reference values for a variety of size and function parameters. While used worldwide, these were predominantly obtained from American and European Caucasian populations and may not represent individuals from other regions around the world. Accordingly, ASE in collaboration with its International Alliance Partners conducted the World Alliance of Societies of Echocardiography (WASE) Normal Values Study to establish and compare normal echocardiographic values across races, ethnicities and countries worldwide. While most previous studies focused on left ventricular (LV) size and ejection fraction, LV stroke volume (SV) in healthy normal subjects has not been well defined. In this report, we aim to examine similarities and differences in normal LV SV indexed by body surface area (SVI) among regions around the world.

Methods

WASE Normal Values Study is a multinational, observational, cross-sectional study. Individuals free from known cardiac, lung and renal disease were prospectively enrolled with even distribution among age groups and gender. Echocardiographic images were acquired following a standardized protocol. LV SV was assessed by Doppler-derived (LVOT diameter and VTI) and two-dimensional (2D) biplane Simpson’s methods. LV SVI was calculated to account for differences in body size. These measurements were analyzed (TOMTEC) in a single core laboratory following ASE/EACVI Guidelines.

Results

As of May 2019, LV SV has been analyzed in 1164 cases from 13 countries, representing 8 distinct regions worldwide. In this population, age, body surface area and 2D LV ejection fraction were 47 ± 17 years old (range 18-87 years old), 1.76 ± 0.22 m² (range 0.95-2.44 m²) and 63.2 ± 2.9 % (range 52.7-73.7 %), respectively. LV SV and SVI by Doppler were larger than those obtained by 2D method in all regions. LV SV and SVI in both methods had significant differences among regions (p< 0.0001, Kruskal-Wallis test). LV SV and SVI in South Asia (India) were smallest in both methods and were also significantly smaller than other Asian regions (Figure). North America and Europe had largest LV SV and SVI by Doppler method, while Oceania had largest values by 2D.

Conclusions

The WASE Normal Values Study shows geographical variability in LV SVI across continents and countries. This information should be considered when determining normative values for SV and SVI.

Abstract P1766 Figure.
P1774 Myocardial work indices in adult patients with repaired aortic coartation
Authors: Timoteo A T , Moura Branco L , Galrinho A , Ilhao Moreira R , Sousa L , Agapito A , Cruz Ferreira R
Published: January 2020

Background

Myocardial strain analysis is a tool that allows a more precise assessment of cardiac performance. However, strain is relatively load dependent. New tools have been developed, with afterload adjustment. It was our objective to assess myocardial work (MW) in patients with repaired aortic coartation (ACo).

Methods

Study of consecutive adult patients with corrected ACo submitted to a routine transthoracic echocardiogram in 2018 at our centre. Patients with an aortic valve prosthesis, more than mild aortic stenosis / regurgitation, with pacemakers, with other non-corrected congenital heart diseases (with the exception of bicuspid aortic valve) were excluded from the analysis. A semi-automated strain analysis was performed with speckle tracking technology and both global longitudinal strain (GLS) and MW were estimated using GE software™. Blood pressure was simultaneously measured in the patient’s right arm. We specifically assessed: Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste (GWW) and Global Work Efficiency (GWE)

Results

Twenty patients were included in the study, mean age of 36 ± 9 years, 30% males. Mean body surface area was 1.7. In this group of patients, 40% were hypertensives and in 55% there was a concomitant bicuspid aortic valve. Mean maximum aortic valve gradient was 11 mmHg and mean descending aortic gradient was 19 mmHg. Compared to recently published reference values for a normal population, repaired ACo patients had lower values of MW (Table). In multivariate linear regression analysis, independent predictors of GWI are systolic blood pressure (β=0.441) and let atrial volume indexed (LAVI) (β=0.507). For GCW, male gender (β=-0.605), LAVI (β=0.530) and diastolic blood pressure (β=-0.742). For GWE, the only predictor was LAVI (β=0.498) and no predictor was identified for GWW. The presence of bicuspid aortic valve, aortic valve gradient and descending aortic gradient did not have any influence in MW parameters, although higher aortic valve gradients were excluded from this study.

Conclusion

Adult patients with repaired ACo, present lower MW indices and the main determinant for that difference are LAVI and blood pressure. GWW is the most independent parameter.

Results Variable Reference population n = 226 Patients with repaired ACo n = 20 p-value GWI (mmHg%) 1896 ± 308 1782 ± 389 <0.001 GCW (mmHg%) 2232 ± 331 2154 ± 390 <0.001 GWW (mmHg%) 78 (53-122) 76 (56-197) <0.001 GWE (mmHg%) 96 (94-97) 95 (91-97) <0.001
P1822 Exercise stress echo in the preventive assessment of the coronary heart disease: experience in the real life practice
Authors: Acquistapace F
Published: January 2020

The predictive of the functional tests compared to the anatomical tests in the diagnosis of coronary artery disease (CAD) is still debated. Cost-effectiveness ratio play a primary role in the best application of clinical practice.Methods 3200 pts (1600 men and 1600 women) were selected during a medical and cardiological screening. Two groups. The first one: evaluation or absence of events and the second one: presence of CAD. Evaluated datas: risk factors (FRC) and presence of clinical parameters limiting the predictive value of the Stress ECG from Effort (EE) such as: ECG’s abnormalities, branch blocks, hypertrophic, cardiomyopathy, gender. FRC evaluated parameters: hypertension 2080 (65.5%: 1040m; 1040f), hypercholesterolemia 1084 (37%: 592m; 592f), smoking 595 (18.6%: 298m; 297f), familiarity 1088 (34%: 1038m; 1042f), anxiety, depression, dystonia 1210 (37.8%: 430m-35% | 780f-65%), diabetes 320 (10%: 176m-55% 144f-45%).Results 900 pts were subjected to ESE: 540m 360w. Outcome at 1 year of CAD for mortality due to myocardial infarction, hospitalization for unstable angina major complications (CM): no pts. After ESE coronary angiography (CG) followed in 60 pts (7%): revascularizations (PTCA/CABG) 8 (1%: all men). ESE/CG correspondence in 100%. Comparison of CAD without revascularizations, ie diffuse atheromasia with sub-critical stenosis 35 (4%: 9m-25%, 26f-75%) all in primary evaluation without events and all hypertensive, evaluable as vasospastic ischemia (ie: x syndrome). Nobody pts was exposed to further radioactive stress procedures.Conclusions the functional test with ESE is confirmed as a valid tool, in term of cost-effectiveness also, in the screening and follow-up of CAD. Women and pts with multiple risk factors are different in the development of CAD. They are more exposed to the risk of an unappropriated and useless investigations, also radioactive. In general, ESE improves the prognosis and cost- effectiveness ratio in management of the pts with CAD.
P317 Assessment of atrial function in elite soccer players
Authors: Castro F A , Lourenco M , Leite P V A , Azevedo O , Dias G , Faria B , Nogueira I , Lourenco A
Published: January 2020

Introduction

Athlete´s heart is associated with physiological remodelling as a consequence of repetitive cardiac loading. Atrial dilation may occur in athletes, but atrial size is insufficient to provide mechanistic information about the atrium itself and an increase in atrial size is not intrinsically an expression of atrial dysfunction. Two dimensional (2D) LA strain analysis by speckle tracking emerges as a gold standard for evaluation of atrial myocardial function.

Aim

To compare LA function between elite soccer players and sedentary healthy controls through 2D-strain analysis by speckle tracking.

Methods

We included 44 consecutive male professional soccer players and 25 sedentary male healthy controls, matched by age and race. All subjects underwent transthoracic echocardiogram, including evaluation of LA diameter and volume and 2D-strain analysis by speckle tracking. Peak atrial longitudinal strain (PALS) was measured at the end of the reservoir phase and peak atrial contraction strain (PACS) was measured just before the start of the active atrial contractile phase. The average of PALS and PACS was obtained from the 12 LA segments at apical 4 and 2-chamber views. The LA contraction strain index (CSI) (ratio PACS/PALS x100) was also calculated. SPSS 20.0 was used for statistical analysis.

Results

Mean age was similar between athletes and controls (22.3 ± 4.2 vs 25.0 ± 2.4 p = 0.13) as well as body mass index (23.3 ± 5.8 vs 24.6 ± 2.7 Kg/m2, p = 0.24).

Athletes had significantly higher LA volume (29.1 ± 6.9 vs. 21.1 ± 5.5, p < 0.001). No statistical differences were observed in LA diameter between the two groups (18.7 ± 2 vs 18.0 ±1.7, p = 0.163).

Athletes had significantly lower PALS (36.3%±5.8 vs. 44.2%±8.9, p < 0.001), PACS (9.5%±2.8 vs 15.3%±4.8, p < 0.001) and LA CSI (26.3 ± 7.8 vs. 35.0 ± 9.3, p < 0.001) than controls. LA volume was correlated with PALS (p < 0.001 r = 0.99), but not with PACS or CSI (p = 0.089 and p = 0.142, respectively).

Conclusion

This study showed that in top-level athletes LA PALS and PACS are lower and PALS correlates with LA volume, suggesting that LA suffers not only a morphological but also a functional remodelling in response to intensive exercise. This can be mediated by increased LA workload imposed by the increased left ventricular work.