bluuebunny/crossref_metadata_2025 huggingface dataset:
P931 Feasibility of comprehensive multi-plane right ventricular free wall longitudinal strain evaluation pre-LVAD implantation - preliminary results from a single centre experience
Authors: Bowen D J , Strachinaru M , Mcghie J S , Van Den Bosch A E , Soliman O , Caliskan K
Published: January 2020

Introduction

Right ventricular failure (RVF) is recognized as a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation and identifying patients at risk remains a challenge. Given its structural complexity, it is not possible to fully assess the RV from one echocardiographic 2D plane and entire free wall visualization is more challenging in advanced heart failure patients with very severely dilated left ventricles. Our centre previously introduced a novel multi-plane approach whereby four different RV free wall segments (lateral, anterior, inferior and inferior coronal – figure 1) can be imaged from the same echocardiographic position using focused RV views and electronic plane rotation.

Purpose

The aim of the study was to determine the feasibility of using multi-plane echocardiography (MPE) to quantify right ventricular free wall longitudinal strain (RV-FWLS) in a small cohort of advanced heart failure patients prior to LVAD implantation.

Methods

Sixteen advanced heart failure patients underwent detailed RV assessment by MPE prior to LVAD implantation (median - 15 [6.3-29.8] days before). Feasibility and values of RV-FWLS were retrospectively assessed by an experienced sonographer on each of the 4 free wall segments using specialised RV strain analysis software. Feasibility was confirmed if all regions of the free wall were visualised and tracked appropriately throughout the cardiac cycle. Standard right heart 2D echo parameters and pre-implant right heart catheterisation (RHC) data were also collated.

Results

Mean RV-FWLS and feasibility in the four segments were as follows: lateral -12.4 ± 4.3% (81.3%); anterior -12.7 ± 6.1% (62.5%); inferior -11.8 ± 4.7% (75.0%); inferior coronal -11.6 ± 3.9% (43.8%). TAPSE values on the same segments were feasible in 100% of cases and mean values were as follows: lateral 15.1 ± 4.9mm; anterior 15.3 ± 4.7mm; inferior 13.4 ± 5.2mm; inferior coronal 11.4 ± 5.1mm. Mean pulmonary artery pressure (mPAP) measured by RHC was 27.2 ± 11mmHg. There was a slightly stronger negative correlation of RV-FWLS with increased mPAP in the lateral, anterior and inferior RV free wall segments compared to TAPSE (r²: -0.07-0.11 v -0.01-0.05).

Conclusion

There is reasonable feasibility for assessing RV-FWLS using MPE in 3 out of the 4 free wall segments and mean values were considerably lower than normal reference values. A stronger negative correlation with increasing mPAP suggests that RV dysfunction may be detected better by strain than by TAPSE measurement in pre-LVAD recipients. Larger, multi-centre studies are required to further assess these preliminary findings.

Abstract P931 Figure. Multi-plane RV imaging with strain
P932 What is new in the assessment of patients with hereditary hemochromatosis - can 2D speckle tracking echocardiography be helpful in the early detection of heart abnormalities?
Authors: Danilowicz-Szymanowicz L , Rozwadowska K , Swiatczak M , Sikorska K , Fijalkowski M , Raczak G
Published: January 2020

Background

Hereditary hemochromatosis (HH) is a very common genetic disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron lead to progressive body iron accumulation and the generation of oxidative stress in tissues. In the late stages iron overload of the heart can lead to the left ventricular (LV) dysfunction. It is believed, that two dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately and earlier than conventional echocardiography. Evaluation of such assessment was the purpose of this paper.

Methods

We prospectively enrolled 58 patients with genetically confirmed HH; 29 healthy age- and sex-matched volunteers constituted the control group. Classic echocardiographic and 2D STE parameters (GE VIVID E9, EchoPAC v201) were compared between the groups, additionally correlations between echo and iron turnover parameters were performed.

Results

The HH patients had all standard echo parameters within the normal range. All 2D STE parameters were significantly worse in HH than in control group (Table 1). We did not find any correlation between echo and iron turnover parameters, whilst significant correlation with the time from diagnosis and the numbers of venesections was noticed.

Conclusions

Novel 2D STE analyzes seem to be helpful in early detection of heart abnormalities in HH patients. The correlations between the echo and iron indices are weak, allowing to suggest the lack of a "direct" relationship between the iron turnover and myocardial function and that myocardial iron overload is not the only mechanism involved in development of HH cardiomyopathy.

HH All n = 58 Controls n = 29 p LAVI (ml/BSA) 31 (23-37) 22 (19-27) <0.001 RWT 0.42 (0.38-0.47) 0.38 (0.34-0.43) <0.003 LVMI (g/BSA) 78 (58-96) 66 (53-72) <0.006 E/Em 7.0 (5.6-8.3) 6.7 (5.0-7.5) 0.071 LVEF (%) 60 (54-62) 63 (61-65) <0.006 LV twist (º) 17.2 (13.1-22.2) 24.1 (19.9-32.1) <0.001 LV torsion (º/cm) 2.2 (1.6-2.9) 3.3 (2.7-4.3) <0.001 LV peak rotation velocity (º/s) 118.0 (88.3-146.3) 140.0 (112.7-168.9) <0.015 LV peak untwisting velocity (º/s) -132.0 (-163.5–93.0) -156.0 (-197.0–122.6) <0.039 Peak systolic longitudinal strain (%) -18.3 (-20.0–16.9) -21.0 (-22.0–19.3) <0.001
P938 Myocardial work analysis in hypertrophic cardiomyopathy: low work or high work?
Authors: Manganaro R , Dulgheru R , Marchetta S , Cozza F , Zito C , Carerj S , Lancellotti P
Published: January 2020

Background

Myocardial Work (MW) is an interesting novel non-invasive parameter to evaluate cardiac performance by left ventricle (LV) pressure-strain loops.

Purpose

The present study sought to investigate MW in patients with both non-obstructive (NOHCM) and obstructive hypertrophic cardiomyopathy (OHCM).

Methods

Forty-four patients with hypertrophic cardiomyopathy (HCM) and twenty controls (mean age 53 ± 20 years vs 52 ± 17 years, respectively, p = 0.8) underwent standard two-dimensional and speckle-tracking echocardiography. Global Work Index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE) were estimated by LV pressure-strain loops. In OHCM group, MW was evaluated by adding LVOT peak gradient to SBP. Analysis of multilayer LV longitudinal strain (LS) and left atrial (LA) LS was performed.

Results

Global LS (GLS), endocardial LS, epicardial LS and LA LS were significantly reduced in patients compared to controls (p < 0.001 for all). All patient population had significantly lower GWI, GCW and GWE and higher GWW respect to controls. Regional GLS, endocardial LS, epicardial LS and regional WI were significantly reduced in hypertrophic area compared to no-hypertrophic area in the patient population (p < 0.001 for all). OHCM group ( n = 14) had higher values of GWI and GCW compared to NOHCM ( n = 30) (2160 (1877-2250) vs 1547 (1148-1767)mmHg% and 2285 ± 411 vs 1755 ± 584 mmHg% respectively, p < 0.05 for both, Figure).

Conclusions

GWI and GCW are reduced in patients with NOHCM. Patients with OHCM, have higher GWI and GCW compared to non-obstructive ones, as expression of work at higher level of energy necessary to counteract high afterload. Our proposed method to estimate MW in OHCM needs to be validated in invasive studies.

Abstract P938 Figure.
P943 Added value of quantification of dobutamine stress echocardiography in patients with suspected coronary artery disease
Authors: Stankovic I , Stefanovic M , Janicijevic A , Milicevic P , Panic M , Kalezic-Radmili T , Putnikovic B , Neskovic A N
Published: January 2020

Background

Patients with chest pain and suspected coronary artery disease (CAD) frequently undergo dobutamine stress echocardiography (DSE) which is based on visual wall motion analysis.

Purpose

In this prospective study, we investigated accuracy and clinical utility of quantification of DSE.

Methods

In 81 consecutive patients scheduled for DSE, standard test was performed in 35 patients, while in the remaining 46 DSE was quantified. Visual assessment of wall motion abnormalities (WMA) was compared to speckle tracking–derived longitudinal strain parameters – global longitudinal strain (GLS) and mechanical dispersion (MD) at different stages of DSE. Reliable tracking was impossible at high-dose DSE in most patients.

Results

In most patients, it was impossible to obtain reliable speckle tracking analysis at high-dose DSE due to high heart rates. New WMA were observed in 23 patients (28%). Patients with dobutamine-induced WMA had similar values of GLS and MD at rest and during low-dose DSE as those without WMA (p > 0.05 for both). However, during the recovery phase, patients with new WMA at high dose DSE showed a greater amount of MD than those without (52 ± 16 vs. 40 ± 14 ms, p < 0.05). Both MD ≥60 ms and GLS ≤-16% during recovery phase had a low sensitivity (20% for both) but high specificity (90% for GLS and 92% for MD) for the detection of WMA during DSE. (Table).

Conclusions

Patients with WMA during DSE exhibit a lower GLS and a greater extent of mechanical dispersion («ischemic memory») during recovery phase. Clinical utility of strain-based quantification of DSE is limited due to inability to define effective cutoff values of strain parameters.

Abstract P943 Figure.
P944 From systolic pulmonary arterial pressure to pulmonary vascular resistance and reserve: a simplified method for exercise stress echocardiography
Authors: Wierzbowska-Drabik K , Ferrara F , D"alto M , Ciampi Q , Kasprzak J D , Agoston G , Varga A , Amor M , Bossone E , Picano E
Published: January 2020

OnBehalf

On behalf of Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI).

Background

The potential of exercise stress echocardiography (ESE) seems to be still underused especialy in the assessment of pulmonary hemodynamics.

Aim

To assess the feasibility and compare pulmonary vascular resistance (PVResistance) and reserve (PVReserve) during ESE in patients at risk of pulmonary hypertension (PH) and controls.

Methods

We performed semi-supine ESE, in 97 subjects (age 49 ± 16 yrs, 63 females): 58 patients (Group 1) at risk for PH (systemic sclerosis and other connective tissue diseases) and 39 healthy controls (Group 2). Rest and stress assessment included: tricuspid regurgitant velocity (TRV), pulmonary acceleration time (ACT), cardiac output (CO), SPAP estimation with Bernouilli equation or from ACT with formula: log10 SPAP= - 0.004 (ACT) + 2.1. We estimated PVResistance from Abbas formula, and PVReserve as ΔCO/ ΔSPAP or (when CO was not available) as minutes of exercise/ΔSPAP. When ΔSPAP was <10 mmHg, it was considered equal to 1.

Results

With TRV or ACT to estimate pressures, and cardiac output or its proxy to estimate flow, PVResistance or PVReserve could be measured in all patients. At peak exercise, PVResistance was higher and PVReserve lower in Group 1 : see Table.

Conclusion

Estimation of PVResistance and/or PVReserve can be obtained in all patients during ESE, integrating TRV with ACT, and using exercise-time as a proxy of CO when the latter is not available. These indices may be useful for a better, noninvasive characterization of the heterogeneity of pulmonary hemodynamics.

Pulmonary hemodynamics ESE data Parameter Group 1, PH (n = 58) Group 2, normals (n = 39) P value TRV rest (cm/s) 243 ± 63 204 ± 31 =0.0147 TRV peak (cm/s) 344 ± 68 204 ± 53 <0.0001 ACT rest (ms) 113 ± 33 128 ± 20 =0.0205 ACT peak (ms) 86 ± 19 94 ± 22 ns SPAP rest (mm Hg) 26 ± 10 21 ± 4 =0.0039 SPAP peak (mm Hg) 45 ± 19 28 ± 13 <0.0001 CO rest (mL/min) 4.9 ± 1.7 5.1 ± 1.7 ns CO peak (mL/min) 7.8 ± 2.8 7.6 ± 2.9 ns Exercise time (min) 7 ± 2 13 ± 3 <0.0001 PVResistance (WU) rest 1.63 ± 0.52 1.54 ± 0.34 ns PVResistance (WU) peak 2.01 ± 0.89 1.27 ± 0.42 =0.0219 PVReserve (ΔCO/ΔSPAP) 1.38 ± 1.13 3.55 ± 2.45 =0.001 PVReserve (Extime/ΔSPAP) 4.69 ± 2.67 10.96 ± 4.39 <0.0001 Legends: WU -Wood Unit, Ex time - exercise time
P949 Step by step guidance of MitraClip procedure with a new quantitative parameter
Authors: Gavazzoni M , Taramasso M T , Pozzoli A P , Miura M M , Tanner F T , Maisano F M , Zuber M Z
Published: January 2020

Background/Introduction. In step by step guidance of percutaneous mitral valve (MV) repair with MitraClip System (Abbott Vascular, Santa Clara, CA, USA) evaluation of step by step MR reduction by color-Doppler echocardiography can be challenging requiring multiparametric approach and to freeze and process images while the procedure is going. Purpose: This prospective study aimed to assess the role of a new echocardiographic parameter obtained from 3D-Color-Full volume imaging of MR for evaluation of step-by-step MR reduction during MitraClip procedures by a comparison with step-by-step reduction of m-LAP. Methods: We prospectively performed the computation of a new parameter that is obtained by acquisition of MR by 3D-zoomed-color image in dual volume layout for seeing the ventricular aspect of the jet area corresponding to proximal isovelocity surface "zone"; then, measure of that area is traced, so that it represents the 2D area of the proximal isovelocity surface zone visualized from the ventricular view, without any imaging processing ("3D dual volume PISA area"). In double orifice, we added the two computations obtained by the two orifices. We compared the variation of this parameter with variations of m-LAP at the two steps of MitraClip procedures requiring implantation of 2 MitraClips. Results: The study includes dataset of 19 patients. The baseline value of 3D dual volume PISA area was 1,47 ± 0,49 cm2 and the mean change obtained after first clip was 0,25 ± 0,21 cm2 (- 65 % of reduction from baseline, p value: 0.001) and a further change from first to second clip was of 46% (p 0,1). Conversely, the m-LAP decreased more in the second step of procedure: basal m-LAP was 15 ± 13,3 mmHg and decreased by 32% by the end of procedure; in the first step m-LAP was reduced of 12% from baseline (from 15 ± 13,3 to 14,1 ± 9,8 mmHg) and in the second step of 18% (from 14,1 ± 9,8 to 11 ± 4 mmHg). We tested correlation between relative reduction of 3D-PISA and reduction of m-LAP at each of the procedural steps and we observed significant correlation only during the first procedural step (baseline-to-first clip) (R: 0,527, p 0.02), not in the second (1 st-to-2 nd clip) (R: 0,345, p 0.13). Considering the whole procedure, reduction of 3D-PISA was correlated to reduction of m-LAP at the end. Conclusions: Our study demonstrate that this new parameter is related to hemodynamic improvement during procedures, mostly in the first step, when the amount of reduction is marked; for further step invasive monitoring of LAP would be more pivotal. These data need to be confirmed by a larger study.
P951 Intraprocedural echocardiographic technique to locate the insertion points of artificial chordae during transventricular beating heart mitral valve repair: ultrasound ""starry sky""
Authors: Vairo A , Marro M , Speziali G , Rinaldi M , Salizzoni S
Published: January 2020

BACKGROUND

Mitral valve repair is the preferred surgical treatment for severe mitral regurgitation due to degenerative leaflet prolapse. Within the growing era of transcatheter treatments for valvular heart disease, an innovative micro-invasive trans-ventricular beating-heart procedure was developed. Three-dimensional transoesophageal echocardiographic guidance is crucial to assist the operator in instrument navigation and chords positioning. Indeed, it is important an equidistant chords placement on the leaflet to ensure a uniform force distribution on the prolapsing segment and to avoid damaging of the previously inserted chords.

PURPOSE

To propose an intraoperative three-dimensional echocardiographic technique that allows operators to see the exact location of the polytetrafluoroethylene (ePTFE) chords used for the mitral repair.

METHODS

The procedure is performed using a device that is introduced through a posterolateral ventriculotomy and it is advanced towards the mitral valve under real-time 3D transoesophageal guidance. The prolapsing segments are grasped with the jaw of the instrument and the chords are implanted to achieve the proper distribution of forces and then tensioned and secured outside the ventricle.

The proposed technique exploits the greater echogenicity of the artificial chord loop compared to native chords and leaflets. By lowering of the gains, remaining in the three-dimensional mitral valve surgical view, the signals of the native structures are attenuated, the underlying ventricular cavity appears black and the insertion points are visible as an intense signal on the virtual free edge of the leaflet treated.

Figure 1 shows the intraoperative sequence of images of a case performed at our centre. The images were acquired using real time single beat three-dimensional reconstruction. Figure 1A shows the surgical view of the native valve with prolapse of the P2-P3 scallops. Image 1B reveals the prolapsing leaflet grasping and device location. After gain lowering, it’s possible to see the intense signal of the positioned artificial chord (Figure 1C). It can also be noted how this position matches with the position of the device at the time of grasping. Image 1D shows the partial disappearance of the prolapse during the tensioning test after the positioning of a second chord in a more medial position. Figure 1E shows the correct position of the ePTFE chords. We can notice the second chord placed in a medial position from the first one. This view, with dark ventricular chamber and intense signals of chordae loops, looks like a "STARRY SKY".

RESULTS

This technique allows to locate the correct insertion points of the artificial chords during the procedure.

CONCLUSIONS

This is a simple technique to guide operators during trans-ventricular beating heart mitral valve repair with ePTFE chords.

Abstract P951 Figure 1
P954 Paps / Actpo ratio indicator of pulmonary arterial ventricle coupling in normal subjects and in pulmonary hypertension
Authors: Serra W , Marangoni L M , Goldoni M G , Chetta A C
Published: January 2020

In Pulmonary Hypertension (PH), the development of dilatation and right ventricular failure (RV) are signs of accelerated progression of the disease resulting in an increased risk of cardiac death, and right ventricular failure. Even the non-invasive assessment of the systolic blood pressure pulmonary artery (PAPs) by well-established doppler echocardiography, this does not give us a measure of ventriculo-pulmonary interaction. Some studies have shown the potential use of echocardiography to indirectly evaluate the PVR and the pulmonary outflow acceleration time (ACTPO), it should be a good correlated indirect measure.

To have a measure of the ventriculo-pulmonary interaction, we used a parameter that contained information related to pulmonary pressure and a parameter that was an indicator of pulmonary vascular resistance. We have therefore called it PAPS / ACTPO ratio [strength / surface unit] / [time]. We wanted to study this parameter in apparently healthy subjects to code the normal range. From January 2017 to December 2017, we have studied 60 normal patients subjecting them to a complete two-dimensional echocardiographic / Doppler evaluation of the right function and hemodynamics. Echocardiographic imaging was performed using a Philips IE33 and a 3.5 MHz transducer (Philips Medical Systems, Andover, MA). We planned to evaluate this parameter in patients with Pulmonary Hypertension associated with systemic sclerosis.

Statistical analysis. To test the diagnostic power of variables, ROC curves were extrapolated. AUC and cut-off point (max sensitivity + specificity) were also calculated. Pair of variables were correlated by using Pearson’s test. Significance was always set at 0.05. IBM SPSS 25.0 (IBM, Amork, NY) was always used for all the statistical tests. PAPs/ACTpo ratio was measured by two echocardiographers blinded to the clinical data in order to assess interobserver variability

Results

In normal subjects we found a mean PAPS / ACTPO ratio of 0.26, indicator of an optimal pulmonary arterial ventricle coupling. The first data derived from the only 19 patient analysis shows that those presenting pre-capillary pulmonary hypertension to cardiac catheterization have a PAPS/ACTPO ratio of 0.40 ± 0.05 . Interobserver variability was lower than 5%

Conclusion

PAPS / ACTPO ratio may be an indicator of pulmonary arterial ventricle coupling.

Table 1 PAPs/Act PAPs NYHA 24m Tapse (mm) Act (msc) PVR WUmm/Hg.min.L CAT dx PAPs PAPs/Act R value ,877 ,491 -,076 -,901 ,820 ,795 Sig ,000 ,033 ,757 ,000 ,000 ,000 19 19 19 19 19 19 18 Statistical analysis
P970 Significant differences in atrial structural and functional parameters leading to differing mechanisms of atrial fibrillation in athletes compared to non-athletes
Authors: Trivedi S , Claessen G , Stefani L , Flannery D , Brown P , Janssens K , Thomas L , La Gerche A
Published: January 2020

Background/Introduction: There is an increased incidence of atrial fibrillation (AF) in endurance athletes. We sought to evaluate the likely mechanistic basis for this phenomenon.

Methods

36 endurance athletes in sinus rhythm, with a previous history of AF (ATH-AF) were compared to age and gender matched endurance athletes with no prior history of AF (ATH), non athletes with paroxysmal AF (NONATH-AF) and age and gender matched healthy controls (CONTROL). A detailed transthoracic echocardiogram was performed with all groups in sinus rhythm, with detailed left atrial (LA) and left ventricular (LV) measurements, including strain analysis.

Results

All athletes had increased LA and LV size when compared with healthy controls (Table 1). Non athletes with paroxysmal AF had increased LA size when compared with controls. However, indexed LA/LV ratio was preserved in athletes and similar to healthy individuals, whilst AF patients had significantly increased LA/LV ratio. Athletes with AF had higher e’ velocity and lower E/e’, whereas e’ was reduced and E/e’ elevated in non-athlete AF patients.

Athletes had impaired LA reservoir and contractile strain, and reduced LV global longitudinal strain (GLS) compared with healthy controls.

Conclusions

Compared to healthy controls, athletes have reduced LA and LV strain, with preserved LV diastolic function and LA/LV ratio. In contrast, altered diastolic function with differential increase in LA volume was observed in AF patients. The increased risk of AF in athletes is likely mediated by different mechanistic processes other than an atrial myopathy consequent to diastolic dysfunction as observed in non-athletes with AF.

Table 1. LA and LV parameters Parameter ATH-AF ATH NONATH-AF CONTROL P value LVEDV indexed (ml/m2) 84 ± 12 79 ± 14 57 ± 10 51 ± 13 <0.001 LVESV indexed (ml/m2) 35 ± 6 34 ± 7 25 ± 8 27 ± 33 0.02 LV ejection fraction (%) 58 ± 4 56 ± 4 56 ± 10 58 ± 8 0.586 LV global longitudinal strain (%) 19.2 ± 1.7 18.9 ± 2.1 21 ± 3.1 21.7 ± 2.9 <0.001 e’ vel (cm/s) 10 ± 2 10 ± 3 8 ± 2 9 ± 2 0.007 E/e’ 5.7 ± 1.3 5.9 ± 1.8 9.1 ± 3.3 7.5 ± 1.5 <0.001 LAV max indexed (ml/m2) 45 ± 11 43 ± 12 38 ± 11 27 ± 8 <0.001 Indexed LAV/LVEDV ratio 0.5 ± 0.1 0.6 ± 0.2 0.7 ± 0.2 0.5 ± 0.1 <0.001 LA reservoir strain (%) 27.2 ± 4.8 28.2 ± 3.7 27.9 ± 8.4 33.2 ± 7.0 <0.001 LA conduit strain (%) 14.2 ± 4.5 14.4 ± 4.0 14.9 ± 5.5 16.6 ± 6.3 0.182 LA contractile strain (%) 13.0 ± 3.1 13.8 ± 3.6 13.0 ± 5.1 16.6 ± 3.1 <0.001 LV = left ventricular, LAV = left atrial volume, LA = left atrial
P972 Quantitative methods for assessing contractile reserve in patients with diastolic heart failure
Authors: Hristova K , Tselov N , Tsonev S V , Marinov R , Kostova V , Katova T Z V
Published: January 2020

Aim

The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamics parameter in patients with diastolic heart failure is unknown. We assessed the effect of several hemodynamic parameters and it changes during handgrip maneuvers in patients with different stages of diastolic heart failure during chemotherapy and their improvements after 4 months follow up (4mFU) treatment with single pill combination of ACE inhibitor ACE) and beta –blocker(BB) .Methods: The study population included 65 patients- female / mean age of 45 ± 12 years/ 55 with breast cancer and undergoing chemotherapy / 30 pts with HFpEF and 25 pts with HFmrEF / and 10 pts with HFnEF and without chemotherapy.The effect of handgrip maneuver on hemodynamic parameters were studied by speckle tracking echocardiography. Following maximal squeeze by 100%, during the next 3 minutes patients were instructed to apply pressure at 50%. The global longitudinal strain were extracted by 3, 4 and 2 chamber apical view images on 70-85 fr/s and MAP and HR were performed at basal level, 1st, 2nd and 3rd minutes during handgrip stress test. The contractility /force/ of LV were also calculate as ratio SBP / ESV . Patients with HFmrEF and HFpEF received for 4 months treatment with single pill combination ACE (perindorpril)/ BB (bisoprolol) 5/5 mg.Results:Heart rate(HR) and mean arterial pressure(MAP) increased significantly after handgrip maneuver / from 75 ±6 beats /min to 101 ±12 beats/ min, 109 ± 15 mmHg to 118 ± 19mmHg, p < 0,05 / .Pulmonary artery systolic(s) and diastolic (d) pressure(PAP),pulmonary capillary wedge pressure (PCWP) , cardiac index(CI) , LVEF did not change significantly(p > 0,5) after handgrip maneuvers . On the other hand, LV force (SBP/ ESV ratio) ,MAP and HR decreases significantly (p < 0,01) in group with HFmrEF. In same group were found significantly decreased GLVLS at 2nd and 3rd minutes during stress- test comparable with other 2 groups with HFpEF and HFnEF. After 4mFU and treatment with 5/5 mg doses combination of ACE / BB were found improvement in parameters: HR /p < 0,001/, MAP /p < 0.01/ and contractile reserve as well as LV force /p < 0, 01/ and GLVLS /p < 0,001/.Conclusion: Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Patients with good LV reserve had a rise in stroke –work with little or no change in LVEDP. Patients with poor contractile reserve had a fall in stroke- work reserve together with a substantial rise in LVEDP. It is concluded that the stress imposed by sustained handgrip provides a simple test for evaluation of LV contractile reserve in patients, who will develop cardiotoxicity during chemotherapy treatment. The treatment with combination with small doses ACE/BB is a big challenge in patients with HFmrEF and HFpEF to improve the contractile reserve.
P982 Correlation between electrocardiographic and imaging data in patients with acute myocarditis: a single centre retrospective analysis
Authors: Caretta A , Leo L A , Paiocchi V L , Viani G M , Schlossbauer S A , Faletra F F
Published: January 2020

Funding Acknowledgements

None

Background

Acute myocarditis is a clinical and pathological condition defined as an inflammation of the myocardium. Its diagnosis is often challenging and requires multiple information derived from different diagnostic modalities.

Purpose

The aim of the study is to evaluate the correlation between electrocardiographic and imaging data in patients with acute myocarditis.

Methods

We made a retrospective analysis of 102 patients admitted to our Centre between January 2012 and April 2019 for suspected acute myocarditis. Diagnosis was confirmed with cardiac magnetic resonance (CMR) by identification of myocardial edema in T2-weighted images and/or typical subepicardial or midwall pattern of late gadolinium enhancement (LGE). Significant coronary artery disease was ruled out with coronary angiography.

Electrocardiogram (ECG) was analysed on admission - in order to evaluate the presence of ST segment abnormalities, atrio-ventricular or bundle-branch block and heart rhythm disorders - and at the time of discharge. Every patient underwent echocardiography and CMR: from both these exams we reported the presence of regional wall motion abnormalities and left ventricular ejection fraction (LVEF).

Results

Mean age of our population was 39 ± 18 years; 92 people (90%) were males. At admission, 85 patients (83%) presented ECG abnormalities; the most frequent was ST-segment elevation (65 cases). Conduction or rhythm disorders were observed in 26 cases (25%). At the time of discharge, 41 out of 85 patients had complete regression of ECG changes.

Mean value of LVEF measured with echocardiography was 56.4 ± 7.6%. In patients with normal ECG on admission it was 59.9 ± 3.1%, whereas in patients with abnormal ECG 55.7 ± 7.9% (p = 0.045).

Considering CMR, mean LVEF in the population was 58.5 ± 8.6%, varying between 64.0 ± 8.9% in the group with normal ECG and 57.4 ± 10.1% in the group with ECG abnormalities (p = 0.02). Moreover, subjects with altered ECG on admission had a higher prevalence of wall motion abnormalities both in echocardiography (47/85 – 55% vs 3/17 – 18%, p < 0.01) and in CMR (45/85 – 53% vs 3/17 – 18%, p < 0.01).

Patients with ECG normalization at discharge had a higher prevalence of ST-segment elevation (88 vs 66%, p = 0.02), while the group with persistent ECG alterations had a higher incidence of AV or bundle-branch block (23 vs 7%, p = 0.048). No statistical difference was noted between these two groups regarding echocardiographic or CMR values.

Conclusion

In our experience evaluation of ECG at admission in patients with suspected acute myocarditis identifies a subgroup of individuals with lower values of LVEF and a higher prevalence of wall motion abnormalities both in echocardiography and in CMR, while data derived by imaging techniques had no significant predictive value on ECG evolution at the time of discharge.
P983 ATTR cardiac amyloidosis and aortic stenosis: the same physiopathology, different prognosis?
Authors: Almeida I , Victor M , Cruz I , Marques A , Gomes C , Pereira H
Published: January 2020

Introduction

Degenerative aortic stenosis and age-related amyloidosis share common demographic and clinical characteristics. Both surgical and transcatheter aortic valve replacement provide excellent outcomes in elderly patients with isolated aortic stenosis, however previous reports have suggested the potential negative impact of concomitant transthyretin amyloidosis.

Purpose

Evaluation of the association of ATTR amyloidosis and degenerative aortic stenosis.

Methods

Single center retrospective analysis of patients’ data referred to perform a 99mTc-DPD between September 2014- July 2018 due to an abnormal echocardiogram or family history of ATTR. Data was collected regarding clinical, echocardiographic and 99mTc-DPD parameters to evaluate prognostic impact of concomitant cardiac ATTR amyloidosis and aortic stenosis.

Results

35 patients were reviewed. 12 (34.3%) had a positive 99mTc-DPD, performing the diagnosis of an ATTR amyloidosis. 33.3% had a cardiac uptake level 2 and 66.6% level 3. 16.7% of patients with ATTR amyloidosis had at the same time of amyloidosis diagnosis, a diagnosis of at least moderate degenerative aortic stenosis (mean maximal velocity 3.73 m/sec and mean gradient 22mmHg). These patients were older (mean age 80.5 ± 14.1 versus 77.9 ± 6.4 years, p 0.527) and all male gender in both groups. There was no evidence of higher level of cardiac uptake in patients with aortic stenosis. Cardiac function was not significantly different between groups: mean ejection fraction 45.5 ± 13.4% in patients with concomitant aortic stenosis versus 45.5 ±10.1% in patients without (p 0.672); mean global longitudinal strain -8.7 ± 2.4% versus -7.3 ± 3.0% (p 0.402). Most patients in both groups were at NYHA class II at the diagnosis. There was no difference regarding mean value of NTproBNP (7381.5 ± 32.6 versus 43332.1 ± 23.7 pg/ml, p 0.267). During follow up, 30% of patients without aortic stenosis was hospitalized due to acute heart failure and 50% died. In the group of aortic stenosis, the hospitalization and all-cause mortality rate was 100%.

Conclusions

In this study, although there were no differences regarding demographic neither clinical parameters between groups, patients with aortic stenosis presented more cardiac events and higher mortality, dying yet before the aortic stenosis became symptomatic. More studies are needed to evaluate the prognosis of cardiac amyloidosis on the postoperative.
P985 The use of strain analysis in patients under cardiotoxic chemotherapy: possible early detection of cardiotoxicity
Authors: Ozturk C , Validyev D , Becher U M , Nickenig G , Tiyerili V
Published: January 2020

Cardiotoxicity is a frequent side effect of chemotherapy leading to impaired outcomes in cancer survivors. Because of that cardiooncology has recently gained more importance in clinical practice. We aim to echocardiographically evaluate the development of cardiotoxicity and to detect early signs for preventing severe cardiomyopathies by repeated strain analysis.

We included 80 patients (46.7 ± 14.7 years, 75% female) under diverse cardiotoxic chemotherapies (43.7% breast cancer, 43.7% haematological malignancy, 12.5% others). All patients underwent echocardiography before and during treatment. Follow-up echocardiography was performed approximately 5.5 ± 1.2 months after the first application of the chemotherapy. The apical four-chamber view was used to perform strain analysis employing dedicated and automated offline software as shown previously.

Eight patients deceased due to oncological complications during follow up. Twelve patients showed significant reduced left ventricle ejection fraction (LVEFbaseline 63.2 ± 4.5%, LVEFFollow-up 48.6 ± 7.8%, p = 0.02) correlated with decrease in left ventricular global longitudinal strain (LV-GLSbaseline 17.1 ± 5.2%, LV-GLSFollow-up 9.7 ± 3.2%, p = 001). All of these patients presented heart failure symptoms, mostly with dyspnoea (85% functional NYHA class > II) and oedema (65%). In 15 patients we found a reduction of left ventricular global longitudinal strain from <5% without relevant reduction of LVEF. However, these patients showed also heart failure symptoms. During follow up 20 patients had to be admitted due to decompensated heart failure. Four patients deceased due to cardiovascular causes.

Delta LV-GLS (LV-GLSbaseline – LV-GLSFollow-up) was found to be strongest independent predictor of mortality. Baseline LV-GLS < 15% was found to be associated with mortality and frequent rehospitalisation.

Solely LVEF is insufficient to detect cardiotoxicity and to estimate prognosis of patients under cardiotoxic chemotherapy. In our small patient collective we found baseline LV-GLS <15% to be an adequate parameter for prognosis estimation and delta LV-GLS > 5% a strongest independent predictor for mortality in patients with preserved LVEF under cardiotoxic chemotherapy.
P990 Multi-plane echocardiographic analysis of right ventricular function in patients with systemic and subpulmonic physiology
Authors: Van Berendoncks A , Bowen D J , Mcghie J , Cuypers J , Kauling M , Roos-Hesselink J W , Van Den Bosch A E
Published: January 2020

Background

Right ventricular (RV) function is recognized as a prognostic factor in congenital heart disease (CHD). Accurate echocardiographic parameters to assess systolic function in systemic RV (sRV) lacking. We previously introduced a novel four-view approach with different RV walls visualized in their long axis from one apical view using 2D-multi-plane transthoracic echocardiographic (TTE) (iRotate).

Aims

To extensively evaluate RV systolic function using iRotate echocardiography in CHD patients with systemic RV compared with a whole spectrum of CHD patients with abnormally loaded subpulmonic RV.

Methods and Results

Thirty CHD patients with sRV and 112 age, gender and BSA matched patients with abnormally loaded subpulmonic RV were recruited from the outpatient clinic. All subjects underwent complete TTE with evaluation of TAPSE, TDI S’ and peak systolic global longitudinal RV strain (RV-GLS) from the RV walls using the four-view iRotate model. The feasibility of TAPSE and TDI S’ ranged between 94% and 100%. The feasibility of RV-GLS in CHD was 98%, 69%, 87% and 72% respectively in the lateral, anterior, inferior and inferior coronal view walls. All echocardiographic parameters were significantly lower in sRV compared to versus subpulmonic RV cohort (p < 0.001) (Table).

Conclusion

This study provides for the first time an extensive RV specific analysis of the systemic RV. The feasibility of all RV parameters in the four-view iRotate model is excellent in CHD and represents a reproducible, easily applicable and complete RV assessment in daily practice. Systolic function is significantly reduced in systemic RV compared to subpulmonic RV physiology.

Abstract P990 Figure.
1025 Global strain rate do not reduce biological variability compared to S", and do not normalize for body size
Authors: Stoylen A , Molmen H E , Dalen H E
Published: January 2020

Background

As the Left ventricular (LV) apex is stationary, and maximum velocities are in the mitral plane, peak systolic annular velocity (S") normalized for wall length (WL) is a measure of peak systolic strain rate (Fig. 1), as is strain rate measured by tissue Doppler. As the normalization presumably corrects for the size of the heart (and thus body), this should reduce biological variability, but this assumption has previously been shown to be faulty for annular displacement (MAPSE) vs global longitudinal strain.

Methods

The HUNT study examined 1266 subjects without evidence of heart disease, from a mixed urban / rural population of North Tøndelag county in Norway. Annular systolic velocity was measured by pulsed-wave Tissue Doppler in the septal, lateral, anterior and inferior points, and averaged. Wall lengths was measured in a straight line in the same points, and S" was normalized (S"/WL) and averaged. Segmental systolic strain rate was also measured by combined speckle tracking / Tissue Doppler and averaged to a global value (GLSR).

Results are given in table 1. All three measures declined with increasing age (R was -0.23, -0.29 and -0.29, respectively, all p < 0.001) The over-all relative standard deviations were similar for S", normalized S" and global strain rate. Both S"/WL and GLSR correlated negatively with BSA, R was - 0.22 and 0.17, respectively (p < 0.001), while S" showed a modest positive correlation; R = 0.13, (p < 0.001)

Conclusion

Normalizing peak systolic mitral annular velocity for length do not reduce biological variability, and introduces a systematic error in the body size relation, due to the one-dimensional nature of the normalisation, and the three-dimensional nature of LV deformation. This is in accordance with what has previously been shown for global longitudinal strain vs. annular plane displacement.

Table 1 Age (years) S" (cm/s) S"/WL (/s) GLSR (/s) < 40 9.1 (1.2) 0.93 (0.13) 1.08 (0.12) 40 - 60 8.3 (1.3) 0.86 (0.13) 1.03 (0.12) > 60 7.7 (1.3) 0.81 (0.14) 0.98 (0.14) All 8.4 (1.4) 0.87 (0.14) 1.03 (0.13) Relative SD (%) 16.7 16.1 12.6 Mitral annular velocity (S"), normalised velocity (S"/WL) and Global strain by age groups. (Standard deviations in parentheses)

Abstract 1025 Figure. Fig. 1
1029 Anthracycline and trastuzumab-induced subclinical cardiac damage and its prevention in the SAFE trial. Myocardial strain imaging and 3D echo interim analysis data
Authors: Barletta G , Livi L , Martella F , Desideri I , Venditti F , Scotti V , Pilato G , Argiro" A , Becherini C , Bacci C , Terziani F , Visani L , Salvestrini V , Meattini I , Del Bene M R
Published: January 2020

Background

Benefit of anthracyclines and trastuzumab therapies on disease-free survival in breast cancer is well known. Cardiotoxicity is a feared potential complication of both drugs. It usually progresses from cardiomyocyte injury to silent left ventricular dysfunction (LVD) which often becomes symptomatic and irreversible. Therefore, its prevention and early detection are of paramount importance in these cancer patients.

Purpose

SAFE trial (CT registry ID: NCT2236806) is a randomized phase 3, four-arm, single-blind, placebo-controlled study that aims to evaluate the effects of Bisoprolol (B) (5 mg, twice daily), Ramipril (R) (5 mg, twice daily) or the combination of the two (R + B), compared to placebo (P), on subclinical heart heart damage. Interim data of left ventricular function monitored with 3D Echo and Myocardial Strain Imaging are presented.

Methods

Out of 225 patients asked to participate, 191 were enrolled (mean age 48.9 ± 9.0 years). Follow-up monitoring (at 3, 6, 12 months[m]) comprised 3D ejection fraction (3D-LVEF) and Global Longitudinal Strain (GLS). One patient had sub-acute anthracyclines cardiotoxicity. Data at one year of 123 patients were available (34 P, 28 R, 31 B, 30 R + B).

Results

At time 0, no significant differences in age, body mass index, hemodynamic parameters were observed among arms. Data of 3D-LVEF and GLS at time 0 and during follow-up are reported in the figure (p level versus time 0 – GLS repeated measures). There was a significant reduction in 3D LVEF and increase in GLS in P arm (3D LVEF: 3m: -3.3%, 6m: - 5.2%, 12m: -3.7%; GLS: 3m: +5,7%, 6m: +7.8%, 12m: + 7,1%). A similar, though less significant, worsening of 3D LVEF (-2.4%,-1.9%,-2.2% at 3, 6, 12m, respectively) and GLS (+2.7%, +3.2% at 3 and 6m, respectively) was found in R arm. In B and B +R arms there was a worsening at 6m (3D LVEF -2.5%, GLS +2.7%), whereas at 12m only GLS increased (+3.2%) in B, not in B + R. Arm differences were significant (repeated measures two ways) both for 3D LVEF (two-way repeated measures ANOVA, p level = 0.038, observed power 0.855) and GLS (p level = 0.002, observed power 0.973).

Conclusions

This interim analysis of the SAFE trial shows that demonstration of subclinical cardiotoxicity is feasible with 3D echo and myocardial strain imaging. Significant subclinical damage potentially leading to LVD is present at one year. Both B alone on in combination with R may be a successful cardioprotective strategy in patients treated with anthracyclines and trastuzumab.

Abstract 1029 Figure. Time course of GLS and 3D LVEF
1047 Increased interstitial fibrosis in patients with mitral valve prolapse and mitro-annular dysjunction
Authors: Pavon A , Hugelshofer S , Rutz T , Pascale P , Pruvot E , Muller O , Schwitter J , Monney P
Published: January 2020

Background

in patients with myxomatous mitral valve prolapse (MVP), mitral annular disjunction (MAD) has been associated with the presence of late gadolinium enhancement (LGE) at papillary muscle level and the risk of sudden cardiac death. However, patients with MAD but no detectable LGE still may have arrhythmia. We investigated the relation between MAD and the presence of interstitial fibrosis in the basal inferior left ventricular myocardium.

Methods

28 patient with MVP and associated MAD underwent Cardiovascular Magnetic Resonance imaging (CMR) at 1.5 T scanner (Aera, Siemens Medical Solutions, Erlangen, Germany). Exclusion criteria were ischemic heart disease, infiltrative cardiomyopathy and contraindication to CMR. 12 patients with mitral valve regurgitation but no MAD and 10 patients without mitral disease served as the control group. MAD severity was measured from LA wall-posterior MV leaflet junction to the top of the LV infero-basal wall during end systole. Insterstitial fibrosis was assessed by calculating the extracellular volume (ECV) from T1 mapping of the left ventricular basal slice acquired before and after Gadolinium injection.

Results

Mean age was 47,5+\-23,3 years and 60% were male. ECV was higher in patients with MVP compared with controls (basal septum: 0.27 ± 0.04 vs 0.23 ± 0.03 p = 0.006; basal inferoposterior wall 0.28 ± 0.03 vs 0.23 ± 0.02 p = 0.003) and there was a significant correlation between MAD severity and ECV of the basal inferior wall (spearman rho 0.68, p < 0.0001) (Figure 1). Among MVP patients, ECV of the basal inferoposterior wall was higher in patients positive for LGE in the papillary muscles (ECV 0.31 ± 0.03 vs 0.27 ± 0.03 p 0,004).

Conclusion

In MVP patients, MAD severity was associated with a higher amount of interstitial fibrosis even in the absence of detectable macroscopic fibrosis in the papillary muscle region.

Abstract 1047 Figure 1
1093 Multi-modality imaging of a rare cause of constrictive physiology: pericardial ring
Authors: Thabet N , Labib D , Samaan A , Shaaban M , Kharabish A , Elsawy A , Mahmoud-Elsayed H
Published: January 2020

Introduction

Proper pathophysiologic diagnosis of constrictive pericarditis (CP) usually mandates utilization of multiple diagnostic tools.

We report a rare cause of constrictive pericarditis in a 33-year-old female presenting with painful epigastric pulsations, easy fatigability, and lower limb edema of 6 months duration. The patient had no past history of trauma, cardiac surgery, or tuberculosis.

Trans-thoracic echocardiography (figure 1, panels A, parasternal long-axis view, and B, apical 4-chamber view) showed an echogenic band (arrow head) across the left (LV) and right (RV) ventricles, with compressed RV cavity. Septal bounce, with shifting of the inter-ventricular septum towards the LV during deep inspiration, was noted; however, Doppler evaluation of the diastolic function was not conclusive of constriction.

Cardiac magnetic resonance (figure 1, panel C) and computed tomography with 3D segmentation, using Materialise Mimics and 3-matic software (figure 1, panel D),showed an 8-mm thick, calcified pericardial ring (arrow head) encircling and indenting both ventricles at mid-cavitary level, resulting in bi-ventricular compression and dumbbell-shaped heart. Both ventricles were of average cavity size, with preserved LV size, systolic function and mildly impaired RV systolic function. Right heart catheterization confirmed the diagnosis of constrictive pericarditis. The patient was referred for surgical pericardiectomy.

Conclusion

Multi-modality imaging is integral for the diagnosis of CP. Our case represents a rare etiology of constrictive physiology.

Abstract 1093 Figure 1