bluuebunny/crossref_metadata_2025 huggingface dataset:
P1377 Predicting the presence of coronary artery disease by transesophageal echocardiography
Authors: Heidari H , Ran H , Roth C , Hengstenberg C , Binder T , Goliasch G , Schneider M
Published: January 2020

Introduction

The accuracy of ultrasound signs as predictors for the presence of coronary artery disease (CAD) has been evaluated extensively in the 1990s and 2000s. Imaging quality has improved tremendously over the last decades.

Hypothesis

High-end ultrasound systems allow for accurate prediction of presence or absence of CAD.

Methods

We retrospectively evaluated all patients who received transesophageal echocardiography examination (TEE) between 2007 and 2016 and who had coronary angiography within 24 months before or after the TEE.

Results

A total of 242 patients fulfilled the inclusion criteria, 60% were male. Mean age was 70 (SD ±13) years. In multivariate regression analysis, plaque in the aortic arch (OR 2.53, 95%CI 1.01-6.35, p = 0.048), plaque in at least one of the thoracic aortic segments (OR 2.44, 95%CI 1.21-4.9, p = 0.012), the presence of mitral annular calcification (MAC) (OR 1.87, 95%CI 1.03-3.39, p = 0.038), and any two of the three (aortic stenosis (AS), MAC, aortic plaque) in combination (OR 2.05, 95%CI 1.08-3.88, p = 0.028) were predictors of significant CAD. The isolated findings MAC (OR 1.91, 95%CI 1.00-3.65, p = 0.049) and AS (OR 2.45, 95%CI 1.22-4.92, p = 0.012) were significant predictors for the absence of normal coronary arteries.

Conclusion

With a negative predictive value of 80%, the absence of MAC, AS, and aortic plaque makes the presence of significant CAD unlikely. If CAD must be excluded and MAC or AS are present, there is high likelihood for at least mild CAD. Coronary angiography rather than coronary CT angiography should be applied in these patients.
P1388 LA and LV strains are closely linked in patients with diastolic dysfunction and preserved ejection fraction
Authors: Malaescu G , Capota R , Petrescu A , Duchenne J , Voigt J-U
Published: January 2020

Introduction

Left atrial (LA) strain has been proposed as an independent parameter for the assessment left ventricular (LV) diastolic function. However, there is increasing evidence of impaired LV longitudinal function in patients with diastolic dysfunction(DD) and preserved ejection fraction (EF).

Purpose

To assess the relationship between LA and LV strain parameters with different grades of LV diastolic dysfunction in patients with preserved EF.

Methods

We included 95 patients with EF > 50% and good image quality. Patients with a mobile interatrial septum, more than mild valvular regurgitation and previous heart surgery were excluded. Standard echocardiographic measurements and the assessment of the diastolic function were performed according to current guidelines. LA and LV strains were assed using speckle tracking in 4 and 2 chambers apical views, using R-R gating. Strain values from LA and LV strain curves were derived in every phase of the cardiac cycle (peak systolic, early and late diastole strain).

Results

26 patients had normal diastolic function, 23 had grade 1, 19 grade 2 and 13 grade 3 DD. Fourteen patients with indeterminate DD grade were excluded. Both peak LA and LV strain decreased significant with the degree of DD (Fig.). LA and LV early diastole strain were significantly higher in patients with normal diastolic function than any degree of DD. LA and LV late diastole strain increased in grade 1 DD.

LA and LV strain parameters changes correlated significantly in systole, early and late diastole (r = 0.81,p < 0.0001; r = 0.64, p < 0.0001; r = 0.76, p < 0.0001, respectively). Other standard parameters of DD were not capable to differentiate between grades of DD.

Conclusion

LA and LV strain parameters show similar changes with increasing diastolic dysfunction. Diastolic dysfunction was regularly associated with reduced longitudinal strain in both LA and LV despite preserved EF. This suggest that both LA or LV strain could be used for the assessment of diastolic function.

Abstract P1388 Figure. LA and LV strain parameters by DD
P1396 Three-dimensional cardiac mechanics for prediction of events in Chagas disease
Authors: Hotta V T , Abduch M C D , Vieira M L C , Ianni B M , Mady C , Bocchi E A
Published: January 2020

Introduction

Chagas disease (CD) is an endemic infectious disease that still remains a great economic burden. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We assessed the hypothesis that 3D STE may predict clinical events in patients with CD.

Methods

This was a convenience sample. Patients with any systemic disease were excluded. Eight hundred and eight patients with CD were evaluated but only seventy-two were included. Clinical, electrocardiographic and comprehensive conventional and 3D echocardiography were performed. Patients were followed up for thirty-six up to sixty months. Clinical events were defined as hospitalization for heart failure, ventricular arrhythmias and cardiovascular death.

Results

Seventy-two patients were enrolled in three groups: Group 1 (G1), patients with left ventricular ejection fraction (LVEF) < 0.35 (N = 22); Group 2 (G2), LVEF between 0.35 and 0.55 (N = 22); Group 3 (G3), normal LVEF (N = 28). Gender distribution, mean age, anthropometric variables and risk factors were similar between the groups. 2D STE feasibility was 99.5, 99 and 100% in G1, G2 and G3. 3D Longitudinal strain feasibility was 93, 89 e 88% in G1, G2 and G3. Interobserver and intraobserver variabilities (Blant-Altman) for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS) are displayed in Table 1.

Hospitalization was related do indexed left atrium volume (p = 0,03) in G1. In G2, non-sustained ventricular tachycardia were related to 2D GLS values (p = 0,04); all clinical events were related do diastolic function (p = 0,30). In G1 and G2, hospitalization was related do indexed left atrium volume (p = 0,01); all clinical events were related do diastolic function (p = 0,004) and 3D LVEF (p = 0,02). 3D STE parameters were not related to clinical events.

Conclusions

In conclusion, 3D STE in patients with CD appears to be an accurate, reproducible and promising method but was not related to clinical events.

Table 1 INTEROBSERVER INTRAOBSERVER 2D GLS 0.96 ± 0.04 0.90 ± 0.08 3D GLS 0.92 ± 0.07 0.93 ± 0.10 3D GCS 0.88 ± 0.07 0.82 ± 0.15 3D AS 0.93 ± 0.05 0.90 ± 0.05 3D RS 0.85 ± 0.05 0.84 ± 0.11 Table 1. Interobserver and intraobserver variabilities for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS).
P1405 3D echocardiographic assessment of right ventriculo-arterial coupling in mitral valve prolapse
Authors: Filippetti L F , Huttin O H , Venner C V , Aubert R A , Juilliere Y J , Selton-Suty C S S
Published: January 2020

Background

Both pulmonary artery pressure (PAP) and right ventricular (RV) function have shown their value in the prognostic evaluation of patients with mitral valve prolapse (MVP). Echocardiography which allows simultaneous pressure estimation and volume measurement by 3D allows an approach of arterial (Ea) and ventricular elastance (Emx) and of right ventriculo-arterial coupling (RVAC), usually derived from pressure-volume loops, and could be of interest in the assessment of the RV-PA unit.

Methods

Thirty normal patients (group Nl, mean age 52.7 ± 15.9) and 75 patients with stable MVP (mean age 52.4 ± 15.4 (ns for age), 39 (group MVP1) with no or mild mitral regurgitation (MR) and 36 (group MVP2) with moderate to severe MR) underwent echocardiography including 3D RV acquisition. RV end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV) (mL) and ejection fraction (EF) (%) were obtained 3D echo (3DE) volumetric analysis (GE, EchoPac). mPAP was estimated from echo using Chemla’s formula (mPAP = 0.61 x sPAP + 2mmHg). Pulmonary artery effective elastance (Ea) was estimated as mPAP/SV (mmHg/mL), RV maximal end-systolic elastance (Emax) as mPAP/ESV (mmHg/mL), and RVAC as Ea/Emax. Ea, Emax and RVAC were compared between the 3 groups of patients using ANOVA.

Results

Mean LVEF was similar in the 3 groups. There was a significant differences in mPAP (Nl: 15.6 ± 3.0; MVP1: 16.3 ± 3.3; MVP2: 22.9 ± 11.1, p = 0.001).

RVEDV (Nl: 81.3 ± 19.2; MVP1: 80.1 ± 22.0; MVP2: 96.1 ± 28.6, p = 0.09), RVEF (Nl: 50.4 ± 4.4; MVP1: 49.3 ± 5.5; MVP2: 46.6 ± 6.6, p = 0.02) and RVESV (Nl: 39.9 ± 9.8; MVP1: 40.8 ± 12.8; MVP2: 52.0 ± 19.5, p = 0.01) were significantly different among the 3 groups. There was a non significant trend toward progressive increase in Ea (Nl: 0.41 ± 0.12; MVP1: 0.45 ± 0.15; MVP2: 0.53 ± 0.30, p = 0.07) and E max (Nl: 0.42 ± 0.11; MVP1: 0.45 ± 0.17; MVP2: 0.53 ± 0.31, p = 0.11) among the 3 groups but RVAC was not significantly different (Nl: 0.99 ± 0.17; MVP1: 1.04 ± 0.22; MVP2: 1.05 ± 0.37, ns).

Conclusion

3D echocardiography allows a complete analysis of the RV-PA unit and is able to reveal subtle changes in its equilibrium. Together with an increase in RV volumes and decrease in RVEF, our study reveals a progressive increase in arterial elastance in parallel with the severity of MR, compensated by an increase in ventricular elastance to maintain RV – PA coupling in those stable patients with MVP.
P1406 Normal reference values of right atrial strain parameters using three-dimensional speckle-tracking echocardiography in healthy adults
Authors: Nemes A , Kormanyos A , Domsik P , Kalapos A , Ambrus N , Lengyel C , Forster T
Published: January 2020

Introduction

Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects.

Methods

The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases.

Results

While radial strain (RS) does not change significantly over the years in males, RS increases with age most significantly between 40-49 years, and it starts to decline at the age of 50 years in females. While females have higher circumferential strain (CS) and area strain (AS) values, RS decreases with age in both gender. While longitudinal strain (LS) remains almost unchanged in females until 40-49 years and declines above the age of 50 years in females, it decreases over decades in males. 3D strain (3DS) increases with ages in both gender, but almost doubles in females in older ages. While RS at atrial contraction does not change over decades in males, an obvious increase could be seen in females with a higher value between 40-49 years and a decline over 50 years. A decrease could be seen in CS at atrial contraction in males over decades, it is almost tripled in value between 40-49 years in females. Although LS at atrial contraction is higher in females, it decreases over decades in both genders. AS decreases over decades in males, while females have almost doubled AS values at the ages 40-49 years. 3DS is almost unchanged in males, while doubled in older ages in females. During evaluations, 110 subjects were excluded due to inferior image quality from the total of 295 enrolled subjects, therefore the overall feasibility of 3DSTE-derived RA quantification was 185 out of 295 (63% overall feasibility).

Conclusion

3DSTE-derived RA normal reference values with age- and gender-dependency are demonstrated in a healthy population.
P1412 A new light to improve the view of the anatomical details during micro-invasive trans-ventricular repair of degenerative prolapse of mitral valve
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 (3D) transoesophageal echocardiographic guidance is crucial to assist the operator in instrument navigation and chords positioning. 3D ultrasound technology is constantly evolving and a special light, that can be mobilized within the 3D images, has recently been invented. This light allows to illuminate the structures from different points of view and increase the definition of the anatomical details.

PURPOSE

To show the advantages of this new 3D image analysis technology, described above, through a sequence of intra-procedural images of a mitral valve repair by trans-ventricular polytetrafluoroethylene (ePTFE) chords implantation.

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 segment, in this case central part of posterior leaflet (Fig. 1 A, B and C), is grasped with the jaw of the instrument (J in Fig. 1D), then the chords are implanted, tensioned and secured outside the ventricle. Figure 1A shows the pre-operative image of posterior leaflet prolapse with flail (P2 segment) and the light illuminates the valve from above. The broken chords (arrow in Fig. 1A) can be recognized with high definition. The light can also be placed on the valve plane (Fig. 1B) or below (Fig. 1C). When illumination occurs from the left ventricular side, the coaptation loss due to the P2 flail is highlighted (arrow in Fig. 1C). After placement, tensioning and securing the chords outside the ventricle, the prolapse disappears and the correct coaptation is re-established (Fig. 1E). The coaptation deficit is no longer visible, even with the light placed below the valve and it is possible to see the light coming out of the aortic valve (Ao), opened in systole, with mitral valve closed (Fig. 1F).

RESULTS

At the end of the procedure the residual mitral regurgitation was trivial and no loss of coaptation can be evidenced even with the light placed in the left ventricle (Fig. 1F).

CONCLUSIONS

This new light allows to improve the anatomical definition of 3D echocardiographic images, allows better visualization of the coaptation defects and can be used as a further verification of the result especially in cases of micro-invasive mitral repair.

Abstract P1412 Figure 1
P1418 Clinical profile and outcome of infective endocarditis patients transferred to a tertiary center
Authors: Gonzalez M , Vallejo N , Nunez R , Llibre C , Berastegui E , Lopez Ayerbe J , Munoz C , Bayes Genis A
Published: January 2020

Previous studies have described a selection bias with more need for surgery in patients transferred to a tertiary referral hospital. In addition, multidisciplinary Infective Endocarditis units establish criteria for referring patients to the tertiary hospital and keep in contact with the county hospital.

METHODS

Prospective observational study with a retrospective analysis of 468 episodes of infectious endocarditis admitted to our center from 2003 to 2018. Of these, 252 (54%) were admitted directly in our center and 216 (46%) were transferred from hospitals in the area of influence. We analyze the features and compare them.

RESULTS

The average age from transferred patients was lower (63 vs. 66 years; p = 0.015), from which 74% were men. Non-transferred patients had major comorbidity with a significant percentage of comorbidities (81 vs. 66%; p = 0.005), greater Charlson"s index (3.4 vs. 1.98; p 0.005) and EuroScore (logistic Euroscore I ; 27 vs. 22; 0.034). The diagnosis delay was similar (7.3 vs. 7.6 days) with a large number of clinical (84% vs. 73%) and echocardiographic (52 vs. 40; p = 0,012) complications in transferred patients with more need for surgery (81 vs. 61%, p = 0.002), and with more operated patients of those transferred. The mortality of non-transferred patients, admitted directly in the tertiary center, was higher (51 vs. 43%), but presenting no significant differences.

CONCLUSIONS

Patients transferred from other centers have a profile with less comorbidity but high need for surgery, possibly related to well-stablished selection and derivation criteria, with a slightly lower mortality, although with no significant differences in comparison to patients admitted directly to the tertiary referral hospital.
P1419 Sex-related differences in cardiac remodeling in health and hypertension
Authors: Phua A I H , Tara S W , Le T T , Bryant J A , Toh D F K , Ang B W Y , Su B , Cook S A , Chin C W L
Published: January 2020

Funding Acknowledgements

National Medical Research Council

OnBehalf

National Heart Centre Singapore

BACKGROUND

Adverse cardiac remodelling is associated with worse cardiovascular outcomes. Development of left ventricular hypertrophy (defined as increased myocardial mass) is a complex process mediated by myocardial wall thickening and/or ventricular dilatation. Sex-related differences in the relationship between myocardial mass and wall thickening/ventricular dilatation have not been well-described.

PURPOSE

We examine differences in determinants and patterns of cardiac remodeling between males and females.

METHODS

Comprehensive cardiovascular magnetic resonance imaging was performed in 1006 participants: 316 healthy volunteers (50% males, 46 ± 14 years) and 690 asymptomatic hypertensive patients (60% males, 57 ± 11 years). Myocardial mass, ventricular volumes and maximal myocardial wall thickness (across 16 myocardial segments) were measured using standardized contouring techniques. Clinically relevant variables (age, weight, height, and adiposity) that demonstrated significant univariate association with myocardial mass (P < 0.05) were selected in the multivariable linear regression model using the forward approach.

RESULTS

Increased body weight, lower body fat composition and higher systolic blood pressures were independently associated with increased myocardial mass in healthy volunteers (males and females) and hypertensive females. In hypertensive males, only increased body weight and elevated systolic blood pressure were independently associated with increased myocardial mass.

The association between myocardial mass and ventricular volumes was almost identical between males and females (P = 0.65 for interaction; Figure). Conversely, there was a significant gender-related difference in the association between wall thickness and myocardial mass after adjusting for potential confounders (P < 0.001 for interaction). Concentric remodeling was initially more evident in males; but further with increase, myocardial mass was associated with greater concentric remodeling in females (Figure). Similar results were observed when analyses were performed separately in healthy volunteers and hypertensive patients.

CONCLUSION

There were sex-related differences in concentric remodeling at progressive stages of myocardial hypertrophy that may explain the higher prevalence of heart failure with preserved ejection fraction reported in females.

Abstract P1419 Figure
P1427 Mechanical dispersion assessed with echocardiography versus scar characterization with cardiac magnetic resonance to predict malignant arrhythmia in cardiac resynchronization therapy patients
Authors: Doltra A , Bertolani Y , Linhart M , Acosta J , Tolosana J M , Mont L L , Berruezo A , Sitges M
Published: January 2020

Background

Recent data have shown that scar characterization with late gadolinium enhancement magnetic resonance (LGE-CMR) is useful to predict malignant arrhythmic events in a cardiac resynchronization therapy (CRT) population. On the other hand, echocardiography 2D strain parameters (such as mechanical dispersion – MD) have been recently suggested as a predictor of ventricular arrhythmia (VA).

Purpose

To compare the usefulness of strain echocardiography and MR scar parameters to predict VA and sudden cardiac death (SCD) in CRT patients (pa).

Methods

110 pa undergoing CRT implant were included. A 2D strain echo and a 3D LGE-CMR were performed before the implant. In the echocardiographic exam, left ventricle ejection fraction (LVEF), global longitudinal strain (GLS), mechanical dispersion (MD) and delta contraction time were quantified. Regarding LGE-CMR, scar mass, border zone (BZ) mass and the presence of BZ channels were assessed with specific software. The primary endpoint was the presence of SCD or appropriate implantable cardioverter-defibrillator therapy at long-term follow-up (FU).

Results

The primary outcome occurred in 23 pa (20.9%) during a mean FU of 53.5 ± 10.4 months. In these pa, MD was significantly increased (130.3 ± 55.5ms vs. 102.0 ± 45.1ms, p < 0.05) whereas LVEF, GLS and delta contraction time were not significantly different. All LGE-CMR parameters were significantly increased in PA with events. At multivariate analysis, both MD and LGE-CMR parameters were independent predictors of malignant arrhythmia (table). The MD cut-off value for prediction of VA was 80.88 ms, with 91.3% sensitivity and 36.8% specificity. The figure shows the Kaplan-Meier curves. Regarding LGE-CMR parameters, the cut-off value, sensitivity, and specificity were 13.8g/82.6%/81.6% for scar mass, 5.54g/85.7%/81.8% for BZ mass, and 90.9%/82.1% for presence of BZ channels.

Conclusions

MD and LGE-CMR scar parameters are independent predictors of VA and SCD in CRT. Due to its high sensitivity, MD could be used to identify pa at high arrhythmic risk that could benefit from a more complex and specific LGE-CMR study.

Multivariate analysis Model 1 Model 2 Model 3 HR (95% CI) p HR (95% CI) p HR (95% CI) p Basal LVEF 1.01 (0.94-1.09) 0.731 1 (0.93-1.07) 0.974 1.04 (0.97-1.11) 0.273 MD (ms) 1.01 (1.00-1.02) 0.043 1.01 (1.00-1.02) 0.017 1.01 (1.00-1.02) 0.003 BZ mass (g) 1.08 (1.05-1.11) <0.001 Presence of BZ channels 18.39 (4.26-79.51) <0.001 Scar mass (g) 1.06 (1.04-1.08) <0.001 LVEF: left ventricle ejection fraction; MD:mechanical dispersion; BZ:border zone

Abstract P1427 Figure. Kaplan-Meier curves
P1435 The impact of intermediate wall shear strain on changes of plaque morphology in CAD: A systematic review and meta-analysis
Authors: Bytyci I , Artan Bajraktari A B , Elezi S , Michael M Y
Published: January 2020

Background and Aim

The experimental studies found that high wall shear strain (WSS) resulted in the development of more vulnerable plaque compared to low WSS. The aim of this meta-analysis is to assess the role of intermediate WSS on atherosclerotic plaque.

Methods

We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry from 1989 to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and plaque morphology in CAD.

Results

A total of 32,083 segments were recruited in 7 studies with mean follow up 8.4 months. The pooled analysis showed that baseline low WSS is associated with similar plaque morphology to that with intermediate WSS: lumen area WMD 0.96 [-0.12 to 2.04, p = 0.08], plaque area WMD -0.43 [-0.09 to 0.13, p = 0.13], necrotic core area WMD -0.18 [-0.45 to 0.08, p = 0.18], dense calcium score WMD -0.12 [-0.26 to 0.02, p = 0.09] as well as fibrous WMD -0.35 [-0.89 to 0.19, p = 0.21] and fibro-fatty area WMD -0.05 [-0.12 to 0.02, p = 0.12]. At follow-up, the only difference found was an increase of fibrous WMD 0.08 [0.01 to 0.16, p = 0.04] and fibro-fatty area, WMD 0.07 [0.01 to 0.12, p = 0.02] in low WSS compared intermediate WSS.

Conclusions

Intermediate WSS group is associated with plaque features changes similar to those occurring with low WSS. This finding emphasis the role of IVUS in outcome of atherosclerotic plaque in CAD.
P1441 Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients
Authors: Casas G , Oristrell G , Limeres J , Barriales R , Gimeno J R , Garcia Pavia P , Zorio E , Villacorta E , Jimenez Jaimez J , Bayes A , Garcia Pinilla J M , Palomino A J , Evangelista A , Ferreira I , Rodriguez-Palomares J F
Published: January 2020

BACKGROUND

Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established.

PURPOSE

To evaluate the rate of SE in LVNC and describe risk factors.

METHODS

LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis.

RESULTS

514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9-7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype.

Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% Vs 24%, p = 0.31) and atrial fibrillation (35% Vs 19%, p = 0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p = 0.04). A LA diameter > 45 mm had an independent 3 fold increased risk of SE (OR 3.04, p = 0.02) (Image 1).

CONCLUSIONS

LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention.

Table 1 Systemic embolisms (n = 23) No systemic embolisms (n = 491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR) - yr 60 (48-76) 48 (30-64) 0.02 Median follow up (IQR) - yr 5.9 (3.1-7.8) 4.2 (1.8-7.1) 0.18 OAC, n (%) 19 (83) 118 (24) 0.01 LVEF (SD) - % 37 (15) 48 (17) 0.01 LVEDD (SD) - mm 58 (11) 54 (10) 0.04 LA diameter (SD) - mm 46 (9) 39 (9) 0.01 Characteristics of patients with and without systemic embolisms

Abstract P1441 Figure. Image 1
P1442 Outcomes of patients with left ventricular noncompaction and preserved ejection fraction
Authors: Casas G , Oristrell G , Limeres J , Barriales R , Gimeno J R , Garcia Pavia P , Zorio E , Villacorta E , Jimenez Jaimez J , Bayes A , Garcia Pinilla J M , Palomino A J , Evangelista A , Ferreira I , Rodriguez-Palomares J F
Published: January 2020

BACKGROUND

Left ventricular noncompaction (LVNC) has a wide phenotypic expression. Prognosis of patients with preserved ejection fraction (pEF) remains uncertain.

PURPOSE

To describe the characteristics and natural history of this subgroup of patients.

METHODS

LVNC patients were included in a multicentric registry. Those with pEF (LVEF > 50%) were considered for the analysis.

RESULTS

491 LVNC pts from 10 Spanish centres were recruited from 2000 to 2018. 239 (49%) had baseline pEF. Compared to those with reduced EF (rEF), they were younger, with no differences in gender and had less comorbilities (Table 1). Mean LVEF was 62% (SD 8). 18 pts (9% of the available CMR) had fibrosis even though LV volumes and LVEF were normal.

Family screening was completed in 199 pts, being positive in 113 (57%). Genetic testing was performed in 146 index cases, being positive in 80 (55%): ACTC1 (40), MYH7 (17), TTN (8), HCN4 (6) and other individual variants.

During a median follow-up of 4.9 years (IQR 2.1-7.3), there was a significant decrease in LVEF: last LVEF was 30- 40% in 5 pts (2%) and 40-50% in 21 (9%) (p = 0.01 compared to baseline LVEF). 6 pts (2.5%) died during follow-up, only 1 of cardiovascular cause. 9 patients (4%) presented heart failure (HF) and 25 (10.5%) ventricular tachycardia or fibrillation (VT/VF). All cardiovascular outcomes were less frequent compared to rEF (Image 1, all p < 0.05). In multivariate analysis (including demographic, imaging, genetic and family aggregation parameters) the only predictor for HF was change in LVEF (OR 0.89, mean LVEF at the event 47%, p = 0.01 compared to no HF). Fibrosis was not associated with VT/VF.

CONCLUSIONS

Patients with LVNC and pEF have an overall excellent prognosis, which is markedly better than those with rEF. However, there is progressive decrease in LVEF, associated with heart failure, and moderate risk of life threatening arrhythmias. Therefore, periodic follow-up should be promoted.

Table 1 LVNC pEF (n = 239) LVNC rEF (n = 252) p Men, n (%) 131 (55) 146 (58) 0.65 Median age at diagnosis (IQR) - yr 38 (23-54) 58 (42-72) 0.01 Median follow up (IQR) - yr 4.9 (2.1-7.3) 3.9 (1.4-7.9) 0.04 QRS (SD) - ms 93 (18) 117 (32) 0.01 LGE, n (%) 18 (9) 52 (30) 0.01

Abstract P1442 Figure. Image 1
P1446 Correlation of B-Type natriuretic peptide with LV and RV function assessed by echocardiography in adults congenital heart diseases patients
Authors: Kavouras C , Dimopoulos K , La Leggia A , Barracano R , Brida M , Cazzoli I , Gatzoulis M , Li W
Published: January 2020

Introduction

Brain natriuretic peptide (BNP) is a well-established marker for heart failure in the general population however limited data are available on the value of BNP as a diagnostic and prognostic marker in adults with congenital heart disease (ACHD). The purpose of our study is to evaluate the relation between BNP levels and biventricular systolic and diastolic function in patients with ACHD.

Methods

We evaluated clinically stable ACHD patients who underwent echocardiography from May 2015 until January 2018. We studied the correlation of BNP with the degree of systolic and diastolic dysfunction of the left ventricle. Moreover we also investigate the relation of BNP with the right tricuspid annular plane systolic excursion (TAPSE), the fractional area change (FAC) and the pulmonary arterial systolic pressure (PASP).

Results

In total, 385 patients were included in our study (median age, 43 ±12 years; 61% male). Of the 385 patients, 193 (50%) had tetralogy of Fallot, 94 (24%) had systemic RV, including patients with transposition of the great arteries (TGA) after atrial switch operation (Mustard or Senning) and congenitally corrected TGA -ccTGA , 43 (11%) had univentricular hearts and Fontan physiology, 55 (14%) had other lesions. BNP levels were 66 ± 26 pg/mL and 93, ±31pg/mL, for patients with EF > 50% and 50%> EF >35% respectively (p = 0.003). BNP levels correlate with parameters reflecting LV filling pressure, including transmitral early diastolic velocity (E) 81 ± 29pg/mL and its ratio to early diastolic annular myocardial tissue velocity (E/Ea) 77 ± 17pg/mL. (r=-0.607, p = 0.003 r=-0.598, p = 0.005, respectively) BNP levels were also significantly higher in patients with impaired tricuspid annular plane systolic excursion 87 ± 21 pg/mL (TAPSE < 14mm; p = 0.002) and decreased RV FAC 81 ± 18 pg/mL (FAC <35% P= 0.004) and in patients with PASP≥35 mmHg (p = 0.003). The ROC curve and logistic regression analysis spotted the role of BNP in identifying systolic and diastolic dysfunction patterns in ACHD patients. Conclusion: In clinical stable ACHD patiens BNP levels correlate well with LV systolic dysfunction as well as with impaired diastolic function. Furthermore patients with impaired RV function and increased PASP have raised BNP levels. Therefore monitoring BNP levels plays an important role in management of clinical stable ACHD patients
P1450 Pulmonary artery sarcoma mimicking as pulmonary thromboembolism for a young man: the role of multimodality imaging for diagnosis
Authors: Ereminiene R , Sakaviciute E , Ereminas R , Jankauskas A , Poskiene L , Ruminaite A , Miliauskas S , Benetis R , Ereminiene E
Published: January 2020

Patient presentation

A 33-year-old man was referred to our hospital suffering fever with shivers, dyspnea, dry cough, and weakness.

Initial work up

Symptoms appeared three weeks until hospitalization. Laboratory results showed leukocytosis and high levels of inflammatory markers. Haematological diseases were excluded, a chest x-ray showed infiltration in the lower lobe of the right lung, antibiotics were prescribed.

Diagnosis and management

When clinical and laboratory results showed no signs of improvement, chest computed tomography (CT) scan was performed and bilateral pulmonary artery thromboembolism with right lung infarct-pneumonia was diagnosed (Figure 1, 2). Treatment was supplemented with intravenous anticoagulants. In the course of treatment patient’s status worsened, respiratory failure progressed, so CT scan was performed again and showed massive pulmonary artery thromboembolism without the effect of treatment. Transthoracic 2D echocardiography showed dilated right heart chambers, relative severe tricuspid valve regurgitation, increased systolic pulmonary artery pressure (Video 1, figure 3), pulmonary artery valve masses in the stem which caused obstruction with maximum gradient about 50 mmHg(Video 2, figure 4). For a detailed workup, magnetic resonance imaging (MRI) was done, that revealed tumorous masses from pulmonary artery valve to the pulmonary trunk and right pulmonary branch (Figure 5, 6, 7). The patient underwent pulmoangiography and biopsy was taken out of the masses that suspected sarcoma. The multidisciplinary team came to a conclusion to perform surgery considering worsening patient’s status. The patient underwent pulmonary artery prosthesis implantation and right pneumonectomy (Figure 8). Masses from pulmonary artery valve were examined by pathologists, surgical specimen results showed high grade poorly differentiated pulmonary artery intimal sarcoma (Figure 9, 10).

Follow up

Early postoperative period was complicated with cardiogenic shock and respiratory failure. Despite extracorporeal membrane oxygenation (ECMO) and high doses of vasopressors patient did not survive the 2nd postoperative day.

Conclusions

Pulmonary artery sarcoma (PAS) frequently can be misdiagnosed as thromboembolism. Multimodality imaging should be considered pulmonary artery filling defects persist despite proper anticoagulation therapy for early diagnosis and better survival.

Abstract P1450 Figure 3.
P1457 Septic and aseptic valvular involvement in hypocomplementemic urticarial vasculitis syndrome
Authors: Scheggi V , Olivotto I , Alterini B
Published: January 2020

Background

Hypocomplementemic Urticarial Vasculitis Syndrome (HUVS) is a very rare disease involving small vessels and characterized by chronic urticarial vasculitis, arthralgia, arthritis, and activation of the classical complement pathway. To our knowledge, just other seven cases of HUVS with cardiac valvular involvement have been reported in the literature. Unlike previous cases, ours shows a broader antibody positivity, (but no anti-C1q antibodies) with an early and serious cardiovascular involvement.

Case summary

A 32 years old woman was brought to the emergency department because of sudden onset of right hemiplegia and global aphasia due to cerebral haemorrage.

She suffered from a severe HUVS form with cardiac valvular involvement and she was cronically treated with immunosuppressant drugs.

During previous years she had already undergone cardiac surgery twice for chronic aseptic inflammatory process involving aortic and mitral valves.

Right hemiplegia and global aphasia were caused by septic embolism to left cerebral artery complicated by cerebral haemorrage.

The patient underwent neurosurgical intervention followed by antibiotic therapy.

This condition was secondary to Listeria monocytogenes aortic infective endocarditis in an immunosuppressed patient.

Transesophageal echocardiogram showed periaortic abscess with internal colliquation.

A further surgical intervention would have been necessary, but operative risk was judged to high and the patient died one year later.

Discussion

The association between HUVS, Jaccaud"s arthropathy and cardiac valvular disease is rarely described in the literature. The presence of valvular involvement is a negative prognostic factor.

Unlike most cases, it is interesting to note that our patient was negative for anti-C1q antibodies and exhibited an extremely severe cardiac involvement.

The case was complicated by L monocytogenes endocarditis, that is also a rare condition associated with a high mortality rate.

Abstract P1457 Figure. Abscess
P1463 Severe stenosis due to obstructive prosthetic thrombosis with truevue, a new echocardiographic tool
Authors: Merino Argos C , Lopez Fernandez T , Eiros Bachiller R , Valbuena Lopez S C , Caro Codon J , Dalmau Gonzalez-Gallarza R , Dominguez Melcon F , Rosillo Rodriguez S O , Guzman Martinez G , Marco Clement I , Martin Polo L , Martinez Marin L , Rodriguez Sotelo L , Poveda Pinedo I D , Lopez-Sendon J L
Published: January 2020

A 70-year-old woman was admitted to the emergency department because of cardiogenic syncope and acute heart failure. She had a mechanical mitral prosthesis (MMP) (ATS Open Pivot 25 mm) implanted in August 2018, due to degenerative rupture of posterior leaflet. One month before admission anticoagulation was temporally interrupted due to humerus surgery. At admission, a transthoracic echocardiogram demonstrated a significant increase in MMP gradient with preserved ejection fraction and a pulmonary artery pressure of 50mmHg. To improve the assessment of MMP a transesophageal echocardiogram (TEE) was performed showing a restricted mobility of the mitral anterior prosthetic lens and a complete block of the mitral posterior lens leading to a severe mitral stenosis (mean pressure gradient 21 mmHg, peak pressure gradient 34 mmHg and peak velocity 2.9 meters/second) with a CW pattern that simulate an aortic morphology (Image 1A). MMP three-dimensional (3D) images were processed using a dedicated transillumination technology that uses a freely movable virtual light to enhance image details and depth (Image 1B and 1C). This rendering tool allows us to characterize tissue consistency and boundary delimitation, confirming the presence of a large thrombus that surrounded the entire posterior region of the prosthetic ring leading to a MMP 3D effective area of 0.49 cm2. After discussing the case with the valvular Heart Team an urgent surgery was performed to replace MMP.

This case shows how the transillumination rendering tools enhance specific image features in prosthetic cardiac valves in critical clinical scenarios as symptomatic MMP thrombosis.

Abstract P1463 Figure. Image 1
P1492 A rare case of a spontaneous rupture of a congenital inter ventricular septum diverticulum in an adult
Authors: Khalifa E A , Helmy S , Mohamed S F , Ghareep A , Alkuwari M
Published: January 2020

Introduction

A ventricular diverticulum is a rare cardiac anomaly with its true incidence is likely to be underestimated, as most patients are thought to be asymptomatic. Possible known complications include conduction abnormalities, rupture, bacterial endocarditis, and thromboembolism. We report a case of inter ventricular septum diverticulum detected incidentally in an adult during echocardiography and which ruptured spontaneously after 3 years of follow up.

Case report

A 36-year-old asymptomatic gentleman was referred for cardiac evaluation as a part of pre employment general check-up. He was controlled hypertensive on medical treatment. He had no history myocardial infarction (MI), arrhythmias, or stroke. He had never experienced exertional dyspnoea or chest pain. Physical examination was unremarkable.

Transthoracic echocardiography revealed mild left ventricle hypertrophy with normal global and regional contractility with an ejection fraction of 58%. In addition, it showed a myocardial out-pouching (11x9 mm) localized at the basal third of the posterior inter-ventricular septum and bulging into the right ventricle and moving in synchrony with the rest of the left ventricle with no shunt (figures A&B&C).

The patient’s history allowed us to exclude a post-ischemic LV aneurysm and an infective genesis of the lesion.

Contrast enhanced EKG gated cardiac computed tomography confirmed the presence of a blind ended diverticulum of the interventricular septum which was stretching and protruding into the right ventricle. The septum and the diverticulum were intact with no evidence of associated septal defects, (figures D&E&F).

Three years later, during his regular follow up, a loud pan-systolic murmur was heard along the left sternal border. His repeated echocardiographic study revealed a rupture of the inter ventricular septal diverticulum into the right ventricle, with a left to right shunt of a peak systolic gradient of 71 mmHg, (Fig G). His blood pressure was 100/60.

Cardiac magnetic resonance confirmed the rupture of the interventricular septum diverticulum. It revealed a tiny defect with a left to right shunt and the calculated QP/QS was 1.3, (fig H&I).

As the patient was asymptomatic and the shunt was insignificant, the decision was made to be managed conservatively and not to intervene with surgery at this point. This was to avoid the potential of surgical complications as disruption of the patient’s conduction system and the chance of post-operative arrhythmia.

Abstract P1492 Figure.
P1500 Reptilian heart in a man
Authors: Ozpelit E O , Ozcan E E O , Ozpelit M E O , Ozgul N O
Published: January 2020

40 year old man admitted to hospital due to tachycardia episode. His normal ECG was consistent with RBBB with a QRS duration of 200msec. He had undergone a VSD operation when he was 6. He had a 3/6 systolic murmor . On TTE, there was a VSD patch and a residual tiny VSD with a L-R shunt. The maximum systolic gradient of VSD shunt was measured as 92mmHg .There was also moderate tricuspid regurgitation (TR) with a peak velocity of 5.1m/sec and estimated sPAP of 103mmHg. Considering the measured sPAP and the VSD shunt gradients, his systolic blood pressure (SBP)should approximately be equal to sum of those two ( 103+ 92 = 195mmHg). However his BP was 140/90mmHg.When we examined his heart for a possible explanation for this inconsistency, we noticed a systolic aliasing inside the RV with a maximum velocity of 3.1m/sec and systolic gradient of 38mmHg. However the chamber with lower pressure (P) was the one to which the VSD shunt was directed, and this chamber was in direct continuity with pulmonary artery. So to confirm the P in this chamber we also used pulmonary regurgitation flow and measured a peak diastolic velocity of 3.8m/sec, meaning a mean PAP of 60mmHg .Cardiac catheterization also confirmed a sPAP of 116mmHg and mPAP of 65mmHg. The systolic aortic P was 145mmHg and systolic LV P was 152mmHg. So the unexpectedly high gradient of VSD shunt was still a mystery for us. While searching the literature to explain this , we noticed that the patients’ heart was resembling the reptilian heart model. The reptilian heart has two atria and one ventricle with 3 segments seperated via muscular ridges. In our patients’ heart ,the small chamber with high P in the RV was the cavum venosum, the larger chamber of RV with VSD was the cavum pulmonale, and the left ventricle was the cavum arteriosum. (Fig) The reptilian hearts typically have noncompacted myocardium which was actually the case in our patient. The reptilian hearts also have unique conduction system with no AV node and His bundle, and slow depolarization of ventricle from left to right. When we performed EPS, we found that the patient had no AV node and His bundle. Bringing together all these findings, we conclude that the patient has a reptilian heart with all anatomical, electrical and physiological features. And the answer to the mystery of inconsistent P recordings was hidden in ECG. The RBBB with very long QRS duration causes a delay between contraction of ventricles resulting in a dynamic P gradient between ventricles. We demonstrated this dinamic bidirectional shunt on CW recording when we obtained a more optimal recording of the shunt flow.This case demonstrates us one more evidence of human evolution; arising from single cell and developing to fish, to reptiles and to mammals. The evolution takes place again and again during neonatal life. If there is an embryological arrest, as occured in our patient, we can easily see the clues of this amazing human evolution.

Abstract P1500 Figure
P1521 Prosthetic heart valve-related stroke: a single center experience
Authors: Almaghraby A , Abdelnabi M , Saleh Y , Abdelkarim O , Ozden Tok O , Laymouna R , Shehata H , Shehata M , Badran H
Published: January 2020

OnBehalf

YIG-CVR

Introduction

Thromboembolic events or bleeding are by far the most frequent complications of prosthetic heart valves. Cerebrovascular stroke is one of the major thromboembolic complications of anticoagulation-related issues of prosthetic heart valves.

Aim of the work

To determine the pattern and risk factors of acute stroke in patients with prosthetic heart valves.

Methods and Patients

A retrospective single-center analysis of the database registry of consecutive acute stroke patients with mitral or aortic heart valve prostheses admitted to a tertiary care stroke specialized center from 01/01/2012 to 01/12/2017.

All patients were examined by a certified neurologist and underwent a complete work-up evaluation (Computed Tomography or Magnetic Resonance Imaging, Carotid Doppler ultrasound examination, complete blood tests, and electrocardiogram) and a transthoracic echocardiography (TTE) examination as well as transesophageal echocardiography (TOE) if valve dysfunction or thrombosis were suspected.

Results

214 patients with mitral or aortic valve prostheses were admitted by acute stroke in the duration from 01/01/2012 to 01/12/2017 with a mean age of 44 ± 15 years, 132 were males (61.7%) and 178 patients had mechanical valves (83.2%). 135 patients had mitral prosthesis (63.1%) and ischemic stroke was encountered in 151 patients (70.6%).

Conclusion

In a single center experience, mechanical prosthesis at the mitral valve position was associated with higher incidence of ischemic stroke. Proper close follow-up of INR levels as well as the surgical shift to biological instead of mechanical valve should decrease significantly the incidence of prosthetic valve related strokes.

Baseline, clinical and other parameters Patients (n = 214) Age (years) 44 ± 15 Mechanical valve 178 (83.2%) Atrial Fibrillation 101 (47.2%) Rheumatic Heart Disease 175 (81.8%) Left ventricular ejection fraction (%) 54 ±13 Mitral Only 135 (63.1%) Aortic Only 51 (23.8%) Double Valve Prosthesis 28 (13.1%) Ischemic stroke 151 (70.6%) Hemorrhagic stroke 47 (22%) Both ischemic and hemorrhagic stroke 16 (7.4%) Data are represented as mean(±SD) or number (Percentage)

Abstract P1521 Figure. Valve sites