bluuebunny/crossref_metadata_2025 huggingface dataset:
P848 A novel grape-derived prebiotic selectively enhances abundance and metabolic activity of butyrate producing bacteria in faecal samples of inflammatory bowel disease
Authors: Oliver L , Ramió-Pujol S , Amoedo J , Malagón M , Serrano M , Bahí A , Lluansí A , Busquets D , Leyanira T , Serra-Pagès M , Aldeguer X , Jesús G G
Published: January 2020

Background

Inflammatory Bowel Disease (IBD) is a clinical condition of the gastrointestinal tract of unknown aetiology. The two main forms of IBD are Crohn’s disease (CD) and Ulcerative colitis (UC). Recently, it has been reported that the bacterial communities present in the colon of patients with IBD are structurally different compared with those in healthy individuals. This particular dysbiosis consists of a decrease of butyrate producing bacteria and an increase of the pro-inflammatory species. The goal of this work was to test a new prebiotic of selected dietary fibre made from grape for its capacity to balance the dysbiosis typically found in patients with intestinal disorders.

Methods

Faecal samples from 16 healthy subjects and 11 IBD patients (5 CD and 6 UC) were collected by the Hospital Universitari Dr. Josep Trueta. Fresh stool samples were incubated with 200 mg, 600 mg of prebiotic, and 200 mg of apple pectin. A negative control without substrate addition was also performed. The tubes were incubated under continuous stirring for 72 hours at 37 ºC in semi-anaerobic atmosphere. Total DNA was extracted and the abundances of butyrate-producing bacterial markers (Faecalibacterium prausnitzii, and its phylogroups I and II, Roseburia hominis and Subdolinogranulum variabile) were analysed by qPCR. Concentrations of both butyrate and acetate were determined by gas chromatography as an indication of the bacterial metabolic activity.

Results

A significant increase of butyrate producing species, such as S. variabile, R. hominis and F. prausnitzii was observed in CD and UC samples when incubated with 200 mg of prebiotic compared with the negative control. F. prausnitzii phylogroup II, which is underrepresented in UC patients, also increased. No differences were found when samples were incubated with 600 mg. Regarding apple pectin, the increase on the abundance of butyrate producing bacteria was higher than the prebiotic in UC samples. In samples from healthy subjects, an increase in the butyrate producing species abundances was observed in both concentrations of prebiotic when compared with the negative control. In those samples no differences were observed when comparing apple pectin with the prebiotic. Concerning butyrate and acetate production, these substances increased in all prebiotic-supplemented samples when compared with the negative control.

Conclusion

The studied prebiotic causes an increase of the abundance and activity of butyrate-producing bacteria in both IBD patients and healthy subjects. These results points to this new dietary fibre as a promising prebiotic to maintain eubiosis and to promote the microbiota restoration of the intestinal mucosa.
38 Prognostic validation of partition values obtained with conventional two-dimensional and doppler echocardiography to grade tricuspid regurgitation severity
Authors: Previtero M , Guta A C , Ochoa-Jimenez R C , Figliozzi S , Palermo C , Baritussio A , Cecchetto A , Aruta P , Iliceto S , Badano L P , Muraru D
Published: January 2020

Background

Morbidity and mortality associated with severe tricuspid regurgitation (TR) have prompted interest in new corrective transcatheter procedures. However, to properly select patients for interventional procedures, and to assess their effectiveness, a reliable and reproducible grading system of TR severity is mandatory. However, the cut-off values used by current guidelines to differentiate among mild, moderate and severe TR lack clinical validation.

Purpose

We aimed to obtain the threshold values of the currently recommended quantitative echocardiographic parameters used to grade TR severity using pts’ outcome as a reference.

Methods

296 pts, with at least mild TR and complete 2D, 3D and Doppler echocardiographic study, were enrolled and assessed for potential confounders: age, NYHA class, left ventricular ejection fraction, coexistent valvular heart disease and right ventricular (RV) systolic pressure. Average diameter of the vena contracta (VCavg), effective regurgitant orifice area (EROA), regurgitant volume (RVol) and regurgitant fraction (RF) were obtained to grade TR severity. Median follow-up was 47 (17-80) months. The primary composite endpoint was the occurrence of death of any cause or hospitalization for right heart failure (RHF). Survival curves for the composite endpoint were divided in quartiles at median follow-up. Cut-off values for the echo parameters were derived to grade mild (below the 1st quartile), moderate (between 1st and 3rd quartiles), and severe (above the 3r quartile) TR.

Results

33 deaths and 72 hospitalizations for RHF occurred. Event-free rate from death or RHF at the end of follow-up was 14%, 46% and 93% in pts with severe, moderate, and mild TR, respectively. Differences reached statistical significance early (at 1 month), and lasted during the whole follow-up period (Figure). The new threshold values for mild, moderate and severe TR are summarized in Table.

Conclusions

Partition values of quantitative echo-Doppler parameters used to grade mild, moderate and severe TR according to pts’ clinical outcome are significantly lower than those currently reported in guidelines. Further studies are needed to test if these new threshold values for severe TR will translate in earlier referral of pts to valve repair and improved prognosis.

Mild Moderate Severe VCavg <3 mm 3-6 mm >6 mm EROA <0.15 cm² 0.15-0.30 cm² >0.30 cm² R Vol <15 ml 15-30 ml >30 ml RF <25% 25-45% >45%

Abstract 38 Figure.
103 Normal values and gender differences of left atrial volumes
Authors: Selmer Roenningen P , Berge T , Solberg M G , Enger S , Nygaard S , Pervez O , Orstad E B , Kvisvik B A , Aagaard E N , Lyngbakken M N , Rosjo H , Tveit A , Steine K
Published: January 2020

Funding Acknowledgements

Vestre Viken Hospital Trust

Background

Left atrial (LA) enlargement is associated with cardiovascular morbidity and mortality. Echocardiographic guidelines recommend body surface area (BSA) indexed LA end-systolic volume (LAVimax) in the assessment of LA size with an upper normal limit of 34 ml/m² for both genders and all age groups. LA end-diastolic volume (LAVimin) and LA emptying fraction (LAEF) may add valuable information in risk assessment, but there are limited data on normal values.

Purpose

To add knowledge and explore gender differences of LA volumetric measures.

Methods

In The Akershus Cardiac Examination 1950 Study, all inhabitants of Akershus County, Norway, born in 1950 were invited. In 3,489 individuals LAVmax and LAVmin were measured with echocardiography according to the summation of discs method and indexed to BSA. LAEF was calculated. A healthy group was defined by excluding those with heart failure, atrial fibrillation, coronary artery disease, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, body mass index > 30kg/m², eGFR < 60 ml/min/1.73 m², left ventricular ejection fraction < 50%, E/e’>14 and E/A > 2.0. Data are presented as mean ± standard deviation (SD) and a normal range of mean ± 2SD. T-tests were used for comparisons.

Results

In 840 healthy individuals, aged 63.8 ± 0.6 years, mean LAVimax was 25.6 ± 6.3 ml/m² and the normal range was 13.0-38.2 ml/m². Men had significantly larger volumes than women.

Conclusion

We present LA volumes and LAEF in a large cohort from the general population at age 64. The upper normal limit of LAVimax in 840 healthy individuals was 38 ml/m². Men had larger LA volumes than women, contrary to most previous studies. Thus, 13% of the healthy men in our cohort would be defined with an enlarged atrium with the current cut-off value at 34 ml/m².

Table. Left atrial (LA) volumes and LAEF Total (mean ± SD) Total (2SD range) Male (mean ± SD) Female (mean ± SD) P-value (male vs. female) All participants (n = 3489) LAVimax (ml/m²) 26.8 ± 7.6 11.6-42.0 27.9 ± 8.1 25.6 ± 6.8 <0.001 LAVimin (ml/m²) 14.7 ± 5.8 3.1-26.3 15.5 ± 6.5 13.9 ± 4.9 <0.001 LAEF (%) 45.6 ± 9.7 26.2-65.0 45.3 ± 10.2 45.9 ± 9.2 0.07 Healthy group (n = 840) LAVimax (ml/m²) 25.6 ± 6.3 13.0-38.2 26.6 ± 6.7 24.9 ± 5.8 <0.001 LAVimin (ml/m²) 13.7 ± 4.3 5.1-22.3 14.1 ± 4.6 13.3 ± 3.9 0.008 LAEF (%) 46.8 ± 8.8 29.2-64.4 47.0 ± 9.1 46.5 ± 8.4 0.37 LAVimax, LA end-systolic volume, body surface area (BSA)-indexed; LAVimin, LA end-diastolic volume, BSA-indexed; LAEF, LA emptying fraction; SD, standard deviation
P178 Dissecting ventricular septal hematoma; a rare complication of acute myocardial infarction
Authors: Etman I , Abdelgawad H
Published: January 2020

Ischemic heart disease is the single most common cause of mortality worldwide despite the widespread use of reperfusion. The in-hospital mortality rates of unselected patients with STEMI in national European registries vary between 4–12%.Although the incidence of mechanical complications has declined, these adverse events are still inevitable and constitute one of the major causes of death in the early phase after myocardial infarction. Dissecting interventricular hematoma is a rare life threatening mechanical complication following myocardial infarction. The resultant bleeding dissects along a plane beneath the endocardium.

Case presentation

A 57 year old male patient presented to the emergency room complaining of acute stabbing retrosternal chest pain radiating to both shoulders associated with nausea and vomiting that started 2 hours before presentation. He was known to be smoker and diabetic and had uncontrolled hypertension.

Vital signs were stable and physical examination was unremarkable . Electrocardiography (ECG) revealed normal sinus rhythm at 80 bpm, 5 mm ST elevation in leads I, aVL, V1-V6, reciprocal ST depression in leads II, III,aVF. The patient received thrombolytic therapy within 15 minutes of presentation and it was uneventful. Follow up electrocardiography was done showing failed thrombolytic therapy. The patient was managed conservatively using dual antiplatelets, high dose atorvastatin, beta blockers, ACE inhibitors. The patient remained hemodynamically stable for 5 days after which he developed respiratory distress , heart rate was 110 bpm, blood pressure was 100/60 mmHg. Physical examination revealed clear chest ,S3 gallop. 2D/ 3D transthoracic echocardiography revealed akinesis of the apical segments and mid segment of the anterior septum. There was a dissecting hematoma seen starting at mid anterior septum and extending to the apical segment.Severe mitral valve regurgitation was seen.

Conclusion

Dissecting interventricular hematoma(DIH) is a rare yet underrecognized mechanical complication following STEMI. Transthoracic echocardiography is considered to be an important imaging modality for the bedside diagnosis.

Treatment depends upon the rate of expansion of hematoma. Accordingly, stable patients with hematoma regressing gradually does not require any intervention .However, cases with rapidly expanding hematoma with hemodynamic instability will require urgent surgical intervention.

Abstract P178 Figure. Dissecting interventricular hematoma
P207 Adjunctive application of handgrip exercise associated with rapid pacing stress echocardiography in patients with implanted pacemakers
Authors: Gosciniak P , Puzik T , Leciej M , Plonska E
Published: January 2020

The aim

Assessment of safety, diagnostic, and prognostic value of a stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers and concomitant handgrip dynamometer method. There are no data in the literature on this type of modification of the stress test.

Methods

Rapid pacing stress echo tests with further handgrip were performed in 54 patients (33 females, aged 49-88, mean 72 +/- 8 years), using previously implanted permanent pacemakers. Left ventricular segmental contractility was assessed at rest, during 3 minutes pacing at the rate of 100/minutes, over 5 minutes at 85% of maximal age-predicted heart rate and then further at peak stage per 1 minute with the addition of a handgrip (compression of the dynamometer with a force equal to half the maximum strength of the patient measured before the test). The test was performed using only VVI pacing mode in 16 patients in whom atrial pacing was not possible. In the remaining 38 patients AAI/DDD pacing mode was initially used.

Results

No severe adverse effects were observed. Significant increase in heart rate comparing to baseline was achieved [74/minutes vs. 127/minutes (P < 00001)]. Wall motion score index increased significantly (from 1.07 vs. 1.15, p < 00001). During the handgrip stage, both systolic (p < 0.0005) and diastolic (p < 0.0001) blood pressure significantly increased. Among all surveys, 18 (33%) were considered positive, 36 (67%) negative. All the examinations were diagnostic. In 35 patients coronary angiography was performed (15 pts with test positive and 20 pts with test negative). Sensitivity, specificity, accuracy, positive, and negative predictive values for significant coronary stenosis were respectively: 61.6%, 68.2%, 65.3%, 53.3%, and 75%. For patients with DM2 the above values were: 83.3%, 85.7%, 84.6%, 83.3%, 85.7%. No statistical differences were observed depending on the type of the device or the use of beta blockers In patients with LMA stenosis test sensitivity was - 100%, with LAD – 62.5%, with CX - 75% and with RCA was 71.5%. Revasculization was required in 8 patiens with test positive and 3 with test negative (p = 0.01). During 6-moth follow-up there was no cardiac death, myocardial infarction or stroke .

Conclusions

The sensitivity and specificity of the stress test using the pacemaker and the handgrip method for all patients proved to be lower than the values obtained in other stress tests. However, the use of the handgrip method during stimulation caused an increase in mean systolic and diastolic blood pressure. Such an extension makes the pacing stress echo test more physiological. Moreover the stress test using pacemaker and handgrip method proved to be safe and well-tolerated by patients. The prognostic value of the negative result of the study research using stimulation from the patient"s pacemaker and the handgrip method was high in the 6 month follow-up
P230 Pulmonary embolism due to hepatocellular carcinoma: A rare presentation
Authors: Hassan Abdelnabi M , Saleh Y , Almaghraby A , Tok O , Shehata H , Abdel Samad S
Published: January 2020

Introduction

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors and the second leading cause of cancer-related deaths. HCC is a highly progressive cancer with a high rate of metastasis. Intra-cardiac involvement with HCC is quite rare with a very poor prognosis. Acute pulmonary embolism is a very rare presentation of hepatocellular carcinoma (HCC) complicated with tumor thrombi into the inferior vena cava (IVC), right atrium (RA) and right ventricle (RV) with very poor reported prognosis.

Case presentation

A 72-years old hepatitis C virus (HCV) positive male patient for 20 years but he didn’t receive any treatment. He was admitted at our medical faculty with decompensated liver failure and resolved hepatic encephalopathy. He started complaining of acute onset of dyspnea. On clinical examination, he was tachypneic, tachycardic with thready pulse, distressed with deep icteric tinge. He had a massive ascites and bilateral lower limb pitting oedema. His electrocardiogram (ECG) showed sinus tachycardia. Urgent transthoracic echocardiography (TTE) revealed a large solid mass extending through the IVC to RA (Figure 1 Panel A) with another highly mobile cauliflower mass at the RV apex occupying the RV cavity, protruding into RA through TV and nearly obliterating RVOT into pulmonary artery. (Figure 1 Panel B, C, D). Due to patient’s frailty and hazards of contrast medium in an already impaired renal status of him, no further contrast study was performed. Only conservative and supportive measures were initiated for the management of his deteriorated general condition but unfortunately, he passed away shortly after.

Conclusion

Cardiac involvement in HCC rarely occurs and usually develops in advanced stages of HCC. The main mechanism of metastasis into the cardiac cavity is through a direct vascular extension of the tumor to the right side via hepatic vein and IVC. Acute pulmonary embolism in the setting of HCC is a quite rare manifestation of HCC that usually occur due to tumor thrombi in the IVC, RA and RV. The reported prognosis of HCC with intra-cardiac involvement is very poor, with a mean survival of 1 to 4 months at the time of diagnosis.

Abstract P230 Figure. TTE of HCC invading RVOT
P1582 Outcomes, predictors and treatment of intraatrial reentrant tachycardias in Adult with Congenital Heart Disease
Authors: Cambronero Cortinas E , Moratalla-Haro P , Gonzalez-Garcia A E , Avila-Alonso P , Bret-Zurita M , Rivero-Jimenez N , Peinado-Peinado R , Oliver-Ruiz J M
Published: January 2020

Introduction and objectives

Atrial tachycardia (AT) is a major late complication in congenital heart disease (CHD) after surgery. These arrhythmias arise between areas of anatomical barriers or in fibrotic tissue/scars. In our study we examined the clinical predictors of AT.

Methods

A retrospective study of cases and controls in adult patients with CHD was performed. We have included consecutively 71 patients with AT and 71 controls matched by gender, age and type of CHD located in the same database. Medical records, electrocardiograms and echocardiograms were reviewed. Multivariate analysis of the risk factor (logistic regression) and analysis of adverse cardiovascular events (Kaplan-Meier) were performed.

Results

Systolic pressure of subpulmonary ventricle ≥40mmHg (HR:7, 95%CI:2.4-18, p = 0.001), right atrium (RA) dilatation≥21cm2 (HR:3, 95%CI:1.2-7.6, p = 0.005), significant tricuspid regurgitation (HR:4, 95%CI:1.3-10, p = 0.018) were identified as main risk factors for AT. Patients with AT had worse outcomes with more major adverse cardiovascular events (86% vs 14%, P = 0.006), and a 58% free survival events compared to 98% of patients without AT at 8 years of follow-up (p = 0.01). The treatment of the first episode of AT was electrical cardioversion (38%), pharmacological cardioversion (13%), heart rate control (20%). Antiarrhythmic treatment was not been given in 30% of the patients 73% of them had percutaneous ablation as first choice treatment. Ablation was performed in 40 pacientes and 6 patients have recurrences. In total, 24 patients have recurrences of AT. Previous Maze (OR 9 (IC al 95% 1.5, 50), p = 0.016) and surgical paliative shunt (OR 21 (IC al 95% 2.3,192), p = 0.007) were identified as main risk factor for AT recurrences.

Conclusions

The main risk factors identified for AT were RA dilatation, raised systolic pressure of subpulmonary ventricle and significant tricuspid regurgitation. The main risk factors for AT recurrences were previous Maze and surgical paliative shunt. Early treatment of these arrhythmic problems is mandatory in order to improve the prognosis in this group of patients.

Abstract P1582 Figure. Central illustration of AT in CHD
P1585 Cardiac magnetic resonance estimated extracellular volume fraction, but not native T1 mapping, detects scar in patients referred for cardiac resynchronization therapy
Authors: Kjellstad Larsen C , Duchenne J , Galli E , Aalen J M , Kongsgaard E , Lyseggen E , Sirnes P A , Bogaert J , Linde C , Penicka M , Donal E , Voigt J-U , Smiseth O A , Hopp E
Published: January 2020

Funding Acknowledgements

The study was supported by Center for Cardiological Innovation

Background

Myocardial scar burden (focal fibrosis) is associated with poor response to cardiac resynchronization therapy (CRT), and should preferably be detected prior to device implantation. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is considered reference standard for scar detection, but is not available in renal failure. Diffuse fibrosis is assessed by T1 mapping CMR with or without calculation of extracellular volume fraction (ECV). The method is vulnerable to partial volume effects, thus subendocardial tissue is most often not included in mapping analyses. Whether the contrast-free native T1mapping could replace LGE in the preoperative evaluation of patients referred for CRT is unknown.

Purpose

To investigate if native T1 mapping and calculation of ECV can adequately detect scar in patients referred for CRT.

Methods

Scar was quantified as percentage segmental LGE in 45 patients (age 65 ± 10 years, 71% male, QRS-width 165 ± 17ms) referred for CRT. In total 720 segments were analyzed, and LGE≥50% was considered transmural scar. T1-mapping before and after contrast agent injection was performed in all patients. ECV was calculated based on the ratio between tissue T1 relaxation change and blood T1 relaxation change after contrast agent injection, corrected for the haematocrit level. The agreement between native T1/ECV and scar was evaluated with receiver operating characteristic (ROC) curves with calculation of area under the curve (AUC) and 95% confidence interval (CI).

Results

LGE was present in 255 segments, 465 segments were without LGE. Average native T1 in segments with LGE was 1028 ± 88 ms, and 1040 ± 60 ms in segments without LGE (p = 0.16). The corresponding numbers for ECV were 38.7 ± 10.9% and 30.0 ± 4.7%, p < 0.001. Native T1 showed poor agreement to scar independent of scar size (AUC = 0.532, 95% CI 0.485-0.578 for scars of all sizes, and AUC = 0.572, 95% CI 0.495-0.650 for transmural scars). ECV, on the other hand, showed reasonable agreement with scar of all sizes (AUC = 0.777, 95% CI 0.739-0.815), and good agreement with transmural scars (AUC = 0.856, 95% CI 0.811-0.902). (Figure)

Conclusion

The contrast-free CMR technique T1 mapping does not adequately detect scars in patients referred for CRT. Adding post contrast T1 measurements and calculating ECV improves accuracy, especially for transmural scars. Future studies should investigate if diffuse fibrosis could be predictive of CRT response.

Abstract P1585 Figure. Detection of transmural scars
P1589 Yield of invasive coronary angiography following the UK NICE 2016 guideline expansion of CT coronary angiography
Authors: Fyyaz S , Hudson J , Olabintan O , Katsigris A , David S , Plein S , Alfakih K
Published: January 2020

The UK National Institute of Health and Care Excellence (NICE) updated chest pain guidelines in 2016 and recommended CT coronary angiography (CTCA) as the first line investigation for all patients presenting with new stable chest pain and the removal of the pre-test probability risk scoring. There is a concern that using CTCA in populations with higher likelihood of coronary artery disease (CAD), can lead to higher rates of downstream testing with invasive coronary angiography (ICA). We implemented the NICE 2016 guideline and audited the downstream testing after CTCA. We also evaluated the performance of the ESC risk score (ESC RS).

Methods

We undertook a retrospective search of the radiology database from January 2017 to June 2018. CTCA reported CAD degree of stenosis as normal/minimal stenosis, mild (30-50%), moderate (50-70%), or severe (>70%).

Results

In total 652 patients underwent CTCA (mean age 55 yrs; 330 male). 92 patients were found to have moderate or severe stenosis. 69 of them were referred directly to ICA, with 63 undergoing ICA and confirming severe CAD in 40 patients, a yield of 63%. 18 patients with moderate stenosis were referred for stress echo (SE) with one positive result. In total 35 patients went on to be revascularised.

62 patients were found to have mild stenosis. The majority of patients (n = 462) had normal/minimal stenosis. There were 36 inconclusive studies.

The ESC RS was calculated retrospectively with the following results:

70 patients had an ESC RS <15% and 2 (3%) were found to have moderate stenosis. 427 patients had an ESC RS 15-50%; 17 (4%) had severe stenosis and 32 (8%) moderate stenosis. 149 patients had an ESC RS 50-85%; 17 (11%) were found to have severe stenosis and 23 (15%) moderate stenosis. Lastly 2 patients had an ESC RS >85% and one had moderate stenosis.

Conclusions

Our results demonstrate that CTCA is an effective first line test for most patients with new stable chest pain as the majority were found to have normal/minimal disease. In the patients that went on to have ICA, CTCA had a relatively high yield of detecting severe CAD (63%). This was achieved with some use of SE as a gatekeeper to ICA, particularly in patients with moderate CTCA stenosis. SE should be used more after CTCA in patients with moderate stenosis, as a gatekeeper to ICA.

The ESC RS was predictive of significant CAD but overestimated the likelihood of CAD.

Abstract P1589 Figure. Severe CTCA stenosis of the LAD
P1599 Longue term outcome after surgical repair of complete atrioventricular septal defect: 2D versus 3D echocardiographic evaluation
Authors: Ciuca C , Angeli E , Careddu L , Di Dio M , Petridis F , Ragni L , Hasan T , Donti A , Gargiulo D , Balducci A
Published: January 2020

Purpose

Assessment of longue term follow-up after surgical repair of Complete Atrioventricular Septal Defect (cAVSD). Evaluation of 3D versus standard 2D echocardiographic accuracy during the last follow-up.

Methods

43 patients were included in this study. Mean age at surgical repair was 7 months, 48.8% of patients were male; 67.4% had Down Syndrome. Mean time follow-up was 13 ± 6 years. During the last follow-up 2D and 3D echo evaluation were performed.

Results

All patients were alive and had a NYHA class I at the last follow-up. Survival free from new cardiac surgery at 13 years was 86%. During follow-up a progressive moderate to severe/severe mitral regurgitation (MR) was observed in 6 patients (16.3%) while 4 patients developed a progressive left ventricular outflow tract obstruction (LVOTO); overall 5 patients underwent new cardiac surgery (3 for MR and 2 for LVOTO). Echocardiographic evaluation showed: LV end diastolic volume 55.7 ± 13.0ml/m2, LV ejection fraction 64 ± 5%, left atrium volume 24.9 ± 13.9ml/m2, right ventricle systolic pression 21.0 ± 2.0 and a LVOT gradient 14.6 ± 16.4 mmHg. Mitral valve evaluation is evidenced in Table 1. Predictor factors of severe MR during follow-up were the cleft area and depth and the presence of anterior leaflet prolapse. Cohen’s kappa evidenced a good correlation between 2D and 3D VC evaluation with a higher sensibility of 3D evaluation to identify severe MR, data confirmed by the ROC curve analysis (Figure A and B).

Conclusions

Clinical outcome after cAVSD surgical repair is excellent with a low rate of reintervention. 3D echo evaluation is more sensitive to identify both predictors and severity of MR ì.

LAST Follow-up echocardiography 2D evaluation 3D evaluation Mitral Valve evaluation Vena contracta, mm 4.8 ± 2.5 5.3 ± 2.5 Regurgitant volume, ml 25 ± 20 ERO, cm2 0.17 ± 0.13 Mean gradient, mmHg 4 ± 2.4 Residual cleft, n(%) A1 A2 A3 30 (90.7) 4 (9.3) 33 (76.8) 6 (13.9) Cleft area,cm2 0.19 ± 0.21 Cleft depth, mm 5 .0 ± 2.9 Valve thickening, n(%) 14 (13.6) Leaflet Prolapse, n (%) Anterior Leaflet Prolapse, n (%) Posterior Leaflet Prolapse, n (%) 30 (69.7) 25 (58.1) 10 (23.2) Single papilary, n(%) 10 (23.2)

Abstract P1599 Figure.
1640 Pulmonary valve in carcinoid disease: be suspicious of functional assessment
Authors: Gamarra Lobato A L , Rojas A M , Cecconi A , Dominguez L , Benedicto A , Diego G , Nogales M T , Monguio E , Munoz D , Perich J , Montes A , De Rueda C , Jimenez C , Jimenez L J , Alfonso F
Published: January 2020

Carcinoid heart disease occurs in 50% of patients with carcinoid syndrome, especially on serotonin-secreting neuroendocrine tumors (NET) [1, 2]. Carcinoid heart disease"s typical findings are carcinoid plaques, composed of smooth muscle, myofibroblasts and endothelium. These plaques, most frequently localized on the right side valvular cusps and leaflets, produce fixation and retraction, causing regurgitation and/or stenosis [3, 4, 5]. Left-sided heart disease is rare (<10%), as serotonin is purified in the pulmonary circulation [3, 6, 7].

We present the case of a 67 year old female patient with previous history of right ovarian NET. She presented with dyspnea (II-III NYHA functional class), and slight edema in lower limbs. She denied symptoms of carcinoid syndrome before or after the ovarian surgery.

Examination showed an increased jugular venous pulse.

Transthoracic echocardiography (TTE) showed severely dilated right cavities and a rigid, immobile tricuspid valve, with massive tricuspid regurgitation (Panel A, 1). Anatomy of

pulmonary valve was not properly visualized but jet area of pulmonary regurgitation was small (Panel A, 2). Left cavities and valves were intact.

As TTE was not anatomically conclusive, a cardiac magnetic resonance (CMR) and a cardiac computed tomography (CCT) were performed to assess the carcinoid involvement of pulmonary valve.

CMR showed severely dilated right ventricle with mild impairment of systolic function (Panel A, 3). Based on phase contrast imaging, pulmonary regurgitation fraction was 14%,

suggestive of a mild grade. However, CCT showed a diffuse thickening of the pulmonary valve, with complete opening during diastole (Panel A, 4, arrowhead). Finally, the patient underwent replacement of tricuspid valve and pulmonary valve for biological prosthesis without complications.

Our case is remarkable because it highlights the limitations of the functional assessment of pulmonary regurgitation in the presence of a concomitant massive tricuspid valve regurgitation, since the rapid equalization of pressure between pulmonary artery and right ventricle reduces the expression of pulmonary regurgitation. For these reason, the anatomic assessment of the pulmonary valve is mandatory to stage the involvement of pulmonary valve in carcinoid disease.

Abstract 1640 Figure. Panel A
1644 Unusual management of dislodged TAVR prosthesis, Nightmare in Cath lab
Authors: Alnabti A , Abushahba G , Abujalala S , Khalifa E , Alkhulaifi A M , Carr C
Published: January 2020

Introduction

The Trans aortic valve replacement( TAVR) is well established technique that is basically designed for patient with sever aortic stenosis with high surgical risk.

We describe a TAVR procedure was complicated with valve dislodgment and treated without surgical intervention

Case report

75 year old Female Patient hypertensive, diabetic, Hypothyroidism and Atrial Fibrillation on oral anticoagulation.

Her transthoracic echocardiography(TTE) showed sever critical aortic valve stenosis and calculated aortic valve are was 0.6 cm² and Peak gradient is 68mmhg and mean 46 mmHg , sever Left ventricular dysfunction and estimated EF 25 % .

The CT Aortogram showed

The aortic annulus maximum transverse diameter measures was 30 mm and the anteroposterior diameter was 25 mm. The sinus of Valsalva measures 37 mm was Sino tubular junction measures 24 mm and the proximal ascending aorta measures 39 mm.

There is no evidence of coronary artery disease by the CT coronary angiogram.

Because of depressed LV function, it was decided to do the TAVR with ECMO (Extra Corporeal Membrane Oxygenation) support. Based on CT measurements, CoreValve29 was selected

The native valve is pre dilated then CoreValve29 was advanced. Unfortunately valve was larger than the aortic annulus and during trial to valve deployment ( Fig A) ,valve jumped into proximal ascending aorta in opining position just few centimeters from coronary ostium ( Fig B).

We advance balloon for maximum dilatation of core valve 29 to ensure fixation of valve in ascending aorta and complete opening of valve leaflets.

A second smaller valve (coreValve26) was advanced through the dislodged valve and crossing through its leaflet of first core valve (which settled in aorta) and successfully reaches the aortic annulus and confirming proper positioning of the coreValve26 and then deployed safely

The coreValve26 was deployed in acceptable position and coreValve29 was hooked and well-fixed to 26 valves in proximal ascending aorta (Fig C).

Coronary flow was secured and confirmed by aortic root injection (Fig F).

Patient kept supported on ECMO before and during the TAVR procedure.

The patient tolerated the procedure and was stable hemodynamically throughout the procedure.

Successful ECMO weaning and patient hemodynamically remained stable with Total bypass time on ECMO was 142 minutes.

Post procedure chest X ray showed two corValves hooked together in aortic root and ascending aorta in (Fig D).

Follow up TTE showed improved EF systolic LV function (EF 39 %). Normal functioning aortic valve prosthesis.

Conclusion

Up to our knowledge, this is the first case that valve dislodgment was treated percutaneously not required urgent surgical intervention.

Although it is one case report, however it could open the ideas for new approach how to manage difficult cases with dislodged valve with percutaneous approach.

Abstract 1644 Figure.
1676 Prediction of different causes of mortality by exercise echocardiography in women
Authors: Peteiro Vazquez J C , Bouzas-Mosquera A , Pertega S , Barbeito-Caamano C , Broullon F J , Vazquez-Rodriguez J M
Published: January 2020

Exercise echocardiography (ExE) can predict overall and cardiovascular mortality. We aimed to assess the value of ExE for the prediction of cardiovascular (CV), cancer (CA) and non-cardiovascular non-cancer (NCV-NCA) death in women.

Methods

Retrospective analysis of prospectively collected data on 4,714 women (age 64 ± 11 years) with a first treadmill ExE performed in our center for known/suspected coronary artery disease. Exclusion criteria were significant valve disease, cardiomyopathy, congenital heart disease, and age <18 year-old. Ischemia was defined as the development of new wall motion abnormalities (WMAs) with exercise; abnormal ExE as ischemia or resting WMAs. A good functional capacity was defined as a maximal workload of 10 metabolic equivalents (METs). The end point was death (CV, CA or NCV-NCA).

Results

During a follow-up of 4.6± 4.7 years (interquartile range 0.04-8.0 years) there were 345 CV, 164 CA, and 203 NCV-NCA deaths. Multivariate analysis included clinical characteristics, resting echocardiography, exercise testing and peak exercise echocardiography. Different clinical characteristics predicted CV death, along with maximal achieved workload in Metabolic Equivalents (METs: Hazard Ratio [HR] = 0.92, 95% Confidence Interval [CI] = 0.88-0.96, p < 0.001) and ExE variables. CA death was independently predicted by age and achieved METs (HR = 0.93, 95% CI =0.87-0.99, p < 0.02). Similarly NCV-NCA death was predicted by clinical characteristics (age, diabetes mellitus, diuretics, nitrites) and also by achieved METs (HR = 0.83, 95% CI= 0.78-0.88, p < 0.001). Nor ischemia nor abnormal ExE increased the risk for CA or NCV-NCA death. Annualized CV deaths were almost quadruple in women with bad functional capacity as compared to those with good functional capacity (2.2% vs. 0.6%, p < 0.001). The same occurred for NCV-NCA death (1.4% vs. 0.3%, p < 0.001), whereas CA deaths were double in patients with bad functional capacity (0.9% vs. 0.4%, p < 0.001).

In conclusion, an ExE study can predict not only CV death, but death due to CA or to NCV-NCA. Fit women based on the achievement of 10 METs during exercise testing, have less chance of death from any cause.
P242 When there is no time for further imaging
Authors: Ata F , Abdelrahman A , Othman E , Abushahba G
Published: January 2020

Introduction

Cardiac tamponade (CT) is a clinical syndrome characterized by hemodynamic abnormalities resulting from an increase in pericardial pressure due to accumulation of fluid. Tamponade is one of the cardiac emergencies where urgent management steps are crucial and life saving.

Absolute goal of treatment in Cardiac tamponade is to relieve the intra-pericardial pressure and to reverse the hemodynamic shutdown, by removal of the pericardial fluid via pericardiocentesis or surgical drainage.

As much inevitable as it is, pericardiocentesis is relatively contraindicated when the effusion is associated with aortic dissection or myocardial rupture due to the potential risk of aggravating the dissection or rupture via rapid pericardial decompression and restoration of systemic arterial pressure.

Case description

A 44-year-Old transit passenger was admitted after she developed sudden onset of palpitations, vomiting and epigastric pain. She was in sinus tachycardia when brought to the Emergency department, within minutes’ patient went into cardiac shock with severe metabolic acidosis. She was admitted to ICU and subsequently intubated. Chest X-ray showed evidence of Pleural effusion with enlarged cardiac shadow, which prompted an urgent transthoracic echocardiogram. Echo findings were consistent with clinical cardiac tamponade with a large left pericardial mass compressing the lateral LV wall and aortic root, with a color flow from the mass toward the left coronary system.

Mean while the patient was rapidly deteriorating, with and patient was not stable to undergo further imaging (CT or MRI), urgent contrast echo was done to rule out vascular connection between the mass and pericardial fluid, The Echo contrast study showed no vascular connection from the mass to the pericardial space ,however there was a connection from the mass to the left coronary system as shown in the figure, based on these findings a pericardial drainage was done successfully.

These findings were confirmed by contrast CT scan after patient is stabilized.

Patient gradually improved clinically, was extubated successfully, the provisional diagnosis was suspicious of pheochromocytoma,however the final diagnosis not established as the patient travelled to home country for further management.

Conclusion

Some times, it may become clinically challenging to effectively rule out contraindications to a procedure by the gold standard modalities, specially when a patient is collapsing on the table and the clock is ticking. In such scenarios, immediate alternate approaches resulting in safe outcomes are indispensable. Likewise, in our case of emergent cardiac tamponade and a suspicious pericardial mass in a crashing patient, Transthoracic echo with Optison proved to be life saving to rule out vascular connections between cardiac mass and coronaries or pericardial fluid, when there was no time for definitive imaging modalities due to rapid deterioration of patient’s clinical status.

Abstract P242 Figure.
P1713 A case of quadricuspid aortic valve complicated with infective endocarditis diagnosed by 3D transesophageal echocardiography
Authors: Hashimoto G , Ide S , Hayama H , Makino K , Otsuka T , Suzuki M , Iijima R , Hara H , Moroi M , Nakamura M
Published: January 2020

Background

Quadricuspid aortic valve (QAV) is a rare congenital heart disease with an estimated incidence of 0.008% to 1.46%. The functional status of QAV is predominantly a pure aortic regurgitation. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic echocardiography (TTE) is suitable for the diagnosis but, transesophageal echocardiography (TEE), especially 3-dimensional (3D) TEE, is a tool for the accurate definition of the valve anatomy.

Clinical case

A 60-year-old female underwent a head CT for intermittent headaches for one month ago. She was admitted to neurosurgery in our hospital diagnosed of subarachnoid hemorrhage. Four mm aneurysm was found on the periphery of the right middle cerebral artery on CT examination, and a cerebral aneurysm coil embolization was performed with a catheter in emergency. The possibility of infectious cerebral aneurysm was pointed out, and we examined in cardiovascular internal medicine. TTE revealed moderate aortic regurgitation. The ventricular septum exhibits sigmoid septum. A mobile mass was found near the left ventricular outflow tract in the sigmoid septum. TEE revealed a hypoplasia cusp (accessory cusp) is found between non coronary cusp and right coronary cusp. Aortic valve leaflets have become thickened and regurgitation from the central part of the cusps. 3DTEE was able to more accurately visualize that only the accessory cusp was hypoplastic, and the size of the other three leaflets appears almost the same. Similarly, vegetation on the left ventricular outflow tract were clearly revealed by 3DTEE.

Based on the above, it was diagnosed that quadricuspid aortic valve complicated with infective endocarditis (IE) with aortic valve regurgitation. After treatment with antibiotics according to IE, surgical treatment was scheduled.

Discussion

QAV is a rare congenital heart disease, and TTE is an important imaging tool for accurate diagnosis. Furthermore, TEE, especially 3DTEE, was a more appropriate diagnostic method in QAV and IE.

Abstract P1713 Figure. 3DTEE
P1719 A rare complication of homozygous sickle cell disease and high output cardiac failure
Authors: Landells M , Mcaloon C J , Steeds R P
Published: January 2020

Introduction/Background

Sickle cell disease (SCD) is an autosomal recessive blood disorder characterised by chronic anaemia and abnormally shaped red blood cells. SCD impacts multiple organ systems causing effects on morbidity and mortality, including cardiovascular (CV). Long term SCD can have a significant impact on the heart through multiple pathways, including chronic anaemia, microvascular dysfunction and the development of hypertension and chronic kidney disease, leading to the development of a high-output state and adverse cardiac remodelling. We report a rare case of homozygous SCD with the development of high output cardiac failure complicated by the development of associated pulmonary hypertension.

Case summary

A 58 yr old female patient (Height 158cm, weight 51.25kg, cardiac index 4.01 L/min/m²) with known homozygous SCD (HbSS) undergoing regular transfusions for chronic anaemia was admitted following a routine transthoracic echocardiogram (Figure 1a & 1b) due to the presence of a moderate sized global pericardial effusion, severe tricuspid regurgitation, dilated right heart with impaired longitudinal function, and good left ventricular (LV) systolic function (LVEF Simpson’s biplane = 62 +/- 5%). In the months preceding this, the patient described progressive dyspnoea associated with decreasing workload and orthopnoea. On clinical examination there was evidence of right sided heart failure. Blood results demonstrated a longstanding anaemia (Hb 57 g/L) with MCV 109.6. NT-proBNP was 10233 ng/L. Cardiac magnetic resonance imaging demonstrated LV dilatation with hyperdynamic function, severe LV hypertrophy, and impaired longitudinal function (global longitudinal strain -9.7%). Cardiac output was elevated at 6.5 L/min. There was no late gadolinium enhancement and T2* mapping did not demonstrate cardiac iron loading (29.6ms). Right heart catheterisation confirmed pulmonary hypertension (pulmonary artery pressure 55/33, mean 46mmHg) due to left heart disease (PC wedge pressure (24/30, mean 24mmHg). The pericardial effusion was drained and the aspirate demonstrated a cellular infiltrate reflecting pericardial inflammation (moderate pus cells, no growth after 48hrs, total protein = 56 g/L, no histological evidence of malignancy). Additionally, the patient underwent intravenous diuresis and blood transfusion with improvement in clinical status.

Discussion

We report a rare cause of pulmonary hypertension due to elevated left ventricular end-diastolic pressure as a result of long-term high cardiac output in a patient who has established homozygous SCD. Long-term adverse cardiac remodelling in SCD is well described. Pulmonary hypertension is a rare multifactorial complication of this process and the precise mechanisms remain unclear. It confers a poor prognosis and the only current treatment is the management of the underlying condition. Pulmonary hypertension should always be considered in SCD patients with clinical and cardiac imaging evidence.

Abstract P1719 Figure 1
P1747 Left atrial strain identifies diastolic dysfunction in children with cardiomyopathies and correlates with invasive LV end-diastolic pressure
Authors: Sabatino J , Borrelli N , Aversani M , Filippini E , Paredes J , Josen M , Prasad S , Fraisse A , Indolfi C , Daubeney P , Di Salvo G
Published: January 2020

Background

2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its diagnostic performance in children is unknown.

Aim of this study is to investigate whether LA strain and strain rate are able to diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM).

Methods

The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiography and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). Cardiac catheterization was performed within 24 hours after the echocardiographic study in 9 children (mean age 9 ± 7 years) with clinical indication and the LV end-diastolic pressure was measured.

Results

No significant differences in mitral E/A, E/E’, pulmonary S/D ratios and indexed left atrial volumes were observed among the 3 CM groups.

LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. ROC curves showed area under the curve of 0.976 (p < 0.001) for LA strain and 0.946 (p < 0.001) for LA strain rate, to distinguish CTRL from CMs.

Moreover, univariate regression analysis demonstrated that peak LA strain had a strong significant inverse correlation with invasive LV end-diastolic pressure (r -0.892, p < 0.001). On the other hand, invasive LV end-diastolic pressure had non-significant correlations with E’ avg (r -0.139, p = 0.721), E/E’ avg (r 0.238, p = 0.537), MV DT (r 0.485, p = 0.186) and LAVi (r 0.514, p = 0.157).

Conclusions

LA strain is able to recognize and classify DD in children with cardiomyopathies and accurately correlates with invasive LV end-diastolic pressures.

Abstract P1747 Figure.
P1772 Assesment of total atrial conduction time in patients with atrioventricular nodal reentrant tachycardia with and without drug-induced type 1 Brugada pattern and control subjects
Authors: Kocabas U , Hasdemir C
Published: January 2020

Background

Most forms of atrioventricular nodal reentrant tachycardia (AVNRT) are created by reentry between 2 (or more) atrial connections to the AV node. There is a high prevalence of drug-induced type 1 Brugada ECG pattern (DI-Type1-BrP) among patients with AVNRT. Atrial vulnerability and structural remodeling that leads to reentrant circuits in AVNRT is largely unknown. PA-TDI interval assessed by tissue Doppler imaging is a useful technique to determine total atrial conduction time (TACT) which reflects atrial remodeling and arrhythmic substrate.

Purpose

In this prospective study, we aimed to assess TACT in patients with AVNRT with and without DI-Type1-BrP and control subjects.

Methods

Study population consisted of 62 consecutive patients (age 44 ± 12 years; 74% women) undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 42 age and sex matched control subjects. All patients and control subjects underwent ajmaline challenge test and tissue Doppler imaging.

Results

A DI-Type1-BrP was uncovered in 24 of 62 patients with AVNRT (38.7%). PA-TDI interval was longer in patients with AVNRT with or without DI-Type1-BrP compared to control subjects (124 ± 12 ms vs 119 ± 14 ms vs 105 ± 11 ms; P < 0.001, respectively). PA-TDI interval was similar in patients with AVNRT with or without DI-Type1-BrP (124 ± 12 ms vs 119 ± 14 ms; P = NS, respectively). PA-TDI interval was significantly correlated with P-wave duration on the surface ECG (r = 0.23; P = 0.02). Left atrial volume index and left atrial phasic functions were similar in patients with AVNRT with or without DI-Type1-BrP and control subjects.

Conclusion

TACT is prolonged in patients with AVNRT. Further studies are needed to determine the underlying factor(s) such as DI-Type1-BrP that leads to prolonged atrial conduction time.