bluuebunny/crossref_metadata_2025 huggingface dataset:
N07 Patient reported outcome measures collected from patients using a digital tablet: early benefits
Authors: Avery P , Blackmore K , Angel C
Published: January 2020

Background

At a district general hospital (DGH) on the south coast of England the inflammatory bowel disease (IBD) nurse led service introduced an eHealth system in 2015 linked to the IBD registry but limited to access via a desktop limiting flexibility. In liaison with the IBD registry and the software developer the lead nurse instigated an upgrade to the system. This allows patients access both remotely and via a digital tablet in outpatients. Discussion is being had about the best way to collect patient reported outcome measures (PROMS) both for large data analyse and local patient benefit. This presentation of the first 3 months collection of the PROMS seeks to show the benefit of these data locally

Methods

PROMS were gathered from both Consultant and Nurse led clinics from July 2019 to the 22 October 2019. Patients were asked to fill in the IBD control PROM (this PROM forms part of the IBD registry Data set) on a tablet before entering the consultation room. Additionally a disease activity score either the Harvey Bradshaw Score (HBI) or the Simple Clinical Colitis activity index (SCCAI) is collected at the same time. These scores were then extracted from the system and evaluated using a descriptive data analysis approach.

Results

After Data cleansing 200 records are shown in Table 1 covering all disease sub-types.

Fatigue was the most commonly reported complication of IBD in addition,126 patients who attended outpatients reported a wellness score of above 75 out of 100 isolating the wellness score from the PROM score allowed a comparison with the corresponding disease activity score in these patients and correlated in 95% of UC Patients and CD 84% (see Table 2).

Conclusion

Fatigue is a widely reported symptom of IBD as well as pain and anxiety or depression. These data confirm this trend but also present the first local population information for the IBD service at this DGH. When looking at the impact of these scores there is an opportunity to identify patients that may need medically optimising. The patients that remain could then be targeted with support services and a business case for counselling is now planned. In addition to this together with self-testing with IBDoc ® the PROMs and disease activity scores provide opportunity for remote management of some patients. These PROMs collected from patients using a tablet in outpatients at a DGH show promising value for service development.
N08 IBD Home at GHP Stockholm Gastro Center in Sweden
Authors: Jäghult S
Published: January 2020

Background

Patients with IBD and with biological treatment often need close monitoring. In this study, a digital tool was used to meet the patients′ need and increase their participation. IBD Home is a cell phone application that is connected to the national quality registry, SWIBREG. It offers the patients to register their symptoms and to perform a home-test of faecal kalprotectin, the result transmitted directly to the registry. At the Stockholm Gastro Center we decided to offer inclusion in IBD Home to all patients on biological treatment. The aim of this study was to investigate the functionality of IBD Home from the patients and the health care professionals point of view, and to investigate if the patients experienced an increased participation by monitoring with IBD Home.

Methods

In March 2018, a letter with information about IBD Home and an offer to use the tool was sent to all patients with biological treatment. A letter of reminder was sent after two months. Those who accepted were included and got information about how to download the application. In December, both patients and health care professionals got a questionnaire concerning IBD Home.

Results

A total of 166 patients on biological treatment were offered monitoring by IBD Home and 89 (53%) accepted. When answering the evaluation, 79 patients were active in using IBD Home. Causes for inactivity were stated as: too old phone model (n = 1), technical differences (n = 2), worries concerning the security of the system (n = 1), and others e.g. ‘forgotten about it’ and ‘did not find the time to do it’. Only 27 patients (34%) left home-test faecal kalprotectin on a regular basis. The questionnaire was answered by 27 patients (34%). The majority (n = 24) stated that it was easy to install IBD Home. A total of nine patients noted that their participation in their own health care had increased, while the majority (n = 16) stated that there was no difference. A total of five nurses and three gastroenterologists answered the questionnaire. Those using the manual for including patients in IBD Home and the manual to interpret values expressed them to be very clear or fairly clear (n = 4). Four health care professionals had never used the manuals. The majority (n = 6), had used IBD Home in the clinical work and regarded it as useful.

Conclusion

Patients using IBD Home experiences the tool to be very easy to use but most of them did not experience any improvements concerning participation in their own care. The response rate was however low. It may be some difficulties to get started with the home-test faecal kalprotectin since only 34% are using it on a regular basis. The health care professionals using IBD Home in their clinical work found it useful.
N15 A ‘real-world’ observational multi-centre study comparing the side effects and patient acceptability of budesonide MMX with prednisolone in patients with mild to moderate ulcerative colitis
Authors: Kearns J , Scullion L , Masterson C , Kennedy N , Butcher C
Published: January 2020

Background

Budesonide MMX is indicated for the induction of remission in mild to moderate Ulcerative Colitis (UC) patients when 5-ASA treatment is not sufficient. Unlike traditional first-generation glucocorticoid steroids such as prednisolone, budesonide MMX has demonstrated a robust safety profile, comparable to placebo in several randomised controlled trials1,2,3. There is however limited real-world evidence to substantiate this safety claim in clinical practice. The aim of this observational analysis is to evaluate the tolerability and ease of administration of budesonide MMX in the real-world setting using prednisolone as a benchmark.

Methods

Patients receiving treatment for mild to moderate UC were identified in 3 treatment centres between April and October 2019. After providing privacy and data consent, patients completed a detailed nurse-led questionnaire regarding their experiences with prednisolone treatment. Following 6 weeks of therapy with budesonide MMX, patients were sent a follow-up questionnaire. Data from both the initial and subsequent questionnaires were entered by the nurse into a database for assimilation and analysis.

Results

Twenty-eight patients completed initial and follow-up questionnaires. Of these, 78.6% (n = 22) had experienced ≥1 prednisolone-related side effects. In comparison, following treatment with budesonide MMX, 21.4% (n = 6) reported ≥1 side effects. Instances of these side effects are shown in Figure 1.

46.4% of patients (n = 13) reported the impact of prednisolone-related side effects on daily life as moderate or severe vs. 7.1% (n = 2) following treatment with budesonide MMX. By week 2 of treatment with budesonide MMX, rectal bleeding was resolved in 32.1% of patients (n = 9) and stool frequency in 35.7% (n = 10). 93.1% (n = 27) found the instructions to take budesonide MMX given by the health care professional very easy to understand and of those expressing a preference, 71.1% of patients (n = 19) would take budesonide MMX again if prescribed. Additional data will be presented.

Conclusion

Data from this ‘real-world’ observational study appear to support the safely profile of budesonide MMX reported in clinical trials. The incidence of patients who experienced > 1 side-effect was nearly 4 times lower for budesonide vs. prednisolone. In addition, budesonide MMX therapy was acceptable to the majority of patients and accompanying instructions easy to understand. Additional data will be presented.

References
41 Geometric change in valvular apparatus during tricuspid repair for severe tricuspid regurgitation
Authors: Obase K , Matsumaru I , Nakaji S , Miura T , Eishi K
Published: January 2020

Background

For repairing severe tricuspid regurgitation (TR) with leaflet tethering, our team employs spiral suspension procedure, in which papillary muscles (PMs) are approximated and suspended towards annulus by suture in addition to annuloplasty.

Purpose

To visualize subtricuspid apparatus and investigate its geometric change by the procedure, comparing with annuloplasty alone.

Methods

11 patients who underwent spiral suspension and 10 patients who underwent annuloplasty alone were studied. Using 3D dataset derived from transesophgeal echocardiography with transgastric approach, the distances between the mid septal annulus (point C) and the anterior PM tip (point A) and posterior PM (point P) were calculated. Also, annular perimeter, leaflet surface area and tenting height were measured

Results

In all cases, PM tips could be visualized and identified for the measurements. By spiral suspension, the distance CA and tenting height were significantly reduced. On the other hand, by annuloplasty alone, CA and tenting height were likely to be increased but statistically not significant.

Conclusions

Spiral suspension ameliorated leaflet tethering with relocating PMs. Annuloplasty alone reduced leaflet surface area, which indicates increase of coaptation surface. Interestingly, PM tip- annulus distance and tenting height were possibly increased by annuloplasty. Further investigation is need in large number.

Result of measurements Annuloplasty alone Spiral suspension Pre-op Post-op Pre-op Post-op Annular perimeter, mm 120.9 ± 11.2 78.8 ± 5.1* 142.4 ± 18.2* 81.1 ± 6.4** Leaflet surface area, cm2 13.1 ± 3.1 5.6 ± 0.9* 19.3 ± 4.8* 5.8 ± 0.8** Tenting height, mm 2.8 ± 2.3 3.1 ± 1.2 7.0 ± 4.8* 2.9 ± 2.6** CA, mm 27.3 ± 3.9 29.1 ± 6.2 35.7 ± 6.9* 29.6 ± 5.2** CP, mm 33.1 ± 6.0 33.8 ± 9.4 38.5 ± 8.2 33.9 ± 6.1 *p < 0.05, vs Annuloplasty alone pre-op **p < 0.05, vs Spiral suspension pre-op

Abstract 41 Figure. Pre- and post-operative valve apparatus
87 A gynaecological cause of right heart failure
Authors: Wong C Y
Published: January 2020

Introduction

A 68-year-old lady complained of pelvic pain associated with progressive abdominal distension over few months. Physical examination revealed ascites, smooth hepatomegaly and lower limb edema. CT scan of abdomen and pelvis showed a 4 cm x 5 cm right ovarian mass without other intraabdominal lesion. Surgical excision of the ovarian mass was performed with clear resection margin. The ascitic fluid was negative for malignant cells. However, the patient had persistent ascites and lower limb edema after surgery. The gynaecologist suspected that she might have cardiac problems.

Procedure

Transthoracic echocardiogram was performed. The right atrium and ventricle were markedly enlarged. The tricuspid valve leaflets appeared retracted and sclerotic, with failed coaptation during systole (Figure A), severe tricuspid regurgitation (Figure B) and marked dilatation of inferior vena cava without respiratory variation. The pulmomary valve was not well visualized on 2D images. Continuous wave Doppler across pulmonary valve demonstrated short pressure half time 66 msec and premature termination of diastolic flow (Figure C), suggestive of severe pulmonary regurgitation. There was no intracardiac shunt. Left sided valves were unremarkable. Additional tranesophageal echocardiogram allowed better assessment of pulmonary valve, which revealed one of the cusps to be thickened, retracted and immobile on real time 3D images (Figure D, arrow).

Discussion

The ovarian mass was confirmed to be a carcinoid tumour. Due to its direct drainage into systemic venous circulation the vasoactive substances (serotonin, prostaglandin etc) reach the right heart directly without being metabolized by liver, resulting in plaque like deposit of fibrous tissue on the endocardium and valve surfaces, leading to classical appearance of thickened, retracted and immobile leaflet and subsequent valvular regurgitation or, less commonly, stenosis. Left-sided valve disease is less common, and may occur in cases of bronchial carcinoid or in presence of atrial right to left shunt (e.g. PFO). Urinary 5-hydroxyindoleacetic acid (5-HIAA) is a useful non-invasive diagnostic test. Carcinoid heart disease usually does not regress even the tumour is treated, and valve replacement is the only definitive curative treatment. This lady received tricuspid and pulmonary valve replacement with subsequent symptom resolution and chest X-ray showed marked reduction of cardiomegaly (Figure E).

Conclusion

A baseline echocardiogram is recommended for assessment valvular involvement in patient with carcinoid tumour, as the cardiac symptoms may be mistaken to be related to regional spread of tumour. Pulmonary valve is very often the "forgotten" valve in many Echo studies. However, it is crucial to have detailed assessment (with aids by 3D images or TEE) due to its implication to the surgical treatment planning.

Abstract 87 Figure.
91 Mitral fracking: an unusual complication of infective endocarditis
Authors: Cespon Fernandez M , Basalo Carbajales M , Munoz Pousa I , Blanco Gonzalez E , Bilbao Quesada R , Castineira Busto M , Gonzalez Rios C , Matajira Chia T M , Pazos Lopez P , Calvo Iglesias F
Published: January 2020

The conglomerate of microorganisms, inflammatory cells, fibrin and platelets that constitutes the characteristic lesion of infectious endocarditis, that is, vegetation, was considered as a major criterion of infectious endocarditis in the 90s thanks to the development of ultrasound. Ecocardiography allows the diagnosis of complications derived from the infection, such as valvular perforation, prosthetic dehiscence, fistula or abscesses. One of the most infrequent complications is the mitral pseudoaneurysm. It has its origin in the impact of a jet of aortic regurgitation on the anterior leaflet of the mitral valve, which is why we have called it mitral fracking.

A 60-year-old man who had a recent history of pneumonia and for whom he was still receiving antibiotic treatment, debuted suddenly with dyspnea of minimal effort. He went to a cardiology clinic where he was found to have severe mitral regurgitation. He was directly derived to cardiac surgery of our hospital. Prior to the intervention, a transesophageal ultrasound study was performed in our department, which showed the following findings: a bicuspid aortic valve with a small vegetation on its aortic surface (Figure A, surgical piece), a protuberance on the anterior mitral leaflet (Figure B) with internal flow that caused systolic expansion towards the atrium (Figure C) and diastolic collapse towards the ventricle (figure D): the mitral pseudoaneurysm.

The therapeutic action was based on the replacement of both valves with mechanical prostheses. The blood cultures were negative, but the surgical piece revealed unequivocal histological findings of infectious endocarditis. Currently, the patient is stable and the valves are normofunctional in the regular follow-up controls.

Abstract 91 Figure.
92 Aortopulmonary fistula complicating native aortic valve endocarditis
Authors: Kapelios C , Bonou M , Papadimitraki E D , Skouloudi M , Masoura K , Moyssakis I , Barbetseas J
Published: January 2020

A 41-yo male with history of bicuspid aortic valve and dilatation of ascending aorta (49 mm), was transferred from a peripheral hospital with staphylococcus aureus endocarditis. On day 4 he developed fulminant pulmonary edema with a continuous murmur best heard at the left second intercostal space and impressive cardiothoracic index augmentation. TTE revealed the presence of a large aorto-pulmonary fistula (A-PF), (figure 1, left), with left to right shunt during systole and diastole (figure 1, right), between the ascending aorta and the main pulmonary artery. Despite diuretic and antibiotic therapy with cloxacillin, gentamicin and cefazolin, the patient remained in class NYHA IV, soon became inotrope dependent and he progressively developed renal dysfunction. In the ICU unit he had an episode of ventricular fibrillation and was successfully defibrillated. He underwent emergent surgery with aortic valve and ascending aorta replacement. The fistula was closed using pericardial patch. Three years postoperatively he remains well. Aortopulmonary fistula is an uncommon but highly lethal condition if untreated. The etiology of acquired A-PFs includes aneurysm rupture, trauma, aortic dissections and infective endocarditis, most commonly of a prosthetic valve. Chest pain, dyspnea and intermittent hemoptysis are frequent symptoms whereas fulminant heart failure and low cardiac output syndrome may predominate the clinical picture as in our patient. Aortopulmonary fistula is an extremely rare complication of native valve endocarditis.

Abstract 92 Figure 1
94 When the gut affects the heart
Authors: Elmaghraby A , Kumar N , Lengyel Z , Francis W , Al Kuwari M , Chinnakaruppan S , Petkar M , Salustri A
Published: January 2020

A 59-year-old man came to our attention with progressive shortness of breath associated with lower limb oedema. He complained also of recurrent malar flushing, diarrhea and weight loss (14 kg in the last 8 months). At physical examination, a holosystolic murmur best heard over the fourth left sternal border, intensified upon inspiration, and a palpable tender liver with irregular surface were noted.

Transthoracic and transesophageal echocardiogram revealed dilated right chambers. The tricuspid annulus was dilated and the leaflets thickened, shortened and retracted with restricted mobility and incomplete coaptation, leading to severe tricuspid regurgitation (Panels A-B). Moderate pulmonary regurgitation was also detected (Panel C). Cardiac MR confirmed the morphology of the tricuspid valve (Panels D-E, arrows) and the severity of the tricuspid regurgitation (regurgitant fraction 66%). The pulmonary valve leaflets were also thickened and fixed (Panel F, arrow), with moderate pulmonary regurgitation (regurgitant fraction 21%).

With the suspicion of carcinoid syndrome, 5-hydroxyindoleacetic acid (5-HITT) was tested by 24-hour urine sample and a value of 929.5 µmol/24h was found (n.v. 10.5-47.1).

Whole body 18-F DOPA PET was performed. Axial views and reconstructed images revealed a short segment of mural thickening (2.4 cm and 1.1 cm) in the jejunum with a moderate/high uptake (Panels G, arrow). Adjacent to this lesion, a mesenteric spiculated mass (4.0 x 2.8 cm) with moderate uptake was visible (Panels H, arrow). Multiple enhancing nodules with high uptake were present in the liver (Panel I).

One of the liver nodules was biopsied. The biopsy revealed extensive infiltration by well differentiated neuroendocrine tumor (Panel J, blue arrow). The tumor cells were arranged in nests and were composed of cells with round to oval nuclei and eosinophilic cytoplasm (Panel K). The neuroendocrine nature of the tumor was confirmed by strong diffuse positivity with synaptophysin (Panel L), chromogranin and CD 56. Ki-67 showed a proliferative index of less than 3%. The tumor morphology, combined with the immunohistochemical features, was in keeping with a well differentiated neuroendocrine tumor.

Carcinoid heart disease is a rare cause of primary tricuspid and pulmonary valve disease leading to significant morbidity and mortality caused by right heart failure. The characteristic pathological findings are endocardial plaques of fibrous tissue that may involve the tricuspid valve and, rarely, the pulmonary valve. The fibrous tissue in the plaques results in distortion of the valves leading to either stenosis, regurgitation, or both.

Abstract 94 Figure.
108 Uncommon cardiac fatty distribution: a case report
Authors: Redondo Bermejo B , De La Torre Carpente M M , Munoz San Jose J C , Escudero Caro T , Acuna Lorenzo M , Guillem Ares E , Revilla Martinez M , Rollan Gomez M J
Published: January 2020

Background

Fatty masses of the heart are relatively uncommon. This report is about a rare case of extensive fat infiltration along the apical interventricular septum that causes separation of the right ventricular apex from left ventricular apex, simulating a bifid cardiac apex.

Case summary

The patient was a 58-year-old female who was admitted to the hospital because of palpitations and chest pain. A trasnsthoracic echocardiogram was performed and it showed a thickenned anterior pericardium so a cardiovascular magnetic resonance (CMR) was performed. CMR revealed a large amount of epicardial and pericardial fat without adipose tissue inside the right ventricle wall. In the cardiac apex this fat seemed a lipoma however CMR demonstrated the fat was not capsulated and besides, it extended, as if it were an infiltrative disorder, in the cardiac apex between both ventricles.

Patient was discharged with an implantable loop recorder (ILR) in order to ruled out ventricular arrhythmia.

During a two year follow-up, ILR has shown several symptomatic supraventricular paroxysmal tachycardia episodes and no other arrhythmic events have been reported. Also, the CMR has been repeated and it has shown similar results.

Discussion

Fatty masses of the heart are relatively uncommon. Among those masses are included cardiac lipomas, lipomatous infiltration of the right ventricle, arrhythmogenic right ventricular dysplasia (ARVD) and lipomatous hypertrophy of the interatrial septum. The findings in the CMR of our patient do not fulfill the criteria of the aforementioned disorders.

Our patient shows a pattern of unusual fatty infiltration pattern of unclear etiology. The prognostic value of this type of heart disease is unknown. In our patient, although the follow-up has not been very long, it does not seem to have had any relevant consequences, so far.

Conclusion

This is a rare case of a patient with a large amount of epicardial and pericardial fat that seems to infiltrate between both ventricular apex, as a bifid cardiac apex. It is apparently asymptomatic.

Abstract 108 Figure. CMR-Cardiac-fatty_EECHO-2019
162 Right ventricular function: is longitudinal strain by speckle-tracking an option?
Authors: Azul Freitas A , Ferreira C , Milner J , Ferreira J , Alves P , Marinho V , Martins R , Baptista R , Jorge E , Goncalves L
Published: January 2020

Introduction

Estimation of right ventricular (RV) performance by echocardiography is challenging due to its anatomical and functional distinctiveness. RV longitudinal strain (RVLS) by speckle-tracking (STE) is an innovative tool and recent studies show that it can be used with prognostic significance, although it isn’t yet standardized.

Purpose

In this study, we aimed to evaluate global (G) and free wall (FW) RVLS-STE and its correlation with common RV evaluation methods.

Methods

We conducted a prospective observational study including 65 patients and 20 healthy controls. G and FW RVLS-STE were correlated to tricuspid annular plane systolic excursion (TAPSE), Doppler tissue tricuspid lateral annular systolic velocity (S`) and left ventricle ejection fraction (LVEF). Following current guidelines, a TAPSE higher than 17mm, a peak S` wave velocity higher than 9.5cm/s and a RVLS-STE inferior to -20% was considered normal.

Results

Mean age was 66.34 ± 15.45 years with 61.5% males in the patient group and 31.1 ± 7 years with 50% males in the control group. Echocardiographic findings in patient group included 44.6% with reduced LVEF (EF < 50%), 26.2% with moderate to severe valvular disease, 23% with an elevated systolic pulmonary pressure (> 35mmHg) and 36.9% without significant structural disease. The control group had no pathological signs on echocardiography. Peak S` wave and TAPSE showed a better correlation with FW RVLS-STE (r²=0.41, p < 0.001 and r²=0.46, p < 0.001) than G RVLS-STE (r²=0.27, p < 0.001 and r²=0.30, p < 0.001). A high absolute FW RVLS-STE (< -20%) was a good marker of a normal TAPSE and a normal peak S` wave velocity, with a negative predictive value of 87% and 98% respectively. Comparing to control group, patients with reduced LVEF showed a reduction in TAPSE (27.6 mm vs 18.53 mm, p < 0.001), S` (14.8 cm/s vs 10.84 cm/s, p < 0.001) and FW RVLS-STE (-28.7% vs -15.34%, p < 0.001). Patients with moderate to severe valvular disease also showed a reduction in TAPSE (27.6 mm vs 18.4 mm, p < 0.001), S` (14.8 cm/s vs 10.3 cm/s, p < 0.001) and FW RVLS-STE (-28.7% vs -16.04%, p < 0.001). And finally, patients with elevated systolic pulmonary pressure also showed a reduction in TAPSE (27.6 mm vs 17.94 mm, p < 0.001), S` (14.8 cm/s vs 10.47 cm/s, p < 0.001) and FW RVLS-STE (-28.7% vs -16.7%, p < 0.001).

Conclusion

FW RVLS-STE is better than G RVLS-STE as a RV evaluation method. RVLS-STE is correlated with TAPSE and peak S` wave velocity. It was the only parameter that showed reduction to abnormal values (> -20%) in pathological groups and seems to be an accurate marker of RV function particularly detecting early dysfunction
P168 Non-bacterial endocarditis in patients with antiphospholipid syndrome treated with direct oral anticoagulants
Authors: Munoz Pousa I , Calvo Iglesias F E , Cespon Fernandez M , Lopez Rodriguez E , Pradas Montilla G , Legarra Calderon J J , Fernandez Martin J J
Published: January 2020

Introduction

Primary antiphospholipid syndrome (APS) is a hypercoagulability state of autoimmune origin. Vitamin K- antagonists remain the mainstay therapy though the difficulties in maintaining target therapeutic range contributed to prescriptions of direct oral anticoagulants (ACOD). A recent randomized trial reported an excess in thromboembolic events in patients under rivaroxaban therapy compared with warfarin.

Purpose

Description of two cases of Libman-Sacks endocarditis in APS patients on therapy with rivaroxaban due to poor control with coumadin.

Methods and results. Case 1 is a 47-year-old woman and case 2 a 69-yo man with APS with high antibody titers of 3 classes and previous thrombotic events (pulmonary embolism in case 1 and acute coronary syndrome in case 2). In both cases, coumadin was switched to rivaroxaban because of poor control. During follow-up the diagnosis of blood culture-negative endocarditis was stablished in both cases. Echo examinations in case 1 revealed a 12 mm mobile vegetation in the ventricular face of the non-coronary aortic cusp, which resolved after 2 months high-dose warfarin therapy. Case 2 was admitted to hospital because of heart failure. TTE and TOE revealed a 26 mm mass attached to the atrial face of posterior mitral leaflet and moderate mitral regurgitation. He underwent mitral valve replacement with a mechanical prosthesis and the final pathologic diagnosis was Libman-Sacks endocarditis.

Conclusions

Libman-Sacks endocarditis as a thrombotic feature of high-risk APS patients can occur under rivaroxaban therapy. In one of our 2 cases, high-dose coumadin therapy resolved this complication

Abstract P168 Figure. Cases
P173 When the heart doesn"t want to grow up
Authors: Carrer A , Civera S , Muraru D , Videsott L , Sambugaro F , Perazzolo Marra M , De Lazzari M , Iliceto S , Badano L P
Published: January 2020

Background

Blood cysts of heart valves are uncommon and, usually, incidental findings in pediatric population. Rarely seen in adults, blood cysts are normally asymptomatic, even though several cases of embolization, valvular disfunction and left ventricle outflow tract (LVOT) obstruction have been described. Clinical Presentation. We report the case of a 23 year-old woman, with history of a small nodular mass of the mitral valve, found on a previous cardiac magnetic resonance (CMR) at the age of thirteen, who was admitted to our emergency department complaining atypical chest pain. She denied shortness of breath, syncope, tachycardia and fever. She was hemodynamically stable and a fast regression of symptoms was observed. The physical examination was unremarkable. Both the electrocardiogram (ECG) and blood tests were normal. A chest radiography showed normal heart size, without other abnormalities. After having ruled out an acute coronary syndrome, the patient was discharged with the indication to undergo further cardiological assessments. Diagnostic techniques and their most important findings. Therefore, a trans-thoracic echocardiogram was performed revealing normal biventricular function, no aortic root dilation, no pericardial effusion, no valvular regurgitation or stenosis. A round (7x11 mm) mass with hyperechogenic borders and hypoechogenic content was detected on the ventricular side of the anterior mitral valve leaflet consistent with a valvular blood cyst (figure 1: a,b,c). Only trivial mitral valve regurgitation without LVOT obstruction was present. The 3D echo reconstruction allowed to confirm the suspicion of blood cyst and detect a cleft of the posterior mitral valve leaflet, located in the P2 scallop (figure 1: d,e). A repeated CMR showed no contrast enhancement of the mass. Due to the clinical stability and the absence of complications, the patient was suggested to continue an echocardiographic follow-up. Discussion. Cardiac blood cysts are a rare condition with uncertain origin, usually found in infants in the first six months of life. A natural regression after that age has been described, making this condition very unusual in adults. Despite its benign features, when persistent beyond the childhood, the blood cyst can grow and reach even huge dimensions, potentially impairing the valvular function and/or causing LVOT obstruction. Another potential complication of blood cysts may be the arterial embolization. In all these situations surgical resection must be considered. In our patient, the contribution of trans-thoracic echocardiogram and in particular the 3D reconstruction, were pivotal to address the correct diagnosis.

Abstract P173 Figure 1
P174 Left atrial myxoma presenting in a cystic form
Authors: Yagmur B , Simsek E , Ozbaran M , Soydas Cinar C
Published: January 2020

Background

Early diagnosis of atrial myxomas may be a challenge because of their synptoms are often nonspecific. Two-dimensional echocardiography is the diagnostic procedure of choice.

Case presentation

A 42-year-old woman presented with complaints of palpitation and fatigue. Physical examination revealed a diastolic murmur at the apex. Two-dimensional transthoracic echocardiography revealed an extremely mobile mass in the left atrium that consisted of multiple cystic and solid parts. Three-dimensional transesophageal echocardiography showed that the 4.3x3.3 cm mass was connected to the interatrial septum through a 0.7 cm pedincle, and it moved between the atrium and the ventricle through the mitral valve with each carciac cycle. Grade 1 mitral and aortic regurgitation and grade 3 tricuspid regurgitation was accompanied by a SPAP of 90 mmHG. The mass was surgically excised. Histopathologic diagnosis was myxoma.

Discussion

Types of cystic masses that can appear in the left atrium are myxomas, hydatid cysts and interatrial septal aneurysms. In our case report, echocardiographic findings of a mass that was connected to the IAS with a pedicle were supportive of cardiac myxoma. If not removed, myxomas may cause major complications like stroke, rupture, and hemodynamic problems. Surgery was indicated because the mass was cystic and highly mobile.

Abstract P174 Figure. mass
P175 Cardiac device infection: to extract or not to extract, that is the question
Authors: Dias Ferreira Reis J P , Mano T , Valente B , Monteiro A , Silva Cunha P , Oliveira M , Pereira Da Silva T , Soares R , Rio P , Moura Branco L , Ferreira R
Published: January 2020

Introduction

The incidence of infectious complications related to intracardiac devices has been increasing in recent year and is associated with a poor prognosis, which is determined not only by the infectious process but also by the severity of the underlying cardiac pathology and the spectrum of comorbidities presented. Appropriate antibiotic therapy and extraction of the devices are fundamental in the management of these patients.

Case report

We describe the case of a 66-year-old patient on a waiting list for transplantation due to non-ischemic dilated cardiomyopathy with poor left ventricular systolic function (LVEF of 10%), with severe functional mitral regurgitation and severe pulmonary hypertension, who received a CRT-D for secondary prevention (non-responder). He was admitted for decompensated heart failure (NYHA functional class IV and "dry-cold" profile) requiring inotropic support becoming dependent on dobutamine. During hospitalization, there was a progressive increase in inflammatory markers accompanied by recurrent febrile peak and inflammatory signs of the central venous catheter, with catheter-tip and serial hemocultures positive for Morganella morganii. Piperacillin / tazobactam was started. Due to the lack of response to pathogen directed antibiotic therapy, he underwent a transesophageal echocardiogram (TEE) that revealed several filiform images associated with the electrodes, with no image of valvular vegetations, which led to the association of gentamicin and device extraction (DE), according to the Pisa technique, that occurred without complications. On the 7th day after DE, there was a progressive clinical deterioration in spite of increasing doses of inotropes and vasopressors. It was considered that patient would not be candidate for cardiac transplantation or mechanical ventricular assist, and died on the 118th day of hospitalization in refractory cardiogenic shock.

Conclusion

Device endocarditis is a class I indication for intracardiac DE and TEE is fundamental in its diagnosis. Despite being a considered a non-responder to cardiac resynchronization therapy based on clinical and echocardiographic criteria, this case illustrates how the loss of cardiac resynchronization may have contributed to the patient’s hemodynamic deterioration and have played a fundamental role in the clinical outcome.
P184 Broken heart complications
Authors: Azul Freitas A , Ferreira C , Milner J , Ferreira J , Marinho V , Alves P , Jorge E , Goncalves L
Published: January 2020

Introduction

Patients with persistent chest discomfort or other symptoms suggestive of ischaemia and ST segment elevation in two contiguous leads on electrocardiography should be prompt managed to revascularization and emergent angiography for percutaneous intervention in two hours is the preferred reperfusion strategy.

Purpose

Our aim is to show the importance of differential diagnosis in a patient with an initial diagnosis of ST segment elevation myocardial infarction (STEMI).

Clinical case

We present a case of 67 years old women with a past medical history of dyslipidemia and polymyalgia rheumatica, treated with rosuvastatin 10mg id and prednisolone 5 mg id. The patient was admitted to emergency department complaining of chest pain with 3 hours of evolution that started after a period of nausea and vomiting. Physical examination showed slight tachypnea with 22 breath per minute, blood pressure 93/40 mmHg, heart rate 110 beats per minute, oxygen saturation in room air 90%, heart sounds with a systolic murmur II/VI and lung crackles in inferior lobes, with no peripheral oedema. Electrocardiography showed sinus rhythm and ST segment elevation in DI, DII and V2-6. Patient was treated with aspirin 300mg, ticagrelor 180mg, furosemide 40mg, oxygen therapy and was scheduled for emergent coronariography. This procedure revealed no significant coronary lesions and ventriculography identified apical ballooning, diagnosing takotsubo myocardiopathy. Clinical condition starts to deteriorate, and an echocardiography identified akinetic apical and midventricular segments and hyperkinetic basal segments with systolic anterior motion of mitral valve, significant mitral regurgitation and left ventricular outflow tract obstruction (LVOTO) with an intraventricular gradient superior to 60 mmHg. Adequate hemodynamic monitoring and heart rate control allowed a substantial clinical improvement. Two days later a cardiac magnetic ressonance was done, confirmed the diagnosis and identified an apical thrombus. The patient was later discharged stable with oral hypocoagulation with anti-vitamin K antagonist.

Discussion and Conclusion

Takotsubo cardiomyopathy is a unique cardiac syndrome characterized by transient systolic dysfunction witch often mimics acute coronary syndromes (ACS). After exclusion of an ACS, echocardiography is of primordial importance in the assessment of these patients. Left heart failure with pulmonar oedema, mitral regurgitation, LVOTO and thrombus formation were all complications that were present in this clinical case and established the indication to proper therapeutic attitudes.

Abstract P184 Figure.
P185 Primary cardiac lymphoma: an unexpected finding
Authors: Riesgo A , Ibero J , Rodriguez M , De La Torre F , Muniz J , De La Fuente A , Salterain N , Diaz I , Rifon J J , Bastarrika G , Gavira J J
Published: January 2020

BACKGROUND

Primary cardiac malignancies are rare, with a reported incidence of 0.1%. Up to 10% of cardiac tumors are malignant and primary cardiac lymphoma represents (PCL) a very low proportion of them. The wide variety of clinical manifestations and the inespecificity of them, difficults the diagnosis and delays treatment impacting directly in the prognosis of these patients. Here we present a lady with diagnosis of PCL treated in our center.

CASE REPORT

We present a 69 year old female with arterial hypertension and paroxismal atrial fibrilation that attended our clinic in april 2013. She referred severe dyspnoea with daily activities and peripheral oedema for the last three weeks. She also complaint of painful swallowing for bothliquids and solids. Physical exploration was unremarkable and observations where within normal limits. Transthoracic echocardiogram (TTE) was performed which showed an hipoechogenic mass invading the right ventricle, both atria and left ventricle outflow tract. She underwent cardiac MRI which revealed a myocardial isointense mass, with marked signal enhancement in T2 and heterogeneity in late gadolinium enhancement sequences, that was consistent with primary cardiac lymphoma. For histologycal characterization, biopsy of the mass guided with endoscopic ultrasonography was performed, confirming B-cell lymphoma. Positron emmision tomography (PET) scan showed bulky hypercaptant mass invading both atria, superior vena cava and pericardium, with hypercaptant adenopathies in right pulmonary hilum, subcarinal and phrenic chain. Her case was discussed in multidisciplinary team meeting and prompt initiation of treatment under R-CHOP regime was decided. After three cycles, follow up PET was requested, and revealed complete metabolic response. A repeat TTE showed only minimal infiltration of the right atria without ventricular involvement or hemodynamic compromise.

DISCUSSION

The patient we presented, was sent to Cardiology due to heart failure symptoms. Acute heart failure as well as embolisation and life-threatening arrythmias are typical manifestations of PCL. As reported in the literature, our case was a diffuse large B-cell lymphoma, which is the most frequent subtype. Dysphagia, exertional dyspnoea and constitutional symptoms can be present in early stages, as our patient referred. The main strength of this case is based on the quick diagnosis and early treatment. In contrary to what is reported, the overall survival was excellent, and to date the patient is still alive with no signs of relapse. Although TTE sensitivity is 55-60%, it has a key role in the diagnosis, which was supported later on MRI. Right chambers (specially right atria) are more typically involved than the left heart, including right venous drainage. Early systemic chemotherapy can achieve a high response rate and improve survival.

Abstract P185 Figure. Img1
P189 Duplication of the tricuspid valve (DOTV): case report of a rare congenital anomaly
Authors: Moscatelli S , Trocchio G , Stagnaro N , Siboldi A , Derchi M , Nuri H , Pome" G , Marasini M
Published: January 2020

Introduction

Tricuspid valve duplication is an extremely rare condition and in most of the cases it is associated with other congenital cardiac malformations. Because of its rarity, the clinical presentation and the management are not defined yet.

Clinical Case

We report the case of an 18 y/o caucasian male, who was admitted to our Hospital in February 2018 for rapid atrial flutter not responsive to medical therapy (propanolol and digossin). He had a pre-natal diagnose of ventricular septum defect (VSD) and tricuspid straddling. At 1 year of age he underwent pulmonary artery bandage and one year later VSD closure was performed. Blood test showed sub-clinic hypothyroidism, probably related to previous amiodaron therapy. A transthoracic echocardiogram was obtained. The right atrium (RA) was severely dilated and the atrial septum dislocated towards left ventricle (LV); two right atrioventricular valves (tricuspid valves) were detected: the ‘true’ tricuspid opening was inside the right ventricle, and an ‘accessory‘ opening was located inside the LV and severely regurgitant into the RA; the mitral valve was morphologically and functionally normal; both ventricles were dilated with preserved systolic function; systolic pulmonary artery pressure was not detectable. A Cardiac Magnetic Resonance clearly delineated the anomaly. Atrial flutter radio frequency transcatheter ablation was succesfully performed before corrective surgery. The regurgitant accessory tricuspid orifice was closed with an heterologous pericardial patch and a right reduction atrioplasty was also done. The post-operative course was uneventful and only a mild paraseptal tricuspid jet with LV to RA shunt was present at post op echocardiography. After one year follow-up the patient remained asymptomatic, without arrhythmia recurrence.

Conclusion

DOTV is an extremely rare condition that could be responsible of severe tricuspid regurgitation. At the moment, there are not sufficient data to establish the correct timing for surgical intervention. In our case, the presence of severe tricuspid regurgitation, right atrium dilatation, biventricular overload and atrial flutter guided the clinical management and suggested surgical correction.

Abstract P189 Figure.
P195 Postinfarction myocardial remodelling according to 2D ECHO data and genetic predictors: effect of genetic common variants in HSPB7 and MADD genes
Authors: Kuular A , Gamza A A , Ulitin A M , Tishkova V M , Muraviev A S , Kozyreva A A , Lyasnikova E A , Kostareva A A , Sitnikova M YU
Published: January 2020

Purpose

To study the impact of genetic variants rs1739843, rs2290149 and rs10838692 in HSPB7 and MADD genes on myocardial remodeling in the patients with postinfarction cardiosclerosis.

Methods and Results. The study included 252 men aged 30-65 y.o., who had MI more than 1 year ago. All patients had Q-MI of the anterior wall of the LV. Echocardiography was performed by the standard method (Vivid S6, GE, USA). Arterial hypertension (AH) was registered in more than 60% patients. Myocardial revascularization (CABG/PCI) was performed in more than in 50% of cases. Among 252 cases studies 156 patients had HFrEF (II–IV NYHA) LVEF (Sim)<40% (№1 group) and 96 patients had no clinical signs of HF and LVEF (Sim)>55% (№2 group). The groups were comparable in the AH prevalence and age. Patients all groups were on optimal drug therapy. Polymorphic genetic variants were studies using real-time-PCR. Eccentric types of LV remodeling prevailed in group 1 and concentric types of LV remodeling prevailed in group 2 (p < 0.001). The presence AH combined with CC genotype of rs1739843 in HSPB7 gene and TT genotype of rs2290149 in MADD and simultaneous carriage of the CC genotype of rs1739843 HSPB7 were associated with the presence of non-dilated ventricle (LV volume index ≤75 mL/m2) and relative wall thickness (RWT) >0.42 independently to LV mass index (p = 0.03). The T allele of rs1739843 HSPB7 (p = 0.006) and a combination of T allele of rs1739843 HSPB7 with the TT genotype of rs2290149 of the MADD gene were associated with the presence of dilated ventricles (p = 0.009) with LV hypertrophy (LV mass index >115 g/m2) independently to RWT.

Conclusion

Our preliminary data demonstrate that the genotype of HSPB7 (rs1739843) can modulated the association of AH and MADD rs2290149 with markers of ventricular hypertrophy and predispose to various types of post-MI remodeling of LV.
P196 Effect of tofogliflozin on systolic and diastolic cardiac function in type 2 diabetic patients
Authors: Matsumura K , Otagaki M , Sugiura T , Park H , Yamamoto Y , Shiojima I
Published: January 2020

Funding Acknowledgements

None

Background

Recent studies have shown that sodium glucose cotransporter 2 (SGLT2) inhibitors have a favorable effect on cardiovascular events in diabetic patients. However, the underlying mechanism associated with favorable outcome has not been clearly identified.

Purpose

The purpose of this study was to investigate the effect of tofogliflozin, SGLT2 inhibitor, on systolic and diastolic cardiac function in patients with type 2 diabetes mellitus (T2DM).

Methods

We enrolled 26 consecutive T2DM out-patients on glucose-lowering drugs who initiated tofogliflozin and underwent echocardiogram before and ≥ 6 months after tofogliflozin administration. During this period, we also enrolled 162 T2DM out-patients taking other glucose-lowering drugs as a control group. Propensity score analysis was performed to match the patient characteristics. As a result, 40 patients (tofogliflozin group: 20 patients and control group: 20 patients) were finally used for analysis. Left ventricular systolic function was assessed by measuring 2D-echocardiographic left ventricular ejection fraction (LVEF) and diastolic cardiac function by pulsed wave Doppler derived early diastolic velocity (E/e’).

Results

There were no significant differences in patient characteristics and echocardiographic parameters at baseline. Follow-up E/e’ was significantly improved in tofogliflozin compared to control (11.7 ± 3.5 vs. 14.4 ± 4.5, p = 0.037). Moreover, the change in LVEF from baseline to follow up was 5.8± 7.2% in tofogliflozin group and 1.2 ± 6.9% in control group; difference significant: p = 0.047.

Conclusions

In addition to conventional oral glucose-lowering drugs, additional tofogliflozin administration had a favorable effect on left ventricular systolic and diastolic function in patients with T2DM.