bluuebunny/crossref_metadata_2025 huggingface dataset:
612 EVOLUTION OF ATRIAL FIBRILLATION PATTERNS AND IMPACT ON ALL-CAUSE MORTALITY IN A CONTEMPORARY COHORT OF EUROPEAN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Vitolo Marco , Bonini Niccolò , Francesco Imberti Jacopo , Mei Davide , Forzati Nicola , Laus Vera , Stuani Marco , Chiriaco Francesco , Menozzi Matteo , Francesco Romiti Giulio , Proietti Marco , Livio Malavasi Vincenzo , Lip Gregory Yh , Boriani Giuseppe
Published: December 2022

Background

Paroxysmal atrial fibrillation (AF) often shows a natural evolution towards more sustained forms of the arrhythmia. Real-world data on clinical factors associated with AF progression and its impact on long-term outcomes are limited.

Aim of the study

To investigate the factors associated with progression of AF and its impact on all-cause mortality in a contemporary cohort of European AF patients.

Methods

We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Patients with paroxysmal AF at baseline or first detected AF who underwent successful cardioversion were included. Patients with known rhythm status at 1-year were then stratified into two groups: (i) No AF progression and (ii) AF progression, (as defined by transition to persistent or permanent AF). All-cause mortality at 2-year of follow-up was the primary outcome of the analysis.

Results

A total of 2688 patients were included (median age 67 years, interquartile range [IQR] 60-75, females 44.7%, CHA2DS2VASc score median 3 [1-4], HASBLED median 1 [1-2]). After 1-year of follow-up 2094 (77.9%) patients showed no AF progression while 594 (22.1%) developed AF progression. On multivariable logistic regression analysis, no physical activity (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.02-1.78), valvular heart disease (OR 1.63, 95%CI 1.23-2.15), left atrium diameter (OR 1.03, 95% CI 1.01-1.05) and left ventricular ejection fraction (OR 0.98, 95% CI 0.97-1.00) were independently associated with AF progression at 1-year. At the end of 2-year of follow-up, death occurred in 80/2621 (3.1%) patients. Kaplan-Meier analysis showed a lower cumulative survival from all-cause mortality in patients with AF progression compared to non-progression AF patients (Log Rank p=0.01, Figure). On multivariable Cox regression analysis, adjusted for age, sex, heart failure, coronary artery disease, hypertension, diabetes mellitus, previous thromboembolic events, peripheral artery disease, chronic kidney disease and use of oral anticoagulants, patients with AF progression had an independently higher risk for all-cause mortality (adjusted hazard ratio [aHR] 1.77, 95%CI 1.09-2.89).

Conclusions

In a contemporary cohort of European AF patients, a substantial number of patients evolved to persistent/permanent AF within 1 year. Clinical factors related to atrial structural remodeling were independently associated with arrhythmia evolution. AF progression was associated with an increased risk of all-cause mortality.
783 RELATIONSHIP BETWEEN PULSE WAVE VELOCITY AND MYOCARDIAL WORK IN UNTREATED HYPERTENSIVE PATIENTS WITH PRESERVED LVEF
Authors: Lofrumento Francesca , Mandraffino Giuseppe , Trimarchi Giancarlo , Mancinelli Anna , Restelli Davide , De Sarro Rosalba , Cusmà-piccione Maurizio , Manganaro Roberta , Di Bella Gianluca , Micari Antonio , Carerj Scipione , Zito Concetta
Published: December 2022

Introduction

Hemodynamic interaction between left ventricular (LV) and arterial system is a key determinant of cardiovascular performance. The non-invasive carotid-femoral Pulse Wave Velocity (PWV), obtained with applanation tonometry, is considered the most precise way of estimating arterial stiffness. The LV myocardial work (MW), based on non-invasive LV pressure-strain loop (PSL), is a new promising tool to assess LV function.

Aims

The aim of the study was to evaluate the correlation between PWV and MW parameters in a population of non-hypertensive and newly diagnosed untreated hypertensive people.

Materials and methods

80 people (M=48), divided in hypertensive (group 1 n=40, 45±10 years) and non-hypertensive (group 2 n=40, 40±12 years), were prospectively enrolled. All underwent conventional transthoracic echocardiogram and at the same day carotid femoral PWV was calculated with applanation tonometry (SphygmoCor® XCEL). MW parameters were obtained using 2D Speckle-tracking technique.

Results

Comparing the two groups, PWV and Global Work Wasted (GWW) were significantly higher in the hypertensives group (9,73±2,4 vs 7,79±1,1; p=0,001 and 146±50 vs 85±27, p=0,001), as shown in Figure 1, whereas Global Work Efficiency (GWE) and Global Work Constructive (GWC) were significantly lower (93,6±2,5 vs 95,6±1,2, p=0,001 and 2410±122 vs 2167±65, p=0,002). We found a linear and positive correlation of PWV with GWW (r=0,271, p=0,016), as seen in Figure 2, and a linear and negative correlation of PWV with GWE (r=-0,282, p=0,012).

Conclusion

This study highlights the role of PWV and MW evaluation in hypertensives. Higher PWV and GWW could be considered as red flags of myocardial damage suggesting the need of an early appropriate antihypertensive therapy.
275 MST1 MEDIATES DOXORUBICIN-INDUCED CARDIOMYOPATHY BY SIRT3 DOWNREGULATION
Authors: Schirone Leonardo , Vecchio Daniele , Forte Maurizio , Sciarretta Sebastiano
Published: December 2022

Introduction

Heart failure is a major side effect of doxorubicin (DOX) treatment in patients with cancer. However, the mechanisms underlying the development of DOX-induced cardiomyopathy (DCM) need to be addressed. Here, we demonstrate that the serine/threonine kinase MST1, a major Hippo pathway component, contributes to the development of DOX-induced myocardial injury.

Hypothesis

The inhibition of MST1 protects from DCM by preserving SIRT3 expression

Methods

C57BL/6J WT mice and mice with cardiomyocyte-specific dominant-negative MST1 (kinase-dead) overexpression received 3 weekly injections of DOX, reaching a final cumulative dose of 18 mg/kg. Echocardiographic, histological and biochemical analyses were performed 6 weeks after the first administration of DOX.

Results

MST1 signaling was significantly activated in cardiomyocytes in response to DOX treatment in vitro and in vivo. Wild-type (WT) mice treated with DOX had reduced fractional shortening (46,1±1,77 vs. 31,1±1,07, n=7-11) and mitochondrial abnormalities (3,7±0,93 vs. 10,2±1,5, n=12 microscopic fields from 3 independent samples). However, systolic dysfunction was abolished in mice with cardiomyocyte-specific overexpression of dominant-negative MST1 (DN-MST1) (31,1±1,07 vs. 46,3±1,13, n=11) or treated with the MST1 inhibitor ‘XMU-MP-1’ (37,5±1,8 vs. 46,6±1,87, n=8), indicating that MST1 inhibition attenuates DOX-induced cardiac dysfunction. Also, DOX treatment led to a significant downregulation of cardiac levels of SIRT3 (1±0,12 vs. 0,6±0,11, n=4), a deacetylase involved in mitochondrial protection, in WT mice, which was rescued by MST1 inhibition (0,6±0,11 vs. 1,3±0,04, n=4). Pharmacological inhibition of SIRT3 blunted the protective effects of MST1 inhibition (44,5±1,55 vs. 32,5±2,33, n=4), indicating that SIRT3 downregulation mediates the cytotoxic effects of MST1 activation in response to DOX treatment. Finally, we found a significant upregulation of MST1 levels in human myocardial tissue of cancer patients treated with DOX (1,5±0,23 vs. 2,4±0,12, N=81-123 cells from 3 different patients).

Conclusion

MST1 contributes to DOX-induced cardiomyopathy by promoting mitochondrial damage through SIRT3 downregulation in cardiomyocytes.
751 CANCER TREATMENT RELATED COMPLICATIONS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
Authors: Zampieri Mattia , Schoonvelde Stephan , Vinci Michele , Visani Luca , Coppini Raffaele , Michels Michelle , Morelli Ilaria , Meattini Icro , Livi Lorenzo , Romei Andrea , Olivotto Iacopo
Published: December 2022

Introduction

Cardiotoxicity involves direct effects of cancer related treatment on heart function, commonly presenting as left ventricular contractile dysfunction. However, limited data are available regarding cardiotoxicity on hypertrophic cardiomyopathy (HCM), because most studies and registries have not specifically analyzed the effects of oncological treatment in HCM populations. This gap in knowledge may lead to unjustified restriction of HCM patients to radical cancer treatments.

Aim

We aimed at describing the potential clinical cardiotoxicity of oncological treatments in a cohort of consecutive HCM patients, systematically followed up at two national referral centres for HCM.

Methods

We retrospectively analysed all clinical and instrumental data of all consecutive HCM patients who underwent oncological treatment between January 2000 and December 2020, collected in a centralized database.

Results

Of 3256 HCM patients, 121 (3.7%) had a reported diagnosis of cancer; 109 (90.1%) patients underwent oncological surgery, 45 (37.2%) chemotherapic treatment, 22 (18.2%) chest radiotherapy. After a median follow up of 5 (2-13) years from oncological diagnosis, 32 of the 121 patients (26.4%) died. The cause of death was mainly attributed to the oncological condition, while 4 (12.5%) patients died of sudden cardiac death without previous chemotherapy or chest radiotherapy.

No patient interrupted or reduced the dose of oncological treatment due to cardiac dysfunction. No sustained ventricular tachyarrhythmia was induced by chemotherapy or radiotherapy.

Conclusions

Cancer treatment is well tolerated in HCM patients. In our oncology series, none died of cardiovascular complications induced by chemotherapy or chest radiotherapy and none required interruption or substantial tapering of treatment due to cardiovascular side effects. Although expert multidisciplinary evaluation is mandatory and regimens must be tailored individually, the diagnosis of HCM per se should not be considered a contraindication to radical cancer treatment.
154 PROBIOTICS: OBSERVATION IN PRACTICAL MEDICINE
Authors: Acquistapace Flavio , Camponovo Claudio , Odello Tania , Negrini Alice , Graziano Elisa
Published: December 2022

Background

There are several, even recent, basic research studies that have demonstrated the microbiota's cause for the predisposition and development of degenerative disorders and risk factors: cardiovascular diseases, obesity, metabolic syndrome and diabetes. Studies, knowledge and communication on probiotics have gone and are increasingly growing, so much so that almost a "trend" of the probiotic has developed. The importance of defining the "probiotic", developing knowledge and clinical research, or evaluating the results in real clinical practice, is essential for the appropriate use for the benefit of the person. The doctor has and must have a central and primary role.

Purpose

The study, which we conducted in clinical practice, is of an observational type, and has as its primary outcome that of evaluating the impact of nutriceutic integration with probiotics on risk factors of inflammatory and metabolic markers and as a secondary outcome the functional capacity and perception of psychophysical health.

Methods

Out of 70 patients followed, 50 patients were selected and evaluated for homogeneity and adherence characteristics. Eligibility characteristics below: risk profile, familiarity for cardiovascular diseases, dysendocrine disorders, overweight and obesity, hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, fatigue syndrome, neurovegetative dystonia. The evaluation of probiotic therapy was carried out in two stages on the basis of the following parameters: psychophysical perception of the state of health, using the SF-36 Questionnaire, functional capacity by means of the physical ability test (Six Minute Walking Test 6MWT or Walking Test), blood tests: PCR, Vitamins, lipid profile. The nutraceutical scheme consists of taking 2cps after breakfast and 2 cps after Enterelle's dinner, during the first week. Bifiselle, second week, Ramnoselle third week Serobrain 1 cps after breakfast fourth week. Serobioma, one tablet per day, for 3 months: maintenance phase.

Results and Conclusions

The observational study in real practice indicated an efficacy of the probiotic nutraceutical treatment on patients with regard to the reduction of the measurable risk profile, improvement of the perception of health including objective level of functional capacity, stabilization of the levels of vitamins (vit B and D).
300 LITERATURE CASE SERIES REVIEW ON LANDIOLOL IN ACUTE DECOMPENSATED HEART FAILURE SECONDARY TO TACHYARRHYTHMIAS
Authors: Cereda Alberto , Laricchia Alessandra , Marini Claudia , Franchina Gabriele , Conconi Barbara , Lucreziotti Stefano
Published: December 2022

Introduction

Landiolol is a recently innovated ultra-short-acting beta-blocker. Landiolol is the only beta-blocker with a specific dose recommendation for patients with cardiac dysfunction and acute atrial fibrillation (Class I recommendation according to the ESC guidelines). Landiolol has a shorter elimination half-life than any other beta-blocker, and it can be administered safely to patients with various tachyarrhythmias. The short duration of action and titratability of landiolol makes it ideal for use in critically ill patients.

Purpose of the Study

Review the case reports in the literature on the administration of landiolol in critically ill patients with acute decompensated heart failure (ADHF) secondary to tachyarrhythmias.

Methods

11 case reports of ADHF secondary to tachyarrhythmias were identified. Personal, clinical and humoral data were collected. The heart rate and systolic pressure values in the time before and after the administration of Landiolol were plotted in a summary graph.

Results

The mean age of the 11 patients was 55 years old with high proBNP values at admission. The etiological diagnosis of heart failure was heterogeneous but tachyarrhythmia was the trigger event in all patients. Patients were critically ill with a mean EF of 26 ± 16% and an initial shock index of 1.4 ±0.5. Landiolol administered together with other antiarrhythmic drugs (amiodarone in 4/11 patients), epinephrine/norepinephrine (9/11) and levosimendan (4/11) favoured heart rate lowering and an increase in systolic blood pressure.At discharge, 4/11 had improved EF, in 10/11 sinus rhythm was restored, and all patients recovered hemodynamic stability without adverse events related to Landiolol (Figure 1).

Conclusion

In this case series review, Landiolol was a useful strategy in patients with ADHF refractory to conventional therapy by facilitating rate/rhythm control, limiting the toxicity of inotropic drugs and improving the hemodynamic profile.

Figure 1
1032 FEASIBILITY AND RELIABILITY OF COMPREHENSIVE THREE DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY SCREENING PROCESS FOR TRANSCATHETER MITRAL VALVE REPLACEMENT
Authors: Boccellino Antonio , Piroli Francesco , Ingallina Giacomo , Rolando Marco , Melillo Francesco , Francesco Ancona , Stella Stefano , Biondi Federico , Baldetti Luca , Palmisano Anna , Esposito Antonio , Denti Paolo , Montorfano Matteo , Maisano Francesco , Castiglioni Alessandro , Agricola Eustachio
Published: December 2022

The procedural planning of transcatheter mitral valve replacement (TMVR) requires a specific imaging assessment to establish patient eligibility. Computed tomography (CT) is considered the reference method. In this setting, data regarding the role of transesophageal echocardiography (TEE) are lacking.

Aims

To evaluate the feasibility and reliability of a comprehensive 3D-TEE screening in TMVR candidates.

Methods

we performed a retrospective observational study including 72 consecutive patients who underwent a pre-procedural CT and 3D-TEE for TMVR evaluation. The measurements of mitral annulus (MA), length of anterior mitral leaflet (AML), native left ventricular outflow tract (LVOT) and predicted neo-LVOT acquired with CT and 3DTEE were compared using a novel semi-automated software for post processing analysis (3mensio Structural Heart 10.1 - 3mSH, Pie Medical Imaging, Bilthoven, Netherlands). The final suitability decision was given by the valve manufacturer based on CT measurements and clinical conditions.

Results

Among 72 patients screened, all patients had adequate image quality for 3D-TEE analysis. 3D-TEE and CT measurements for AML length (r=0.97), MA area (r=0.90), perimeter (r=0.68), anteroposterior (r=0.88) and posteromedial-anterolateral (r=0.74) diameters were found highly correlated, as well as for native LVOT (r=0.86) and predicted neo-LVOT areas (r=0.96) (all P -values <0.0001). An almost perfect agreement among CT and 3d TEE was found in assessing the eligibility for TMVR implantation (Cohen Kappa 0.83, p<0.001).

Conclusions

3D-TEE appraisements showed good correlations with CT measurements and high accuracy to predict TMVR screening success.

Central Illustration. Mitral annulus segmentation and neo-LVOT area measurement performed by means of the 3mensio software (Pie Medical Imaging, Bilthoven, Netherlands) in a step-by-step fashion by TEE and CT imaging. After the virtual simulation of a valve implantation, the minimal systolic neo-LVOT area is manually measured by planimetry on a plane orthogonal to the centerline.
288 LAY LADY LAY, A TRICKY CASE OF PLATYPNEA ORTHODEOXIA SYNDROME
Authors: Coraducci Francesca , Barbarossa Alessandro , Manfredi Roberto , Coretti Francesca , Torselletti Lorenzo , Belleggia Sara , Paolini Federico , Alfieri Michele , Brugiatelli Leonardo , Bastianoni Gianmarco , Principi Samuele , Ciliberti Giuseppe , Stronati Giulia , Dello Russo Antonio , Guerra Federico
Published: December 2022

Platypnea orthodeoxia syndrome (POS) is characterized by dispnoea and a fall in oxygen saturation levels when in the upright position that resolves lying down in the supine position. It is secondary to a right to left shunt (R-L shunt), typically trough a patent foramen ovale (PFO).

Normally, in the presence of a PFO, R-L shunt does not occur unless there is a clinical condition that raises right side pressures like venous thromboembolism, hydrothorax, pneumothorax or chronic pulmunary hypertension. Although its physiopathological mechanisms are not entirely understood, in the POS, R-L shunt mostly occurs due to anatomical alteration of the interatrial septum in the upright position. Venous flow therefore can pass from the inferior vena cava through the PFO or an atrial septal defect (ASD) to the left side of the heart.

We present a case of a 77 y.o. woman with no relevant past medical hystory, that was admitted to hospital care because of a mild pulmonary embolism and deep vein trombosis of the right popliteal vein. She was promptly treated for PE with direct oral anticoagulation achieving the resolution of the embolism. Despite the CT scan showed the complete resolution of the embolism her dysponoea did not improve. Her blood gas analysis showed normocapnic hypoxiemic respiratory insufficiency with a suspicious lowering of oxygen saturation levels when in the upright position which however improved in the supine position. She also had a transient episode of dysarthria and hypostenia to the right upper limb, the negative head CT scan was suggestive of a transient ischaemic attack. A pulmonary scintigraphy showed arterious renal perfusion as in a right to left shunt. She then underwent a transoesophageal echocardiography which showed an hypermobile interatrial septum with evidence of a patent foramen ovale with left to right shunt. The exame was in fact executed in the supine position. Given these findings, we concluded for a diagnosis of POS. Because of this records, the severity of the shunt and the suggestive clinical hystory of ortodeoxya she underwent PFO closure positioning an Amplatzer PFO Occluder 25 mm. The procedure was carried out without complications and led to complete resolution of the symptoms and the signs of platipnoea-ortodeoxya.
458 CARDIOVASCULAR MAGNETIC RESONANCE IMAGING IN SUSPECTED CARDIAC MASSES: HISTOLOGICAL CORRELATION AND CLINICAL OUTCOMES
Authors: Dellino Carlo Maria , Gaspari Monica De , Garlini Paolo , De Lazzari Manuel , Cipriani Alberto , Cecchetto Antonella , Baritussio Anna , Cecere Anna Grazia , Ruocco Alessandro , Rizzo Stefania , De Conti Giorgio , Motta Raffaella , Basso Cristina , Iliceto Sabino , Perazzolo Marra Martina
Published: December 2022

Background

Cardiac masses represent a major diagnostic challenge given the difficulty in assessing their nature through imaging examinations. Cardiac Magnetic Resonance (CMR) is a noninvasive key diagnostic tool that can provide important anatomical, functional, and tissue characteristic information.

Objectives of the study

analyze the clinical and CMR features of patients with benign and malignant tumors and thrombus; asses the accuracy of CMR in comparison with the histologic examination; evaluate the prognostic rule of clinical and CMR features in predicting the primary endpoint of all cause mortality.

Methods

92 Patients undergoing CMR for suspected cardiac masses between June 2004 and January 2022 were retrospectively evaluated. Patients with no mass 8 (9%) or pseudomass 11 (12%) were excluded. Clinical, CMR and histological data were collected.

Results

73 patients with masses were finally enrolled, 27 (37%) with a diagnosis at CMR of benign tumor, 22 (30%) with malignant tumor, and 24 (33%) with thrombus. Among clinical variables the history of malignancy and smoking were seen in patients with malignant tumors (p>0,02). Among CMR features high size, infiltration, pericardial repeats, pericardial effusion, signal inhomogeneity, First Pass Perfusion and Late Gadolinium Enhancement were associated with malignant masses (p<0.05), while reduced pre-contrast visualization, altered kinetics, low ejection fraction and long-TI were observed in thrombi (p<0.05). CMR was accurate in 91.2% (31/34) of patients in comparison with the histological examination. Accuracy for benign tumors was 91.3% (AUC=0.913), for malignant tumors 94% (AUC=0.940) and for thrombi 83% (AUC=0.833). Patients with thrombus at CMR had similar mortality as those with benign tumor while patients with malignant lesions had higher mortality (HR: 4.98 [95% CI: 1.11-22.2]). Regardless of diagnosis at CMR, age, tumor history, mass size, signal inhomogeneity, presence of FPP, pericardial effusion, and pericardial repeats were found to predict long-term mortality (p<0.05).

Conclusions

although CMR has high diagnostic accuracy, histologic examination remains the diagnostic gold standard in determining the type of cardiac mass. In addition to playing a key role in the diagnostic process, CMR is useful in predicting the outcome of patients with cardiac masses.
704 STRESS TEST STRATEGY WITH CMR AND SPECT-MPI REDUCES CARDIAC EVENTS IN CANDIDATES TO NON-CARDIAC SURGERIES
Authors: Fazzari Fabio , Cannata Francesco , Figliozzi Stefano , Didedda Emanuele , Catapano Federica , Lisi Costanza , Brilli Federica , Chiarito Mauro , Storniolo Salvatore , Chiti Arturo , Condorelli Gianluigi , Monti Lorenzo , Francone Marco
Published: December 2022

Introduction

. Cardiac complications related to non-cardiac surgery have a variable incidence, from less than 1% to more than 5% with a great variability depending on type of intervention, patient's risk factors and results from tests performed during the pre-operative evaluation. The aim of our single centre retrospective study was to evaluate the prognostic role of stress cardiac magnetic resonance (sCMR) and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in relation to 30 days post-surgery cardiac events.

Method

Clinical data of patients from January 2015 to December 2021 were retrospectively collected from review of electronical medical records. Only intermediate and high risk surgeries were included. All patients underwent to cardiologic, electrocardiographic and echocardiographic evaluation before surgery. Stress test was performed according to cardiologist judgment. Primary endpoint was a composite endpoint of myocardial infarction, unstable angina, cardiac death, cardiogenic shock, pulmonary oedema and life threatening cardiac arrythmias. Secondary endpoint were the research of ischemia predictors and the rate of revascularization.

Results

One-thousand-five-hundred-ninety patients were included, 669 stress tests were performed (287 sCMR, 382 SPECT-MPI). Rate of 30-days cardiac events was lower in the stress test group vs non-stress test group (1,2% vs 3,4%; p 0,006). Imaging stress test strategy showed a significant reduction of composite endpoint at multivariate analysis (OR: 0.334, IC: 0.155–0.766, p 0.009). Predictors of ischemia were hypertension, coronary artery disease and diastolic dysfunction. SCMR was non inferior to SPECT with regard the risk of cardiac events, while showed a greater accuracy to predict coronary revascularization (AUC for sCMR: 0.94).

Conclusions

Stress test strategy reduces cardiac events in high risk patients candidate to moderate- to high- risk surgeries. Stress CMR is non-inferior to SPECT with regards to the risk of cardiac events, but has a greater accuracy to predict the need for revascularization.
790 LEFT VENTRICULAR OUTFLOW TRACT VELOCITY TIME INTEGRAL OUTPERFORMS LEFT VENTRICULAR EJECTION FRACTION IN HEART FAILURE PATIENTS WITH SIGNIFICANT MITRAL REGURGITATION
Authors: Gentile Francesco , Buoncristiani Francesco , Chubuchny Vlad , Sciarrone Paolo , Panichella Giorgia , Gasparini Simone , Bazan Lorenzo , Fabiani Iacopo , Taddei Claudia , Poggianti Elisa , Petersen Christina , Pasanisi Emilio , Passino Claudio , Emdin Michele , Giannoni Alberto
Published: December 2022

Background

Reduced left ventricular ejection fraction (LVEF) has been used as a key criterion for the management of mitral regurgitation (MR) in patients with heart failure (HF), including the decision about mitral valve repair. However, LVEF, not taking into account mitral regurgitant volume, may be an imprecise predictor of outcome in HF patients with MR. Conversely, the estimation of the forward volume through the LV outflow tract (LVOT) may be a better metric in this setting. In this regard, LVOT velocity time integral (LVOT-VTI), not relying on geometrical assumptions, has been shown to be more reproducible than the calculated stroke volume (i.e., LVOT-VTI * LVOT cross sectional area), at least in the acute setting.

Objective

To assess the prognostic significance of LVOT-VTI in a contemporary cohort of patients with chronic HF and significant MR.

Methods

Consecutive patients with chronic HF with reduced (≤40%) or mildly reduced (41-49%) LVEF and moderate-to-severe or severe MR, according to the latest European Society of Cardiology criteria, were selected and followed-up for the endpoint of cardiovascular death.

Results

203 patients were enrolled in the study (74±11 years, 66% men, 47% ischemic etiology, HFrEF 86%, LVEF 31±9%, mean LVOT-VTI 21±6 cm). Most patients showed a NYHA class II (40%) or III (31%) and received beta-blockers (95%), ACE-inhibitors/ARBs or ARNI (77%), and mineralocorticoid receptor antagonists (82%). Seventy-seven patients (38%) had permanent atrial fibrillation and 46 (23%) a cardiac resynchronization therapy device. Over a median follow-up of 18 (7-33) months, 30 patients died, 24 of whom for a cardiovascular cause, and 10 underwent mitral valve repair/replacement. When stratified according to the optimal prognostic cut-off of LVOT-VTI, patients with a LVOT-VTI <16 cm (n=36) showed the greater risk of cardiovascular death (Log Rank 18.2, p<0.001, Figure). Similarly, patients with a LVEF <33% (n=122) showed a higher risk of cardiovascular death (Log Rank 5.5, p=0.019). Nevertheless, at Cox regression analysis, a unit decrease in LVOT-VTI (hazard ratio, HR 0.87 [95%CI 0.79-0.95], p=0.002) but not in LVEF (p=0.729) was associated with a higher risk of cardiovascular death (Figure).

Conclusion

Left ventricular forward volume, noninvasively estimated through LVOT-VTI, but not LVEF, predicts the risk of cardiac death in patients with chronic HF and significant MR.
335 CORONARY CT SCREENING: A PRIMARY ROLE IN CORONARY EVENTS PREVENTION
Authors: Mura Lucia La , Izzo Carmine
Published: December 2022

Background

Coronary CT (CCT) is one of the most used noninvasive imaging for the detection of coronary artery disease (CAD) in the US, especially in patients with intermediate CAD risk.

European Society of Cardiology also recommends risk stratifications using coronary CT angiography in patients with suspected CAD (level IB).

Purpose

the purpose of the study was to evaluate in a population that underwent CCT screening, how many had significant coronary lesions and which cardiovascular (CV) risk factors were most involved.

Methods

228 patients (37% female, 63,34±9.9 years) with no previous coronary events and 64,5% with no coronary symptoms (angor, dyspnea), were enrolled. All patients underwent a cardiological evaluation for CV risk factors (age, sex, hypertension, early familiarity for CAD, dyslipidemia, smoke, obesity, diabetes, chronic kidney failure, vascular atherosclerosis) and a CCT (Ca scoring and CT angiography), performed by a 128-slices system and analyzed by a single operator with over 3 years of experience. CCT was considered positive if CAD-RADS was ≥ 4A.

Results

60 patients (26,3%) had a positive CCT and were hospitalized for coronary angiography. The CCT positivity correlated significantly with the sex (p<0.001), familiarity (p<0.001), hypertension (p= 0.006) and Ca Score (p<0.001), but did not significantly correlate with the other risk factors (dyslipidemia, smoke, age, obesity, diabetes, chronic kidney failure, vascular atherosclerosis) or symptoms (Table.1).

Conclusions

family history and sex, together with hypertension, seem to be the factors that most determine the presence of ischemic heart disease, more than the other common risk factors. The possibility of performing CCT in all patients with early family history could be considered to effectively prevent the onset of coronary events.

Table.1
669 ECHOCARDIOGRAPHIC PREDICTORS FOR MORTALITY IN LIVER TRANSPLANT
Authors: Landi Irene , Alharbi Suliman , Alfehaid Abdullah , Eltayed Abdalla , Aldosari Sarah Radaan , Pirisi Mario , Troisi Roberto , Vriz Olga
Published: December 2022

Background and aim

According to the evidence, cirrhotic cardiomyopathy affects about 50% of patients with cirrhosis.). The aim of our study was to evaluate pre- and post-surgery transthoracic echocardiography (TTE) parameters in a cohort of patients undergoing liver transplant (LT) and their relationship with LT complications and mortality.

Methods

We recruited 102 (61 males, 59.8%; median age 59 [54-65] years) patients who underwent comprehensive TTE before and after LT and compared TTE parameters measured before and after LT.

Results

At the end of the follow-up, 76 patients (74.5%) survived, 16 (15.7%) died and 10 (9.8%) were lost at follow-up. Both, left and right side heart chambers significantly decreased after LT as did left ventricular function (EF from 62,9% to 58,8%, p<0,001; global longitudinal strain from -21,5 to -18,13, p<0,001) and right ventricular function (TAPSE from 24mm to 21mm, p<0,001; FAC from 51,54% to 49,14%, p=0,003; right ventricular global strain from pre-LT -23,66 vs post-LT -19,94, p<0,001). Though pulmonary arterial pressure (PAPs) did not change significantly, RV-pulmonary arterial coupling was significantly lower after LT either as TAPSE/PASP (0.9 vs 0.8, p=0.02). Interestingly, post-LT PASP was significantly higher in the group that did not survive. Furthermore higher difference in PASP between pre and post-LT TTE, and TAPSE (Diff PASP HR 1,044, p- value 0,01, C.I 1,01-1,08; TAPSE Diff HR 1,088, p- value 0,03, C.I 1,01-1,17) were determinant of increased risk for death combined with LV EF.

Conclusions

Our data suggest that elevated PASP and lower TAPSE have been associated with increased risk of death after LT.
692 THE USE OF ULTRASOUND ENHANCING AGENTS (UEA) IN THE EVALUATION OF LEFT ATRIAL APPENDAGE (LAA) THROMBUS IN PATIENT CANDIDATE TO PERCUTANEOUS LAA CLOSURE
Authors: Roccabruna Alessandra , Fanti Diego , Bonvicini Eleonora , D´onghia Giovanni , Sarao Emanuele , Guarracini Fabrizio , Bonmassari Roberto , Luciano Ribichini Flavio
Published: December 2022

Introduction

Left atrial appendage closure (LAAC) is an emerging option in patients with atrial fibrillation (AF) and contraindication for oral anticoagulation (OAC) therapy. Patients with left atrial thrombus are usually excluded from this strategy. Therefore, pre-procedural transesophageal echocardiography (TEE) is usually performed for LAA thrombus exclusion. The application of second-generation lipid microspheres ultrasound enhancing agents (UEA) is of growing interest. The following clinical cases reports describe the benefit from UEA implication on subsequent decision-making regarding with LAAC procedure.

Case report num.1

an 88-year-old male with history of symptomatic AF and post – traumatic cerebral bleeding was referred to LAAC because of high risk of bleeding in using OAC. Transthoracic echocardiography (TTE) documented a severely dilatated left atrium and preserved left ventricular systolic function. Pre – operative TEE revealed a “chicken wing” shaped LAA with severe spontaneous echo-contrast and sludge effect. Echo-contrast medium “SonoVue” showed an early filling defect with late but complete LAA opacification, excluding thrombus. Of note, ECG-gated cardiac CT (CCT) could not exclude filling defect with certainty. Consecutively, the patient was candidate to LAAC in a short time.

Case report num.2

a 75-year-old man with valvular permanent AF and multi-territory ischemic ictus despite being on adequate prophylactic OAC (Warfarin). At TTE a dilated left ventricle with mildly reduced ejection fraction was documented. ECG – gated CCT with delayed phases imaging showed a possible filling defect in LAA, however imaging was suboptimal due to a reverb of voluminous hiatal hernia. TEE revealed a “windstock” shaped LAA with incomplete distal opacification when echo-contrast medium “SonoVue” was used, confirming thrombus. The patient was therefore referred for LAAC procedure with concomitant use of cerebral embolic protection devices (CEPDs).

Discussion

Transesophageal echocardiography is the test of choice for the exclusion of LAA thrombus. However technical difficulty, spontaneous echo contrast (SEC) and prominent pectinate musculature within the appendage may make the exclusion of LAA thrombus not easy. ECG – gated cardiac CT may be conclusive as well. UEA use is associated with higher diagnostic power for LAA thrombus exclusion and recent study have shown its utility also in terms of LAA sizing. Thus, the most recent guidelines of American Society of Echocardiography mention echo contrast use for the delineation of LAA thrombi and differentiate between them with SEC.

Conclusion

The use of ultrasound enhancing agents is useful and increases the interpretative confidence in exclusion of LAA thrombus.
1087 QUANTITATIVE CHANGES IN INTRACARDIAC FLOW PARAMETERS DURING HEMODIALYTIC SESSIONS
Authors: Rosa Romano Letizia , Sabatino Jolanda , Calvelli Pierangelo , Bolignano Davide , Coppolino Giuseppe , Presta Pierangela , Strangio Antonio , Leo Isabella , Maglione Marco , Troilo Fabio , Loliva Giuseppe , Critelli Claudia , Andreucci Michele , Salvo Giovanni Di , Indolfi Ciro , Rosa Salvatore De
Published: December 2022

Background

Hemodialysis sessions exert an acute impact on cardiac geometry and mechanics. The recent development of quantitative measurement of intracardiac fluid-dynamics offers a new opportinuty to better understand the fine changes in intracardiac cardiac hemodynamics associated with hemodialysis sessions. Our aim was to assess the impact of an hemodialytic session on intracardiac flow dynamics.

Methods

We included 26 consecutive patients on chronic hemodialysis in clinically stable phase. They underwent echocardiography including intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler) before and after a single dialysis session. Patients with hemodynamically relevant valvular disease were excluded. A complete fluid-dynamics evaluation included the measurement of multiple parameters such asvortex area (VA); vortex length (VL); vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Changes in fluidodynamics after dialysis sessions were tested using the Wilcoxon matched-pairs test.

Results

Mean Vortex Area (VA) (p=0.034), Vortex Depth (VD) (p=0.024) and Vortex Length (VL) (p=0.037) were significantly reduced after the dialysis session. A similar trend towards the reduction of Direct Flow (DF) parameter after the session was found, which was significantly larger for patients with larger baseline left ventricular (LV) end-diastolic diameter (r=0.446; p=0.037). On the other hand, mean Vortex Intensity (VI) was significanlty increased after dialysis (p=0.046). Among energy parameters, the intradialytic change in Kinetic Energy Fluctuation (KEF) (r=0.4; p=0.058) and Shear Stress Fluctuation (SSF) (r=0.435; p=0.038) were most closely correlated with intradialytic weigth change. Some fluid-dynamic parameters had similar trends of intradialytic change, with stonger correlations among geometric parameters. Delta changes in VA were closely related to changes in VI (p<0.001) or LV (p<0.001). VI was also correlated with VL (p<0.001) and with Kinetc Energy Dissipation (KED) (p=0.030), which was also correlated with VL (p=0.044). KEF was correlated with KED (p=0.001) and SSF (p=0.022). Finally, chenges in SSF were correlated with those in Flow Force Parameter (p=0.033) and Flow Force Angle (p=0.034), that were very closely correlated each other (p<0.001).

Discussion

This is the first study assessing the impact of hemodialytic sessions on intracardiac flow dynamics. Measurement of hyperdoppler indices on hemodialysis chair was feasible and reliable in the whole population. Our results uncovered quantitative chenages of echocardiographic parameters of vortex geometry and energy during hemodialysis.
708 PATTERNS OF BIOLOGICAL AGING OF THE HEART AND THEIR PROGNOSTIC VALUE: THE SARDI-NIA STUDY
Authors: Saba Pier Sergio , Orrù Marco , Sanna Giuseppe , Delitala Alessandro , Lakatta Edward , Fiorillo Edoardo , Cucca Francesco , Ganau Antonello
Published: December 2022

Background

As people age at different rates, the concept of biological age has been introduced as a measure of functional deterioration. Associations of echocardiographic traits with age were analyzed to detect different biological aging rates of the heart and their prognostic value.

Methods

Echocardiographic left ventricular mass, geometry, left atrial volume, diastolic function, and aortic root size were measured in 3817 adults (58% females). Sex-specific correlations of age with six cardiac traits were assessed in 2614 healthy subjects. According to two-sided 95% tolerance intervals, three patterns of heart aging rates were identified in the whole cohort: slow aging pattern (n=287), normal aging pattern (n=2669), and accelerated aging pattern (n=796). The phenotypic (biological) age of the heart (HeartPhAge) was estimated from the cardiac traits by multiple linear regression. Cardiovascular and non-cardiovascular incident events at follow-up (46 months (IQR 34–64 months) were grouped into three endpoints and analyzed in survival analyses.

Results

Compared to chronological age, HeartPhAge was nine years younger (p<0.0001) in the slow aging pattern, similar in the normal pattern, and three years older (p<0.0001) in the accelerated pattern. The incidence of all endpoints was higher in the accelerated pattern than in the normal and slow aging patterns (p<0.0001 to p=0.0003). In Cox proportional-hazards analysis, the heart aging patterns significantly predicted all endpoints in both the whole cohort and the healthy subset, independent of chronological age and risk factors.

Conclusion

Heart aging patterns reflect the rate of biological aging and independently predict cardiovascular and non-cardiovascular events.
701 LEFT ATRIAL APPENDAGE CONGENITAL ABSENCE AND ATRIAL FIBRILLATION
Authors: Sforna Stefano , Bardelli Giuliana , Mengoni Anna , Zuchi Cinzia , Lauciello Rosanna , Crusco Federico , Carluccio Erberto , Ambrosio Giuseppe
Published: December 2022

Introduction

Left atrial appendage (LAA) is a finger-like muscular extension of the left atrium (LA). It acts as blood reservoir, modulates LA pressure and elicits adaptive responses to stress. Several LAA shapes and variants have been described. We report a case of congenital absence of LAA diagnosed by transesophageal echocardiography (TEE) and confirmed by computed tomography (CT).

Case report

A 55-year-old male patient with history of hypertension was admitted to our hospital for an episode of atrial fibrillation (AF). TEE was performed and showed normal LA volume, absence of thrombi and spontaneous echo contrast in the LA, but, despite acquiring three-dimensional (3D) en-face views, we were unable to identify LAA. Congenital absence of LAA was suspected and multidetector cardiac CT confirmed the abnormality.

Discussion

Congenital absence of LAA is an extremely rare condition: only eighteen cases were described on a review of the literature published in 2020. Associations with other congenital abnormalities or with atrial fibrillation have been reported, but a causal relationship cannot be established. Multiple imaging modalities can be used to define the anatomy and function of LAA, to detect or rule out in situ thrombosis and to guide catheter-based therapies, but the most widely used technique is TEE. Among intracardiac thrombi in patients with non-valvular atrial fibrillation, more than 90% are identified in the LAA, meaning that the remaining 10% may develop in other sites of the LA. The congenital absence of LAA could be considered similar to LAA percutaneous occlusion or surgical exclusion; because of the few published randomized controlled trials, the current ESC guidelines on atrial fibrillation are unclear about the true thrombotic risk in these cases. Since LAA percutaneous occlusion is actually indicated only in cases of contraindications for long-term anticoagulant treatment, in our opinion in patients with non-valvular AF, LAA congenital absence, high stroke risk and low bleeding risk, anticoagulant therapy should be considered.

Conclusion

Congenital absence of LAA is an extremely rare condition and its pathophysiological role, especially with regard to antithrombotic therapy in patients with AF, is still not well defined.
511 INCREMENTAL VALUE OF RIGHT ATRIAL STRAIN ANALYSIS TO PREDICT ATRIAL FIBRILLATION RECURRENCE AFTER CARDIOVERSION
Authors: Tomaselli Michele , Cannone Vincenzo , Muraru Denisa , Oliverio Giorgio , Gavazzoni Mara , Heilbron Francesca , Radu Noela , Perelli Francesco , Stucchi Davide , Pece Cinzia , Camponetti Virginia , Rizzo Salvatore , Battista Perego Giovanni , Caravita Sergio , Baratto Claudia , Parati Gianfranco , Brasca Francesco , Paolo Badano Luigi
Published: December 2022

Background

In patients with paroxysmal atrial fibrillation (AF), left atrial (LA) mechanics has been reported to be important to predict recurrences after cardioversion. However, the potential additive role of right atrial (RA) function in this setting remains to be tested. Accordingly, the aims of our study was to assess the added role of right atrial reservoir longitudinal strain (RARS) for prediction of AF recurrence after electrical cardioversion.

Methods

we prospectively studied 130 (mean age 69±14, 55% men) consecutive patients with persistent AF who underwent electrical cardioversion, acquired between June 2020 and December 2021. Exclusion criteria were: presence of pacemaker, more than moderate mitral and tricuspid regurgitation, left or right ventricular dysfunction, prior cardiac surgery, and, inadequate acoustic window. LA and RA 2D-speckle-tracking echocardiography analyses were obtained from dedicated, non-foreshortened 4-ch and RV-focused apical 4-ch views respectively, using a dedicated software package (AFI LA, EchoPAC 204, GE Vingmed, Horten, Norway). The primary endpoint was AF recurrence.

Results

after a follow-up period of 12 months, 60 patients (45%) reached the primary endpoint. The mean left ventricular ejection fraction (LVEF) was 56.5±8%, for all patients. No significant difference in LA (98±31 vs 94±30 mL, p= 0.333) and RA (68±26 vs 65±26 mL, p=0.286) volumes was detected between patients with and without AF recurrence, while left atrial reservoir strain (LARS, 10±6 vs 14±7%, p<0.001) and RA reservoir strain (RARS, 14±10 vs 16±8%, p<0.001) were significantly lower in patients with recurrent AF. Receiving operator characteristics curve analysis showed that the predictive power of LARS (AUC 0.68 [IC 95% 0.58-0.78]), was lower than RARS (AUC 0.75 [IC 95% 0.66-0.84]) (p<0.001, for all), with cut-off of 10.5% (sensitivity 62%, specificity 70%) and, 15.5% (sensitivity 75%, specificity 75%), respectively. Kaplan-Meier curve for time to primary endpoint showed that patients with LARS≤10.5% and RARS ≤15.5% had a significant risk for AF recurrences (log rank,p<0.001), even after correcting for confounding variables. However, at multivariable Cox regression RARS (HR 3.42 [CI 95% 1.72-6.8], p< 0.001) was the only parameter independently associated with the primary endpoint.

Conclusions

RARS is an independent predictor of the recurrences of AF after electrical cardioversion and provides an incremental prognostic value over LARS. This study highlights the pivotal role of the assessment of bi-atrial remodeling in patients with AF.
631 THE IMPACT OF BMI ON MYOCARDIAL WORK AND LEFT ATRIAL STRAIN IN YOUNG OVERWEIGHT PATIENTS WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Authors: Taverna Giovanni , Trimarchi Giancarlo , Lofrumento Francesca , Mancinelli Anna , Teresi Lucio , Alagna Giulia , Carerj Scipione , Zito Concetta , Di Bella Gianluca
Published: December 2022

Introduction

Overweight and obesity are a health problem of growing significance all over the world with increasing prevalence in both developed and developing countries. Numerous studies have demonstrated a relationship between obesity and cardiovascular diseases, underscoring the need to early treat this pathological condition. Overweight and obesity cause structural and functional changes on left ventricular (LV) and left atrial (LA) performance, which lead to heart failure. In this context we aimed to evaluate the impact of BMI on myocardial work parameters and left atrial strain to early detect LV and LA performance changes in overweight patients.

Methods

80 young individuals were prospectively enrolled, distinguishing between overweight patients with BMI greater than or equal to 25 to 29.9 kg/m^2 (n= 36; 45±11 years) and normal weight patients with BMI greater than or equal to 18.5 to 24.9 kg/m^2 (n=44; 43±9 years). All patients underwent transthoracic echocardiogram to calculate global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), global wasted work (GWW), global constructive work (GCW) and left atrial strain.

Results

Overweight patients have higher BSA (1,9±0,16 vs 1,6±0,17 mq; p<0,0001), Diastolic Blood pressure (81±12 vs 74±10 mmHg; p= 0,01) mean arterial pressure (98±15 vs 91±11 mmHg; p = 0,01), Heart Rate (71±13 vs 70±12 bpm; p= 0,02) and Global Longitudinal Strain (-19,3% ±1,7 vs -20,3% ±1,8; p = 0,02). With respect to myocardial work parameters, in overweight patients GWE (93% vs 95%; p=0,01) is significantly reduced, whereas GWW (132 vs 102 mmHg%; p=0,03) is significantly increased. Left atrial reservoir (LAres) (36% vs 40%; p=0,04) and conduit (-19% vs -24%; p=0,005) function are significantly reduced in overweight patients. BMI inversely correlates with GWE (r=-0,36; p=0,005) and LAres (r=-0,33; p=0,007), whereas it directly correlates with GWW (r=0,31; p = 0,006).

Conclusions

Overweight induces early LV and LA performance changes that can be precociously detected by myocardial work and left atrial strain, in order to better characterize individual cardiovascular risk profile.