bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1339 Clinical masks of aortic aneurysm: staged rupture of an aortic aneurysm under the guise of a recurrent infection
Authors: Volkova A L , Bykov V A , Petrova E V , Grigoryev V A , Tyurin M Y U , Averkov O V , Mednikov G N , Baldin D G 
Published: January 2020

Abstract
A 63-year-old man was admitted to the medical intensive care unit because of hypotension and suspected sepsis. Two months before he was admitted to military hospital for cerebrovascular event, considered as transient ischemic attack. Few days after discharge the fever (with a temperature of 39.5°C) occurred and patient was readmitted to the same hospital. Empirical treatment with cefalosporine was inefficient. Only combination carbapenem and vancomycin after E.coli was verified in blood culture stopped the infection. With normal body temperature, normal leukocytes count, mild azotemia, sterile blood and urine cultures and diagnosis of treated urosepsis patient was discharged. Two echocardiogram during hospital stay found no abnormal findings and chest CT scan was also normal.
Seven days later, he was seen in our hospital because of fever (with a temperature of 40°C), severe sweating and arterial hypotension. Immediately fluids and norepinephrine infusion was started. Fluoroquinolone was chosen as an antibiotic.
There was complete LBBB on ECG that had been registered previously. Leucocyte count at admission was 14 x 109/l and creatinine 300 µmol/l. Transthoracic echo (TTE) reportedly showed evidence of mild aortic and mitral regurgitations, pericardial effusion (1.0 – 1.3 cm with signs of right atrium compression). Aortic root seemed quite normal. On the third day, the number of leukocytes and creatinine increased significantly, reaching 450 µmol/l and 41 x 109/l respectively. Chest CT scan revealed signs of bilateral pneumonia, pericardial and left-sided pleural effusions. Vancomycin and ceftriaxone intravenously were started. Transesophageal echo revealed degenerative changes of aortic valve with mild insufficiency, mild mitral regurgitation. The amount of fluid in the pericardium was approximately unchanged. Patient became normotensive and norepinephrine infusion was discontinued. On the 6th day after admission patient’s temperature became normal, level of creatinine decreased to 230 µkmol/l and leukocytes reached 11.4 x 109/l. On the same day, the patient"s condition worsened. He complained of mild heartburn and progressive weakness, the number of leukocytes and the activity of transaminases increased, his blood pressure dropped to 75/40 mm Hg. This has led to the resumption of norepinephrine infusion. Repeated CT scan revealed inhomogeneous contents in the pericardium. Repeated TTE found increase of pericardial effusion with heterogenous content and signs of cardiac tamponade. Patient was transferred to operating room. After pericardiotomy multiple blood clots and active bleeding from pseudoaneurysm of ascending aorta were found. Despite surgical attempts and massive transfusion, patient died. Autopsy revealed the rupture of pseudoaneurysm of ascending aorta and flat hematoma in pericardium.
Abstract P1339 Figure.
P1348 Impact of left ventricular ejection fraction and aortic valve sclerosis on cardiovascular outcome in patients with acute ischemic stroke
Authors: Kim M , Kim H L , Park K T , Lim W H , Seo J B , Kim S H , Kim M A , Zo J H 
Published: January 2020

Abstract

Background/Introduction
Previous studies have focused on only 1 or 2 echocardiographic parameters as prognostic marker in patients with acute ischemic stroke (AIS).

Purpose
Various echocardiographic parameters in the same patient were systemically evaluated for their prognostic significance in AIS.

Methods
A total of 900 patients with AIS who underwent transthoracic echocardiography (TTE) (72.6 ± 12.0 years and 60% male) were retrospectively reviewed. Composite events including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization were assessed during clinical follow-up.

Results
During a median follow-up of 3.3 years (interquartile range, 0.6-5.1 years), there were 151 (16.8%) composite events. Univariable analyses showed that low left ventricular ejection fraction (LVEF) (&lt; 60%), increased peak tricuspid regurgitation (TR) velocity (&gt; 2.8 m/s) and aortic valve (AV) sclerosis were associated with composite events (P &lt; 0.05 for each). In the multivariable analyses after controlling for potential confounders, LVEF &lt; 60% (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.30-2.77; P = 0.001) and AV sclerosis (HR, 1.56; 95% CI, 1.10-2.21; P = 0.013) were independent prognostic factors associated with composite events. Multivariable analysis showed that HR for composite events gradually increased according to LVEF and AV sclerosis: HR was 2.8-fold higher in the highest-risk group than in the lowest group (P = 0.001).

Conclusions
In patients with AIS, LVEF &lt; 60% and the presence of AV sclerosis predicts the future vascular events. Patients with AIS exhibiting reduced LVEF and AV sclerosis may benefit from aggressive secondary prevention
Abstract P1348 Figure. COX plot for composite event
P1351 Right ventricular diameter added to D-dimer independently influence on prognosis of patients with pulmonary embolism and intermediate risk
Authors: Bosevski M , Krstevski G , Gjorgievski A , Mitevska I , Jovanova S , Srbinovska Kostovska E 
Published: January 2020

Abstract

Purpose
The paper was aimed to determine predictors for of patients with pulmonary embolism (PE) and intermediate risk.

Methods
84 patients with PE from National registry on VTE (age 60.3 + 12.5 years) were selected in a prospective study. Bedside echocardiography was done in all of them. Pulmonary embolism was confirmed by CT angiography. They were stratified as intermediate risk pts due to simplified PESI score &gt; 1. Study population was followed up for 6.7 months. Multivariate regression analysis was done when right ventricular diameter (RV, mean 37.5 mm), systolic pulmonary artery pressure (68 + 23 mmHg), measured by echocardiography, D-dimer level at baseline 2654.5 + 420,3ng/ml, number of comorbidities (2.4 + 0,7) and occurred symptoms (3.1 + 0,9) entered the model. A model was adjusted for age.

Results
D-dimer revealed as a predictor for length of hospitalization (β 0,25, p 0,05), and RV diameter as a factor for duration of anticoagulation (β 0,29, p 0,05).

Conclusion
Our results imply that baseline measurement of right ventricular diameter when added to D-dimer independently influence on short and long term prognosis of patients with pulmonary embolism and intermediate risk.
P1368 Effect of angiotensin receptor blocker in patients with moderate or severe aortic stenosis: a randomized controlled trial
Authors: Hwang I , Lee J M , Park J B , Yoon Y E , Lee S P , Kim H K , Kim Y J , Cho G Y , Park S J , Kim K H , Hong G R 
Published: January 2020

Abstract

Funding Acknowledgements
This study was supported by grants from Boryung Pharmacy Research Fund.
Background/Introduction: Pathophysiology of aortic stenosis (AS) and several previous studies suggested the potential role of angiotensin receptor blocker (ARB) in patients with AS.

Purpose
We aimed to investigate the effects of Fimasartan, an ARB, on exercise capacity and progression of AS in patients with moderate to severe AS.

Methods
We conducted a prospective, randomized, double-blind, placebo-controlled trial in 32 normotensive or controlled-hypertensive patients with moderate or severe AS. Study participants were randomized to Fimasartan 30 mg to 60 mg daily (n = 14) or placebo (n = 18) for 1 year, and underwent cardiopulmonary exercise test, 6-minute walk test, and echocardiography at 0, 6, and 12 months, with follow-up data available in 29 subjects.

Results
Significant reductions in blood pressures were observed in the Fimasartan group but not in the placebo group. Two of the 14 patients in the Fimasartan group withdrew the study due to mild symptoms probably related with the decreased blood pressure, and one patient decline the study protocol. After the 12-month treatment, the peak oxygen consumption (VO2; the primary outcome) in the Fimasartan group was significantly decreased (from 28.3 ± 5.9 to 25.4 ± 3.8 mL/min/kg, P = 0.021) but not in the placebo group (P for interaction = 0.046) (Figure 1A). The severity of AS showed a gradual progression in both groups, without inter-group differences (mean transaortic pressure; Fimasartan group, +4.0 ± 3.8 mmHg/year; placebo group, +5.3 ± 6.2 mmHg/year; P for interaction = 0.429) (Figure 1B). Parameters of left ventricular systolic and diastolic function did not change in both groups.

Conclusions
The use of ARB impaired exercise capacity in patients with moderate or severe AS, and did not prevent the progression of AS. However, due to the small number of participants, further studies are required to confirm these findings.
Abstract P1368 Figure.
P1381 The utility of left ventricle deformation in patients with myocarditis with midle-range and preserved ejection fraction
Authors: Krljanac G , Veljic I , Ristic A , Maksimovic R , Milinkovic I , Asanin M , Stanisavljevic D , Polovina M , Seferovic P M 
Published: January 2020

Abstract

Background
Predicting malignant ventricular arrhythmias and heart failure in patients (pts) with acute myocarditis and middle-range and preserved EF is challenge Aim: to define whether quantification of myocardial mechanics in early, acute phase of myocarditis offers more information to predict six months outcome of patients.Methods: In the 36 consecutive pts with myocarditis, middle age 32.86 ± 12.04yr, 75% males, echocardiography exam was done 1-3 day of diseases, including conventional parameters and comprehensive speckle tracking LV deformation analysis with longitudinal (L), circumferential (C) strain (S;%), strain rate (SR, 1/sec) and rotational LV mechanics. Results: The most patients were present as infarct-like myocarditis (80.56%), the others patients were present as heart failure-like (11.11%) and arrhythmia-like myocarditis (8.33%). At admission 27 (90%) pts had chest pain, 20 (66.7%) pts had ECG changes, 15 (50%) pts had symptoms of heart failure, 5 (16.7%) pts had arrhythmias. Amount of edema and fibrosis assessed by cardiovascular magnetic resonance (CMR) and echo correlate significantly. Classical and conventional parameters of LV systolic function, and deformation were not significantly different between groups. However, mechanical dispersion index (IMD) of global LS and systolic S were significantly different between groups (p &lt; 0.05). Conclusion: Myocardial deformation imaging, like speckle tracking echocardiography, offers deeper insight into complex mechanical abnormalities during not only LV contraction but LV relaxation in longitudinal directions in patients with acute myocarditis.
Infarct-like Arrhythmia-like Heart failure-like p EF (%) 57.5 ± 5.42 54.7 ± 12.9 58.3 ± 6.8 NS GLS endo (%) -20.8 ± 2.59 -19.78 ± 2.27 -17.36 ± 5.65 NS GLS (mid (%) -18.31 ± 2.4 -17.31 ± 1.52 -15.3 ± 5.10 NS GLS epi (%) -16.15 ± 2.28 -15.20 ± 0.92 -13.55 ± 4.68 NS IMD LS (ms) 37.04 ± 7.71 33.04 ± 6.58 60.75 ± 38.56 0.008 CS endo (%) -26.39 ± 6.93 -21.59 ± 3.88 -25.17 ± 6.48 NS CS mid (%) -17.32 ± 6.77 -13.03 ± 2.07 -15.95 ± 4.41 NS CS epi (%) -10.99 ± 6.89 -7.13 ± 0.72 -9.53 ± 2.73 NS IMD CS (ms) 47.69 ± 8.86 41.43 ± 23.92 41.01 ± 20.51 NS IMD SL peak S* 12.27 (21) 13.96 (4) 20.28 (84) 0.042 *Median and range values are presented.
P1385 Mechanical dispersion of the right atrium in dilated cardiomyopathy: does the etiology matter?
Authors: Vijiiac A E , Iancovici S , Onciul S , Petre I , Zamfir D , Onut R , Stoian M , Dorobantu M 
Published: January 2020

Abstract

Funding Acknowledgements
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF

Background
Mechanical dispersion assessed by myocardial strain reflects a susceptibility for arrhythmia development. While the contractile heterogeneity of both ventricles has been assessed in different clinical settings, the incidence and significance of right atrial (RA) dyssynchrony in dilated cardiomyopathy (DCM) are unknown.

Methods
50 consecutive patients with DCM were divided in 2 groups according to the etiology: group I had 26 patients with ischemic DCM (68 ± 10 years, 23 men), group N had 24 patients with non-ischemic DCM (52 ± 12 years, 18 men). We assessed the RA strain by 2D speckle-tracking analysis, and we calculated RA mechanical dispersion as the standard deviation of the time-to-peak contraction strain in 6 RA segments. 20 healthy individuals served as controls. Data were compared between groups with one-way analysis of variance and using a post-hoc Bonferroni correction.

Results
The RA strain was reduced in DCM patients, both in group I and in group N. All three components of the RA strain were most reduced in group I (p &lt; 0.001 for reservoir and conduit strain, p = 0.001 for contraction strain) (Table). The RA mechanical dispersion was highest in group I (56.8 ± 21.6 ms), followed by group N (39.9 ± 15.3 ms) and controls (23.8 ± 7.7 ms)(p &lt; 0.001). Patients with DCM and documented supraventricular arrhythmias (either atrial fibrillation, atrial flutter or premature atrial contractions) had higher RA mechanical dispersion (57.5 ± 19.7 ms) than DCM patients with no documented atrial rhythm disturbances (44.9 ± 19.9 ms, p = 0.04).

Conclusion
Mechanical dispersion of the RA is pronounced in patients with DCM and it is higher in patients with documented supraventricular arrhythmias. Patients with ischemic DCM have a more pronounced mechanical dispersion of the RA than patients with non-ischemic DCM, reflecting a more heterogenous RA contraction in ischemic heart disease when compared to other forms of DCM. The prognostic significance of RA dyssynchrony in a disease primarily involving the left heart warrants further studies.
Group I Group N Controls P value Reservoir RA strain (%) 12.9 ± 7.4§ 17.6 ± 12.9§ 30.1 ± 9.9 &lt;0.001 Conduit RA strain (%) -6 ± 5.5§ -8 ± 8.9§ -15.2 ± 6.4 &lt;0.001 Contraction RA strain (%) 6.9 ± 6§ 9.6 ± 8.1 14.9 ± 6.1 0.001 RA mechanical dispersion (ms) 56.8 ± 21.6§ 39.±15.3§* 23.8 ± 7.7 &lt;0.001 § significant difference with controls; * significant difference with group I
P1407 Three dimensional echocardiography in cardiac myxomas
Authors: Galzerano D , Di Michele S , Elmahi I , Al Shaihid M , Al Amri M , Arshi F , Vriz O , Colivicchi F , Al Buraiki J 
Published: January 2020

Abstract

The majority of cardiac myxomas (75–80%) are located within the left atrium, characteristically originating from the mid-portion of the atrial septum by a narrow stalk; The detection of such a feature has paramount importance for the diagnosis of myxoma ; in fact other anatomical findings as sessile implantation or other locations may be common to other cadiac tumors. Two dimensional (2D) transthoracic (TT) and transesophageal(TE) echocardiography E and cardiac magnetic resonance imaging (MRI) are mainstay in the diagnosis; It has been reported that Three dimensional(3D) E and in particular the 2D orthogonal cross sectional planes generated by electronically sectioning the 3D volume, could correctly identify the attachment and the peduncle sometimes missed by other imaging modality and therefore lead to a correct diagnosis.
Purpose of our study was to assess the usefulness of 3DE in the detection of the mainstay anatomical features of the cardiac myxomas;
We retrospectively reviewed all the case of the myxomas with pathology confirmation that underwent 2D TEE, 3D TEE and MRI in the past 5 years in order to assess the ability of the techniques in identifying the following anatomical features: site of attachment (mid atrial septum, other locations ) , modality of attachment (pedunculated or sessile); Every study was reviewed by an expert reader.
Our study group is comprised by 7 patients, 6 female, mean age 48.8 ±9.7 with 12 myxomas ; 8 located in the left atrium 3 in the right atrium ; In 6 case was the first diagnosis , in one patient was a recurrence. 9 mixomas were in the left atrium , 3 in the right atrium. & were pedunculated, 5 sessile.

There was an agreement in detecting the anatomical features except in two patients
in a one patients the attachment by a peduncle in the atrial septum close to the opening of the left upper pulmonary vein was seen only by 3DE ; in a second patient a small myxoma close to the left atrial appendage was detected only by TEE ;
Until now few reports have described the uselfuness of three dimensional echocardiography in detecting the anatomical features of cardiac myxomas. Even though MRI is the only technique able to detect perfusion of a mass otherwise it is not able to distinguish among different tumors; therefore the visualization of the anatomical features may lead a more correct diagnosis that can help in a better therapeutical and surgical plan. In our study 3DE was the only technique able to correctly depict the mainstay anatomical features of cardiac myxomas. It was possible in particular by using the 2D cross sectional planes generated by electronically sectioning the 3D volume in a case of a small peduncle attached in an uncommon location of the interatrial septum.
All the techniques are reliable in assessing the anatomical features of myxomas however 3DE could have an additional value in particular in not common location and will compliment 2D imaging in cardiac myxoma diagnosis
P1416 Clinical importance of consecutive transthoracic echocardiography in the patients with hypertrophic cardiomyopathy
Authors: Kim K , Kim H R , Kang M G , Park H Y , Koh J S , Hwang S J , Hwang J Y , Park J R 
Published: January 2020

Abstract

Funding Acknowledgements
nothing

OnBehalf
nothing

Background
prediction of outcomes Hypertrophic cardiomyopathy (HCM) have been robustly analyzed with echocardiography. However, there is limited data of serial follow-up (FU) transthoracic echocardiography (TTE) to predict outcomes in patients with HCM.

Objectives
This study aim is to discover clinical predictors associated with consecutive TTE follow-up in patients with HCM.

Methods
From 2010 to 2016, 162 patients with HCM were enrolled retrospectively. Concentric LVH and others systolic disease related to wall thickness were excluded. Index TTE (baseline) was measured when firstly admitted in our hospital. FU TTE was analyzed at the end of follow-up, defined as the last recorded value in patients who did not develop events or the last recorded value before events developed.

Results
The average of FU TTE and clinical FU period was 3.7 ± 2.0 years. Clinical outcomes were defined as stroke, syncope, heart failure, arrhythmia and death. Interestingly, only baseline TR V max was a predictor for clinical outcome whereas the others echo parameters were not associated with events (Table 1). KM curve showed the TR Vmax ≥2.5m/s was also significant (log rank = 0.008, Fig 1.)
Conclusions Our study showed short-term FU TTE did not bring clinician with clinical benefits in the aspect of prediction for events. Only baseline TR V max was good correlation with cardiovascular outcomes and even in the survival analysis.
Serial TTE and changed values Total N = 162 index TTE (baseline) FU TTE Change of FU per year event no event p-value event no event p-value event no event p-value IVDd, mm 14 ± 4 15 ± 5 0.500 15 ± 5 14 ± 5 0.758 0.23 ± 0.51 -0.07 ± 1.27 0.200 LVIDd, mm 47 ± 5 48 ± 6 0.256 47 ± 7 48 ± 6 0.560 -0.22 ± 2.79 0.10 ± 2.27 0.444 LVEF, % 62 ± 5 61 ± 7 0.379 61 ± 6 61 ± 10 0.927 -0.43 ± 3.10 -0.04 ± 4.94 0.620 LAVI 43 ± 9 43 ± 8 0.879 57 ± 27 58 ± 23 0.849 0.53 ± 14.5 3.11 ± 7.2 0.134 EA ratio 0.9 ± 0.6 0.9 ± 0.6 0.782 1.0 ± 0.8 0.9 ± 0.6 0.595 -0.02 ± 0.76 0.003 ± 0.027 0.594 DT,ms 196 ± 58 201 ± 62 0.603 203 ± 91 217 ± 89 0.370 17 ± 57 5 ± 40 0.154 septal e` 4.4 ± 2.1 4.2 ± 1.6 0.585 4.4 ± 1.6 4.6 ± 1.7 0.438 0.24 ± 0.91 0.05 ± 0.65 0.190 E of e` 17 ± 11 17 ± 23 0.993 15 ± 9 15 ± 6 0.726 -0.48 ± 4.42 -1.66 ± 22.78 0.728 TR velocity 2.6 ± 0.5 2.4 ± 0.4 0.012 2.7 ± 0.6 2.6 ± 0.4 0.604 0.05 ± 0.30 0.04 ± 0.18 0.905 Max wall thickness 17 ± 3 18 ± 3 0.137 17 ± 4 17 ± 3 0.888 -0.01 ± 2.19 -0.18 ± 1.14 0.522
Abstract P1416 Figure. TR Vmax and CV outcomes in the KM curve
P1429 B-Type natriuretic peptide prediction of right catheterization parameters in the first year after heart transplant
Authors: Valentim Goncalves A A , Pereira-Da-Silva T , Soares R , De Sousa L , Ilhao Moreira R , Rio P , Feliciano J , Cruz Coutinho M , Reis J , Mano T , Mendonca T , Cruz Ferreira R 
Published: January 2020

Abstract

Introduction
Despite being the gold-standard for hemodynamic assessment, right heart catheterization (RHC) was overcome by plasma B-Type Natriuretic Peptide (BNP) levels in daily clinical routine. However, in the first year after heart transplantation (HT), the relationship between BNP and adverse hemodynamics have yielded conflicting results.

Purpose
The aim of this study was to evaluate whether BNP values can be used to estimate adverse hemodynamics in the first year after HT.

Methods
Prospective study of consecutive RHC performed in the first year after HT (according to the endomyocardial biopsies program). Plasma BNP levels were measured at the same day.
The area under the curve (AUC) was analysed to find the BNP values with higher sensitivity and specificity to detect adverse hemodynamics.

Results
From 2017 to 2018, 50 RHC were performed. Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml.
Prediction of adverse hemodynamics by AUC results are represented in the table. BNP values were significantly increased in patients with pulmonary capillary wedge pressure (PCWP) &gt;12mmHg (p &lt; 0.001), cardiac index &lt;2.5L/min/m2 (p = 0.001), mean pulmonary artery pressure (mPAP) ≥25mmHg (p &lt; 0.001), pulmonary vascular resistance &gt; 1,5WU (p = 0.044) and right atrial pressure &gt;5mmHg (p = 0.003).
BNP &gt;500pg/ml had a sensitivity of 78.3% and 87.5% and a specificity of 76.0% and 67.7% to detect PCWP &gt;12mmHg and mPAP ≥25mmHg, respectively.
Conclusion Significant associations were found between BNP values and adverse hemodynamics in RHC, supporting the clinical utility of BNP in the first year after HT.
BNP prediction AUC values SR HEMODYNAMIC PARAMETERS AUC p 95% CI Best BNP value Sensitivity Specificity Pulmonary capillary wedge pressure (PCWP) &gt; 12mmHg 0.798 &lt;0.001 0.671-0.925 &gt; 500pg/ml 78.3% 76.0% Mean pulmonary artery pressure (mPAP) ≥ 25mmHg 0.830 &lt;0.001 0.714-0.946 &gt; 500pg/ml 87.5% 67.7% Cardiac output &lt; 4L/min 0.833 0.002 0.667-1.000 &gt; 1500pg/ml 77.8% 87.5% Cardiac index (CI) &lt; 2.5L/min/m2 0.810 0.001 0.663-0.957 &gt; 1150pg/ml 76.9% 86.1% Pulmonary vascular resistance (PVR) &gt; 1,5WU 0.678 0.044 0.509-0.848 &gt; 200pg/ml 83.3% 47.1% Right atrial pressure (RAP) &gt; 5mmHg 0.744 0.003 0.607-0.880 &gt; 500pg/ml 70.8% 65.4% BNP prediction