bluuebunny/crossref_metadata_2025_split huggingface dataset:
P586Left ventricular volume and mass adaptation after 58-days head-down bed-rest assessed by cine-MRI, and effectiveness of high-intensity jump training countermeasure
Authors: Egoriti R , Landreani F , Costantini L , Mulder E , Gerlach D , Vaida P , Migeotte P.-F , Caiani E G 
Published: October 2019

Abstract

Aims
Prolonged immobilization generates cardiac deconditioning, a risk factor for cardiovascular disease, and efficient countermeasures (CM) are needed to prevent it. Our aim was to assess by Cine-MRI the effects of long-term strict head-down (−6 degrees) bed-rest (BR) deconditioning, and the effectiveness of high-intensity jump training CM, on left ventricular (LV) function and mass.

Methods
23 male participants (29±6 years, 181±6 cm, 77±7 kg) were enrolled. The experiment was conducted at: envihab (Koln, DLR, Germany) as part of the European Space Agency BR studies. Volunteers were randomly allocated to the jump training group (JUMP, n=12) or the control group (CTRL, n=11). A typical training session consisted of 4x10 countermovement jumps and 2x10 hops in a sledge jump system, with 5–6 sessions per week.
Steady-state free precession cine-MRI images were obtained (25 frames/cardiac cycle, 8mm thickness, no gap, no overlap) as stack of short-axis images covering the whole LV from base to apex, before (PRE) and after 58-days (HDT58) of BR. Endocardial and epicardial semi-automated contouring was performed using custom software.

Results
In CTRL group, at HDT58 a reduction in LV mass (9%), end-diastolic (21%), end-systolic (8%) and stroke volume (23%) were observed, while ejection fraction did not change. In JUMP group, the reduction in LV end-diastolic volume was only by 9%, followed by a decrease in end-systolic (10%) and stroke volume (10%), with a preservation of LV mass. In both groups, ejection fraction did not change.
Left ventricular changes after 58d BR EDV (ml) ESV (ml) SV (ml) EF (%) Mass (g) CTRL PRE 171 (163; 191) 60 (58; 65) 113 (102; 124) 64 (63; 67) 133 (121; 160) HDT58 143 (131; 149)* 56 (50; 58)* 86 (83; 92)* 62 (60; 63)* 127 (106; 138)* JUMP PRE 156 (140; 204) 70 (61; 84) 91 (78; 117) 58 (56; 60) 118 (104; 134) HDT58 141 (135; 175)* 63 (54; 69)* 90 (78; 92)* 58 (55; 60) 113 (105; 128) Results expressed as median (25th; 75th percentiles). *p<0.05 Wilcoxon non parametric paired test (PRE vs HDT58). CTRL: control group; JUMP: countermeasure group.

Conclusions
Cardiac adaptation to deconditioning due to immobilization induced by BR resulted in a reduction of cardiac volumes and function, together with a decrease in LV mass. Interestingly, the applied JUMP countermeasure appeared able to partially reverse these effects, in particular by reducing the decrease in end-diastolic volume and preserving LV mass. This information could be useful for better understanding physiologic changes in patients undergoing long periods of immobilization, as well as to apply the studied countermeasure during space flight to reduce cardiac deconditioning.

Acknowledgement/Funding
Italian Space Agency (contract 2018-7-U.0),CNES/DAR 48ehz747.01950965,BELSPO, via the European Space Agency PRODEX program (PEA 4000110826)
P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography
Authors: Ribeyrolles S , Monin J L , Rohnean A , Diakov C , Caussin C , Sarran A , Paul J F 
Published: October 2019

Abstract

Background
Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification.

Purpose
Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach.

Methods
We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR.

Results
33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]).

Conclusion
4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.
P595Characteristics of the right ventricle in patients with nonischemic dilated cardiomyopathy
Authors: Becker M , Allaart C P , Wubben M , Cornel J H , Van Rossum A C , Germans T 
Published: October 2019

Abstract

Background
In nonischemic dilated cardiomyopathy (DCM), diagnosis and prognosis is based on left ventricular function. Although concomitant right ventricular (RV) dysfunction is frequently observed, the underlying mechanism is currently not fully understood.

Purpose
We aimed to describe the characteristics of right ventricular function in DCM patients with cardiac magnetic resonance (CMR) imaging using cine and late-gadolinium enhancement (LGE) imaging.

Methods
Patients with DCM and left ventricular (LV) dysfunction (ejection fraction (EF) <50%) on LGE-CMR were included prospectively. LV and RV volumes and function were quantified and RV systolic dysfunction was defined as RV ejection fraction (RVEF)<45%. The presence and pattern of LGE were assessed visually and the extent was quantified using the full-width half maximum method. Septal midmyocardial LGE pattern was defined as midwall striae or hinge-point myocardial hyperenhancement. Moreover, left atrial (LA) volumes were calculated using the bi-plane area-length method.

Results
The study included 214 DCM patients (42% female, age 58±14 years) with a mean LVEF of 34±12% and RVEF of 46±12%. RV systolic dysfunction was present in 39% and was associated with the presence of septal midwall LGE (OR 1.96 (95% CI 1.09–3.54) p=0.026). In patients with RV dysfunction, LV dilation was more severe (LV end diastolic volume (EDV) 242±97mL vs. 212±58mL, p=0.011) and LVEF was lowere (26±12% vs. 39±8%, p<0.001) (figure A). There was a weak correlation between septal LGE amount and LVEDV and RVEDV (respectively r=0.36, p=0.003 and r=0.35, p=0.005)
In patients with RV dysfunction, left atrial volumes were enlarged (56±23mL/m2 vs. 46±14mL/m2, p<0.001) and LA emptying fraction was moderately correlated to RVEF (figure B), also after exclusion of patients with a history of atrial fibrillation.
RVEF in DCM patients

Conclusion
In DCM, reduced RVEF predominantly occurred in patients with a) LVEF lower than 30%, b) septal midwall enhancement, indicating progressive LV remodeling, c) LA dilation and d) LA dysfunction. This suggests that RV dysfunction in advanced DCM is drive by LV diastolic dysfunction resulting in increased afterload of the RV.
P597Clinical and prognostic correlates of volume/time curve at cardiac magnetic resonance in patients with non-ischemic heart failure and left bundle branch block
Authors: Aimo A , Barison A , Valleggi A , Salerni S , De Caterina R , Emdin M , Aquaro G D 
Published: October 2019

Abstract

Background
In patients with non-ischaemic systolic heart failure (HF) and left bundle branch block (LBBB), the systolic phase of the left ventricular (LV) volume/time (V/t) curve at cardiac magnetic resonance (CMR) can display a wide or a narrow pattern (WP/NP). The clinical and prognostic significance of these patterns are currently unknown.

Methods
Consecutive patients with systolic non-ischaemic HF (LV ejection fraction <50%) and LBBB were enrolled. They underwent a baseline evaluation including CMR, and were periodically re-evaluated during follow-up. The endpoint was a composite of cardiovascular death, heart failure (HF)-related event, and ventricular arrhythmias requiring defibrillator shock.

Results
Out of 101 patients (mean age 64±11 years, males 50%), NP was found in 29 and WP in 72, with no difference in QRS duration. Patients with WP had worse clinical presentation and greater LV volumes, but similar LGE prevalence, extent or distribution. The WP subgroup displayed a greater maximal dyssynchrony time, expressed both as absolute duration (192±80 vs. 143±65 ms, P<0.001), and as percentage of the RR interval (25±11% vs. 8±4%, p<0.001). Even the systolic dyssynchrony index was higher in patients with WP (13±4 vs. 7±3%, p<0.001). The contractility index was lower in patients with the WP (2.6±1.2 vs 3.2±1.7, p<0.05). Over a median follow-up duration of 44 months (interquartile interval 23–59), only WP (p=0.029) and NT-proBNP (p=0.004) demonstrated an independent prognostic value for cardiac events.

Conclusions
In patients with non-ischaemic systolic HF and LBBB, the WP of V/t curves identifies a subgroup of patients with greater LV dyssynchrony, worse clinical conditions and prognosis.
P610The microvascular obstruction and intramyocardial haemorrhage: impact of different reperfusion strategies in primary myocardial infarction
Authors: Vyshlov E , Alekseeva Y A , Usov V , Ryabov V 
Published: October 2019

Abstract

Background
The coronary reperfusion in patients with ST-elevated myocardial infarction (STEMI) is often complicated by reperfusion-ischemic myocardial injury: microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH). Contrast-enhanced cardiac magnetic resonance imaging (MRI) is the best diagnostic method, which allows to assess these phenomena. It is known that in patients with STEMI and primary percutaneous coronary intervention (PCI), the prevalence rates of MVO and IMH are 50–60% and 40–50%, respectively. There is not enough knowledge about the prevalence of these phenomena in patients with pharmaco-invasive strategy.

Purpose
The aim of the study was to evaluate the prevalence of MVO and IMH in patients with primary STEMI and different reperfusion strategies.

Materials and methods
This observational cohort study included 47 patients with primary STEMI within the first 12 hours after the onset of disease. Exclusion criteria: pulmonary edema, cardiogenic shock, creatinine clearance <30 mL/min or dialysis, severe comorbidity, acute psychotic disorders, and inability to undergo or contra-indications for MRI. These patients were divided into 2 groups. Patients of group 1 (n=30) were treated with a pharmaco-invasive strategy. Fibrinolysis was performed in all patients in the pre-hospital setting. Patients of group 2 (n=17) were treated by primary PCI. MRI was performed at day 2 post-STEMI in all patients. Late gadolinium enhancement and T2-weighted IMH imaging for microvascular obstruction and IMH were used.

Results
Patients with primary PCI more often had MVO: 70.5% (n=12) vs. 40% (n=12) in the pharmaco-invasive group (p=0.05). The occurrence of IMH between the groups did not significantly differ: 40% (n=12) in group 1 vs. 64.7% (n=11) in group 2, respectively. The presence of combination of MVO with IMH was observed significantly more often in group of primary PCI: 47% (n=8) vs. 20% (n=6) (p=0.03). The left ventricular ejection fraction was significantly lower in patients with combination of IMH and MVO compared to those without it: 55% (34–66) vs. 62.5% (53–72) (p=0.01).

Conclusion
MVO and IMH were common findings in patients with primary STEMI and different reperfusion strategies and were present in 40% to 70% of patients. The MVO and combination of MVO with IMH occurred significantly more often in the group of primary PCI. The prevalence rates of IMH in patients with different reperfusion strategies did not significantly differ.
ClinicalTrials.gov, identification number is NCT03677466.
P616RV Strain and 3D RV imaging in diagnosis of acute mountain sickness
Authors: Amuthan V , Ananth R V A , Thinlas T , Chosdol R , Rabgais L , Vivek R 
Published: October 2019

Abstract

Introduction
Right Ventricular (RV) strain and 3D RV ejection fraction sensitivity and specificity has made it a practical and reliable test to detect Acute mountain sickness. All previous studies have been done mainly using M Mode and 2D Echo. Hence it was conceived that 3D Echocardiography would be a better option. Regardless of the type of Acute Mountain Sickness (AMS), the echocardiographic evidence is always the same: Severe Pulmonary hypertension. The visual analysis of these abnormalities requires a trained operator. This operator-dependence has promoted the search for a semiautomatic method to reduce limitations of Echocardiography and improve test accuracy

Purpose
The purpose was to study AMS by 3D Echocardiography

Methods and results
Two dimensional echocardiography with RV strain analysis by speckle tracking echocardiography along with 3D RV ejection fraction was done in nine patients with AMS who were tourists on unplanned, unacclimatized assent to Pangong lake, situated near Leh-Ladakh in the Himalayas, approximately at the height of 4350 meters above sea level and six highlanders, living in Leh-Ladakh. Figure 1A shows the map of the Pangong Lake, B. Shows features of Acute Pulmonary Edema in the Chest X-ray from a patient with AMS, C. Shows the TAPSE (Tricuspid Annular Plane Systolic Excursion) D. Shows the Speckle tracking derived RV Free Wall strain (From a software made for LV) and E: Methodology to derive 3D RV Ejection Fraction. 3D Echocardiographic Equipment with LV strain (which was modified to derive RV Free wall strain) and 3D RV Ejection Fraction software was used for acquisition of images and offline analysis was done. TAPSE, FAC, RV Free wall strain, RV EDV index, RV ESV index and 3D RV EF were consistently lower in patients with AMS than in persons living in high altitude (High landers) Table 1
Results Age Sex M/F Diabetes/ Hypertension TAPSE (mm) FAC RVFW Strain % RV EDVI (ml/m2) RV ESVI (ml/m2) 3D RV EF % AMS (9) 40.2±2.3 5/4 1/2 16±1.7 38.2±2.7 14±1.9 55±3.7 35±2.4 36±3.2 High-Landers (6) 53.6±3.7 5/1 1/1 20±2.7 46.9±4.7 28±2.2 52±4.1 29±2.8 45±2.3
Fig 1

Conclusion
Strain or myocardial deformation analysis based on two-dimensional (2D) speckle tracking and 3D RV ejection fraction is feasible even in the remote altitudes and allow accurate quantification which has resulted in a growing interest to introduce this new technique in analysis of acute mountain sickness.
P619Stress-strain loop area better represents regional myocardial work than pressure-strain loop area in the dyssynchronous and remodelled left ventricle
Authors: Duchenne J , Cvijic M , Turco A , Unlu S , Pagourelias E D , Bezy S , Vunckx K , Nuyts J , Claus P , Gheysens O , Rega F , Voigt J U 
Published: October 2019

Abstract

Background
Pressure-strain-loops (PSL) have been suggested as surrogate parameter of regional myocardial work. However, in left ventricles (LV) with inhomogeneous remodelling, e.g. due to left bundle branch block (LBBB), wall stress may be unevenly distributed. Stress-strain loops (SSL) include information on both regional wall thickness and curvature, and may therefore provide a better surrogate.

Study plan
We therefore compared the correlation of segmental myocardial work estimated through both PSL and SSL to segmental myocardial glucose metabolism as a gold standard, in an animal model of pacing-induced LV remodelling.

Methods
Twelve sheep developed LV dilatation, thinned septum and thickened lateral wall, due to eight weeks of rapid right-atrial and right-ventricular free wall (DDD) pacing (at 180 bpm), causing a LBBB-like dyssynchrony. Invasive LV pressure and echocardiographic speckle tracking based circumferential strain were used to construct PSL. SSL were calculated by considering in addition dynamic changes in segmental myocardial wall thickness and curvature using the formula of Laplace. 18F-fluorodeoxyglucose (FDG)-uptake was measured by positron emission tomography (PET) in absolute values as standardised uptake ratio (SUR). Spatial resolution of PET was improved by ECG- and breathing-gating and using anatomical priors. All imaging was performed during dyssynchronous DDD-pacing and synchronous AAI-pacing (right-atrial pacing only), at baseline (n=3 animals), and after eight weeks of pacing induced remodelling (n=12 animals).

Results
Both at baseline (Fig. A+B) and after 8 weeks (Fig. D+E), switching between AAI and DDD-pacing caused an acute re-distribution of regional myocardial work as measured by both PSL and SSL. In contrast to PSL, however, SSL identified more regional differences among walls in remodelled hearts and showed clearer regional changes when switching between AAI and DDD-pacing. The correlation between regional work, assessed by PSL and SSL, and metabolism by PET, was comparable at baseline (r=0.65 and r=0.64, respectively) (Fig. C). In remodelled hearts after 8 weeks, however, the correlation of regional work assessed by SSL and glucose uptake by PET was significantly higher compared to PSL (r=0.73 vs. r=0.59, respectively; p<0.05) (Fig. F).

Conclusions
Regional myocardial work assessed by stress-strain loops correlates significantly better to regional metabolism as measured by PET glucose uptake, particularly after remodelling. Our findings therefore suggest that integrating information on wall thickness and curvature is essential for the reliable assessment of regional myocardial work, especially in dyssynchronous and remodelled left ventricles.
P622Role of right ventricular strain measured by 2D-echocardiography in the diagnosis of cardiac amyloidosis
Authors: Durante Lopez A , Monivas Palomero V M P , Torres Sanabria M T S , Segovia Cubero J S C , Mingo Santos S M S 
Published: October 2019

Abstract

Introduction
Cardiac amyloidosis (CA) causes a restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic (ALCA) and transthyretin (ATTR, either wild type -TTRwt- or mutant -TTRm-). Left ventricle (LV) apical sparing has been extensively studied by speckle-tracking echocardiography (STE) for diagnosis, but right ventricular (RV) deformation pattern has not been described.

Purpose
To characterize RV involvement in CA patients and to identify which parameters may help in the differential diagnosis between ALCA and ATTR subtypes.

Methods
78 patients with CA (47 ALCA, 20 TTRwt, 11 TTRm) and 24 healthy controls were included. We analyzed global longitudinal strain (GLS) in 16 LV and 6 RV segments. LV and RV apical ratios (AR) were obtained.

Results
LVGLS and Free-Wall RVLS were impaired in all patients (LVGLS: 11.9±2.9% in ALCA, 12.5±3.8% in TTRwt, 14.9±2.7% in TTRm, 21.9±2.6 in controls and Free-Wall RVLS: 13.1±6.8% vs 14.9±4.5% vs 17.2±3.4% vs 22.1±3.1, respectively). LV and RV AR were higher in ALCA as compared to both TTRwt, ATRm and controls (LVAR: 1.1±0.2 vs 0.8±0.2 vs 0.9±0.1 vs 0.7±0.1, p<0.001; RVAR: 1.1±0.2 vs 0.6±0.2 vs 0.6±0.1 vs 0.6±0.1, p<0.001). Cut-off values of LVAR>0.96 and RVAR>0.8 showed high accuracy to differentiate between ALCA and ATTR.

Conclusion
RV disfunction is a common finding in CA. Apical sparing pattern was present in RV strain, similarly to that described in LV and we describe it as an specific finding of ALCA patients. We propose RVAR as an accessible and easy way to differentiate, among different subtypes of amyloidosis based on STE analysis.
P630Role of Indian yoga with pranayam prevent ventricular remodeling and reduce mortality rate according to LV ejection fraction in post PCI patients of STEMI
Authors: Sen N , Tanwar S , Jain A , Mehta A , Shah N , Gokhroo R K , Dhall A 
Published: October 2019

Abstract

Background
Coronary revascularization is fruitful management to relieve angina and reduce mortality as compare to medical management in significant coronary artery stenosis. Although measurement of left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) is a performance measure, little is known about the relationship between EF and post-discharge mortality among MI patients in contemporary clinical practice.

Objectives
To assessment of mortality according to left ventricular ejection fraction and compare between yoga group and non yoga group, so that we can evaluate the importance of yoga and pranayam.

Methods
2,470 patients (25 to 68 years of age) with STEMI were registered and managed with percutaneous coronary intervention at three centres from 2010 to 2012. Method was used to assess the association between left ventricular ejection fraction (LVEF) measured during the index hospitalization and 5-year mortality from date of registry. The relationship was examined with EF as a categorical variable, utilizing four clinically relevant categories (EF ≤34%, 35 to 45%, 46 to 54%, and ≥55%), and also with EF as a continuous variable. We divided two groups, group A was yoga with pranayam (n=1470) and group B was normal group (n=1000).

Results
Among STEMI patients we found a graded inverse association between EF category and mortality. For patients relevant categories (EF ≤34%, 35 to 45%, 46 to 54%, and ≥55%) mortality after 5 years was assessed by 21%, 14.3%, 12.2% and 11% in yoga, pranayam group (p<0.004). For patients relevant categories (EF ≤34%, 35 to 45%, 46 to 54%, and ≥55%) mortality after 5 years was assessed by 25%, 17.5%, 14.4% and 13% in normal group (p<0.004). LVEF was increased in yoga & pranayam group by 11±3% versus 4±1% non yoga group.

Conclusion
Yoga and Pranayam; breathing exercise may help to reduce metabolic stress, reduce oxygen demand and prevent ventricular remodeling. Low LVEF after STEMI remains an important risk factor for post-discharge mortality, even after extensive adjustment for patient and hospital characteristics. Routine yoga and pranayam; breathing exercise may reduce the mortality after myocardial infarction.