bluuebunny/crossref_metadata_2025_split huggingface dataset:
P632 Apical mass after acute myocardial infarction
Authors: Jimenez Arjona R , Cepas-Guillen P , Doltra A , Ortiz J T , Vidal B 
Published: January 2020

Abstract

Funding Acknowledgements
No financial support
53-year-old male, with a personal history of high blood pressure and current smoking.
He presented in the emergency department with typical chest pain. The initial electrocardiogram showed a ST segment elevation in DI and AVL leads. An emergency coronariography was performed showing a single vessel disease with two tandem lesions on the first diagonal, which were treated with pharmacoactive stents.
An echocardiography was performed, showing a mild apicolateral hypokinesia, with good contractility of the remaing segments. In addition, a rounded, pediculated and mobile mass in the apex was observed; the mass was hyperechogenic compared to the myocardium. In this setting, the differential diagnosis should include thrombus in context of acute coronary syndrome (despite a small infarction with early revascularization and good contractility of the segments involved) vs. tumoral mass. Anticoagulant treatment was maintained and a cardiac magnetic resonance (MR) was performed. The MR showed an apical round mass of 11 mm, with hyperintense signal in both T1- and T2-enhanced sequences in comparison to normal myocardium; although no contrast uptake was observed in early gadolinium enhancement sequence, the mass showed homogeneous enhancement in the late enhancement images, both with optimal TI and with long T1. These findings were suggestive of a benign tumoral mass of atypical location. In addition, a small anterior subendocardial enhancement with preserved ejection fraction was observed.
A control echocardiogram after 5 weeks of anticoagulant treatment showed no changes in either size or characteristics of the mass. After risk-benefit assessment and according to patient preferences, surgical resection of the mass was decided by a mini-thoracotomy approach. A surgical piece was obtained, described as a mobile pediculated tumour with a granulated surface and mucinous aspect. The postoperative period was uneventful. Subsequently, the pathological study confirmed the diagnosis of papillary fibroelastoma of atypical location.
This case summarizes the usefulness of MR to characterize cardiac masses and, in particular, to differentiate tumours from thrombus. Although in this setting (recent myocardial infarction) an apical thrombus was initially suspected, the MR exam correctly identified a contrast enhanced mass, which ruled out acute thrombus and suggested benign tumour.
Abstract P632 Figure.
P641 Severe pulmonary steno-insufficiency due to metastatic carcinoid tumor in a 57 years old patient treated with MTPV implantation: first experience
Authors: Viani G M , Paiocchi V L , Leo L A , Faletra F F , Pedrazzini G 
Published: January 2020

Abstract

Funding Acknowledgements
none
Background
Right side heart valve involvement is a well known phenomenon in metastatic carcinoid disease. In recent times bioprosthetic valves have been widely used for replacement of stenotic and regurgitant native heart valves. Melody Transcatheter Pulmonary Valve (MTPV, Medtronic, Minneapolis, MN, USA) has been approved for treatment of native pulmonary valves as well as failing biological prostheses and conduits. We present the first case to our knowledge of severe native pulmonary valve steno-insufficiency due to metastatic carcinoid syndrome treated with MTPV implantation.
Case report
A 57-year-old woman is known since 2007 for metastatic carcinoid syndrome treated with surgical resection followed by chemotherapy (tamoxifene, everolimus) and radiotherapy. For 2 years she has been known for tricuspid and pulmonary involvement, which aggravated progressively, leading to symptomatic right heart failure. She was therefore submitted for multimodality imaging evaluation (see picture) and right heart catheterization.
Transthoracic echocardiogram, cardiac MRI and right heart catheterization confirmed severe pulmonary valve steno-insufficiency. Cardiopulmonary exercise testing revealed a severe limitation of aerobic exercise capacity (VO2 max 14.4 ml/min/kg).
After heart team discussion it was decided to treat the patient in a 2 step approach, initially with implantation of a Melody valve in pulmonary position and subsequently with surgical repair of the tricuspid valve.
Pulmonary valve was treated by placement of a 39 x 25 mm ANDRA stent and subsequent implantation of a 22 mm Melody valve. Before stenting, coronary angiography with simultaneous balloon inflation in RVOT was performed to exclude coronary artery compression. During the procedure the patient developed hypotension, which was treated effectively with Octeotride.
Post-operative echocardiogram showed a significant reduction in pulmonary valve gradient and no significant residual regurgitation.
Conclusions
We treated effectively severe pulmonary steno-insufficiency due to metastatic carcinoid tumor with MTPV implantation. No complications occurred. Multimodality imaging is fundamental for patients selection and preoperative planning of prosthetic valve dimensions.
Abstract P641 Figure. Multimodality imaging of PV
P650 A rare form of cardiac mass: primary cardiac lymphoma
Authors: Yagmur B , Simsek E , Ozbay B , Calkavur T , Kayikcioglu M , Can L 
Published: January 2020

Abstract

Funding Acknowledgements
We declare no conflict of interest and no financial support

A rare form of cardiac mass
primary cardiac lymphoma

Introduction
Primary tumors of the heart are rare and constitute 5% of all cardiac masses. Primary cardiac lymphoma is a curable form of cancer that responds well to early diagnosis and chemotherapy.

Case report
56 year old male patient presented to our outpatient clinic with abdominal swelling. Echocardiography revealed a mass lesion that surrounded the right ventricle and restricted ventricular diastolic function. The mass lesion was poorly discernable from normal myocardial tissue. Magnetic resonance imaging (MRI) showed an infiltrative mass lesion that filled the right pericardial space, and that surrounded the junction between vena cava superior and the right atrium, as well as the root of the aorta. Subxyphoidal biopsy revealed diffuse large B cell lymphoma. Patient died on the 10th day of chemotherapy.

Discussion
Primary cardiac lymphoma constitutes only 2% of all primary cardiac tumors. Cardiac lymphomas are curable in early stages with chemotherapy without the need for surgical excision. Cardiac lymphoma should be kept in mind when faced with a cardiac mass lesion and imaging modalities such as MRI and PET scanning and tissue biopsy should be utilized before planning surgical interventions since these lesions respond well to chemotherapy
Abstract P650 Figure.
P660 Arterial hypertension as confounding factor in the echocardiographic assessment of patients with significant aortic stenosis
Authors: Velegraki E , Stefanidis A , Barmpatzas N , Filippou K , Kranidis A 
Published: January 2020

Abstract

Purpose
Increased arterial pressure affects the accuracy of clinical conclusions in a number of cardiac pathologies, including valvulopathies. We investigated the influence of increased blood pressure in the assessment of multiple echo variables in patients with significant aortic stenosis of different physiologies.

Methods
Seventy two patients (33 women, aged 72 ± 12 years old, EF: 56 ± 9%) with significant aortic stenosis [18 (25%) with low flow low gradient (LFLG) and 7 (10%) with paradoxic LFLG (PLFLG) physiology] and arterial systolic pressure ≥140 mmHg on admission, were assessed with a full 2D and Doppler echocardiographic study including non-invasive assessment of pressure recovery and valvuloarterial impedance (z). Echo study was performed on two occasions during their hospitalization, on admission and after normalization of blood pressure. Arterial pressure was controlled by any therapeutic means at the discretion of the referring physician. Significant serial changes between echo variables were assessed by the Student paired t-test.

Results
Arterial pressure and heart rate were significantly lowered between the two studies (from 152 ± 13 to 116 ± 11 mmHg and 78 ± 7 to 73 ± 5, p&lt; 0,001 respectively). Differences between the echo variables are depicted in the following table.

Conclusions
Small but significant changes were noticed in several echo parameters after lowering blood pressure in patients with significant aortic stenosis. These patients should always be assessed after normalization of their blood pressure since the degree of stenosis can be erroneously overestimated and affect clinical decision.
p &lt; 0,001
Echo variable 1st study 2nd study Stroke vol index (i) (ml/m2) 37,1 ± 9,5 44,1 ± 10* Mean gradient (mmHg) 42 ± 6,2 44 ± 5,8 * Pressure recovery (mmHg) 8,4 ± 2,5 9,5 ± 2,7* Z (mmHg/mL * m2) 5,4 ± 1,5 3,8 ± 1,1* AVAi (cm2/m2) 0,44 ± 0,06 0,49 ± 0,06*
P664 Relationship of left atrial function assessed by 2D speckle tracking echocardiography with left ventricular systolic function in patients with degenerative mitral regurgitation
Authors: Melillo E , Palmiero G , Ferro A , Carlomagno G , Dell"urzo L , Ascione R , Caso V M , Severino S , Ascione L , Caso P 
Published: January 2020

Abstract

Funding Acknowledgements
none

Background
In degenerative mitral regurgitation (DMR), left ventricle (LV) and left atrium (LA) undergo progressive volume overload leading to chamber remodelling and dysfunction in advanced stages. Speckle tracking echocardiography (STE) is an estabilished technique able in detecting subclinical LA and LV dysfunction in this setting. However data are lacking on the relationship of LA and LV function in DMR patients.

Purpose
Our aim was to assess LA function in patients with DMR and to explore its possible correlations with LV dimensions and systolic function.

Methods
We enrolled 95 patients with mild to severe DMR, dichotomizing them on the basis of mitral regurgitation severity (DMR 1-2: mild and mild-to-moderate MR; DMR 3-4: at least moderate to severe MR). LA function was assesed with 2D speckle tracking echocardiography.

Results
The two groups were well matched. DMR 3-4 group (n= 48) showed higher LA and LV volumes, lower right ventricle longitudinal systolic function and higher values of systolic pulmonary pressure. There was not significant difference in LV ejection fraction (LVEF) and global longitudinal strain (GLS). Among LA function indexes, only peak systolic reservoir strain was significantly reduced in DMR 3-4 group (21,9± 6,2% vs 24,7± 7,2% ; p= 0,04). Then population study was further divided in two groups according to the presence (LA dys+) or absence (LA dys-) of LA dysfunction, defined as reservoir strain values below the median [median 23.7%; LAdys- group (n. 49), LAdys+ group (n.46) ]. At the comparison of continuous variables (Tab.1), LAdys+ group showed larger LV end systolic diameter and more impaired LVEF (60,9± 9,8% vs 65,4± 4,8%; p: 0,004) and GLS (20,04 ± 3,7% vs 23,53 ± 2,7%; p &lt;0,001).

Conclusions
Our data showed that LA reservoir strain was impaired in patients with moderate to severe DMR. Furthermore, patients with LA dysfunction showed reduced LVEF and GLS values. Consequently, LA dysfunction assessed with STE may be a novel marker of early LV systolic dysfunction in patients with degenerative mitral regurgitation.
Tab.1 LAdysf- (n = 49) LAdysf+ (n = 46) P value LVESD (mm) 31.78 ± 4.1 34.74 ± 7.6 0.020 LAVI (mL/mq) 44.5 ± 15.1 55.6 ± 25.6 0.015 TAPSE (mm) 26.30 ± 3.96 24.02 ± 3.31 0.004 sPAP (mmHg) 31.4 ± 7.0 36.4 ± 10.9 0.009 LVEF (%) 65.4 ± 4.8 60.9 ± 9.8 0.004 GLS (%) 23.5 ± 2.7 20.0 ± 3.7 &lt;0.001 Comparison of continuous variables between patients with and without LA dysfunction.
P665 Role of 2-dimensional speckle tracking echocardiography in improving diagnosis of coronary artery stenosis in stable angina pectoris patients
Authors: Eldeib M M 
Published: January 2020

Abstract

Background
conventional echocardiography at rest provides little information regarding the presence of CAD, Longitudinally orientated myocardial fibers are located subendocardially, the area most susceptible to ischaemia, that is why measurements of longitudinal motion and deformation may be the most sensitive markers of CAD using (2DSE) The aim of this study was to determine if 2DSE performed at rest can enhance the sensitivity of exercise test and if it can predict the presence of coronary artery disease in patients with stable angina pectoris.

Methods
our study included (120) subjects suspected to be stable angina pectoris patients presented for evaluation of chest pain at Al-Hussein University Hospital – Al-Azhar University – Cairo – Egypt between December 2013 and December 2015, The patients were classified according to coronary angiography results in to two groups:
Group (A): 40 patients with normal coronary angiography as a control subjects,Group (B): 80 patients with significant coronary artery disease.

Results
There was statistically significant difference between the two groups as regard E wave, A wave, E/A ration, DT, Em and E/Em, there was statistically significant difference between the two groups as regard SLSS and GLS 17 and GLS 12, there was statistically significant difference between the two groups as regard SLSr and Sr17and Sr 12, there was statistically significant difference between the two groups as regard ST segment deviation during stress ECG, exercise capacity (METs) and Duke Score,;in this study we found that strain parameters at BA, BAS, MA, MIS, MAS, AI and AL segments were found to be significant predictor of LAD stenosis and BP and MP were found to be significant predictor of LCX stenosis and BI was found to be predictor of RCA stenosis, also we found that strain rate parameters at BA, MA, MAS, AI, AL and apex segments were found to be significant predictor of LAD stenosis, and BL, BP and ML were found to be significant predictor of LCX stenosis and BI and MI were found to be predictor of RCA stenosis, the diagnostic performance of the exercise test was significantly improved by GLS17 in terms of a significant increased AUC for the exercise test in combination with GLS17 Conclusion: In patients with suspected SAP, GLS assessed by 2DSE at rest is a predictor of significant CAD and significantly improves the diagnostic performance of exercise test, and capable of identifying which coronary artery is stenotic.
P666 left ventricular filling pressure using E/E" ratio as a useful marker for predicting periprocedural myocardial injury following percutaneous coronary intervention in diabetic patients
Authors: Khalil M 
Published: January 2020

Abstract

Background
Identification of patients with risk of myocardial injury during PCI would allow targeted novel therapies capable of limiting the extent of this injury or reducing its patients number.CK-MB, Troponin-T and I have enabled the quantification of previously undetectable myocardial injury that can also be CMRI visualized.Elevated LV filling pressures are associated with adverse remodeling, HF, and worse survival.E" velocity (unlike others) appears to be relatively independent of preload, especially if myocardial relaxation decreased.In addition, early transmitral flow velocity /early diastolic mitral annulus velocity(E/E") ratio has recently been shown as the most accurate noninvasive predictor of high LV filling pressure.Purpose: evaluate the reliability and adverse outcome of high E/E" in predicting periprocedural myocardial injury.

Methods
60 adult diabetic patients with troponin negative CAD admitted for PCI were studied,then analyzed on the basis of post PCI troponin level:(positive and negative group).E/E" ratio was measured and compared with both groups.

Results
24 patients developed high troponin after PCI specially if PCI complicated or number of DES increased (p. value &lt;0.001&0.027 respectively).Septal E" velocity was improved after PCI(p. value 0.031).E/E" ratio was high in troponin positive group as. Average e/e" ratio can differentiate between patient"s with troponin negative and positive values (predict periprocedural myocardial injury) with high p. value &lt;0.0001,with cuttof value &gt;10.7, with sensitivity and specificity(79.17% and 87.11%) respectively. Positive and negative predictive value for average e/e" ratio was (79.2 and 86.1) respectively.

Conclusions
E/E" ratio can provide useful information on LV filling pressure and can be used as a reliable biomarker for early prediction of periprocedural myocardial injury. But, further studies on a larger number of patients are needed for reliability.

Limitations
small sample size and pre-defined set of study parameters.
E/E" ratio and troponin Negative troponin Positive troponin p. value Mean± SD Median(iqr) Mean± SD Median(iqr) EF Biplane 55.8 ± 6.6 56(50:61.5) 53.8 ± 6.5 51(50:59.5) 0.289 LAV index 30.7 ± 4.6 29.5(28:35.5) 31.6 ± 3.6 33(28:35) 0.675 Average E/E" Post 9.1 ± 7.1 7.3(6.5:9.3) 15.9 ± 8.5 14.2(11.1:18.7) &lt;0.001 Lateral E/E" Post 9 ± 6 7(6:9) 15 ± 7 13(11- 18) &lt;0.001 Septal E/E" Post 10 ± 9 8(7:10) 17 ± 11 15(11:20) &lt;0.001 comparison between focused echocardiographic variables & troponin post PCI
P669 Functional remodeling of the left atrium after first acute ST-elevation myocardial infarction: a 3D echocardiography study
Authors: Jarjour F , Civera S , Vijiiac A , Elnagar B , Palermo C , Torlai Triglia L , Previtero M , Muraru D , Badano L P 
Published: January 2020

Abstract

Background
Left atrium (LA) is a dynamic structure which is functionally coupled with the left ventricle and modulates its function in many cardiac conditions. The geometric and functional remodeling of the LA occurring early after myocardial infarction are poorly understood.

Purpose
We sought to evaluate the early changes in LA geometry and function occurring in survivors of a first acute ST-elevation myocardial infarction (STEMI), using three-dimensional echocardiography (3DE).

Methods
LA phasic volumes and strain (both longitudinal and circumferential) were measured using a dedicated automated software package in 54 patients at pre-discharge after STEMI, and in 54 age- and sex-matched healthy volunteers (controls), (figure 1).

Results
In STEMI patients, both maximal (LAV max) and minimal (LAV min) LA volumes were significantly larger than in controls 63 ± 15 vs. 53 ±11 ml; p = 0,002 and 38 ± 15 ml vs. 25 ± 6; p &lt;0.0001 (respectively). Moreover, when compared to controls (Table 1). Both longitudinal (LASr) and circumferential strain reservoirs showed a significant negative correlation with peak cardiac troponin I values (r=-0.344; p = 0.007 and r=-0.357; p = 0.005, respectively) as an estimate of the extent of myocardial damage.

Conclusion
STEMI was associated to significant geometrical and functional remodeling of the LA which was correlated with the extent of myocardial damage.
Table 1 Controls STEMI patients P-value Longitudinal% LASr 21.8 ± 8.4 13.72 ± 8.27 &lt;0.0001 LAScd -12.8 ± 8.48 -6.43 ± 4.74 &lt;0.0001 LASct -9.73 ± 6.04 -7.26 ± 5.87 0.05 Circumferential % LASr-c 27.31 ± 8.07 18.92 ± 9.16 &lt;0.0001 LAScd-c -11.2 ± 5.93 -6.46 ± 5.68 0.0002 LASct-c -16.22 ± 6.33 -12.41 ± 5.94 0.004 LASr longitudinal strain reservoir, LAScd: longitudinal strain conduit, LAScd: longitudinal strain contraction, LASr-c: circumferential strain reservoir, LAScd-c: circumferential strain conduit , LASct-c:circumferential strain contraction
Abstract P669 Figure 1
P692 Curious Bentall procedure complications, not always found in the immediate postoperative period
Authors: Blasco Turrion S , Gonzalez Perez P , Sanchez Brotons J A , Gomez Lopez A , Morales Ponce F J 
Published: January 2020

Abstract
Ascending aorta aneurisms are often diagnosed in patients around 60-70 years old with prior history of hypertension or smoking, or in younger patients with connective tissue illnesses, such as Marfan Syndrome (MS), or bicuspide aortic valve (BAV). In patients with MS an aneurysm of the aortic root, ascending aorta or acute dissection are the most frequent reasons of death, that is why an aggressive surgical approach is recommended, by repairing or replacing the diseased aortic root. Prophylactic aortic root surgery is an effective procedure in preventing acute dissection and rupture with excellent long-term outcomes as published in the literature, being the Bentall procedure usually the treatment of choice. However, the implantation of a mechanic aortic prosthesis makes permanent oral anticoagulation necessary with elevated haemorragic risk.
We present two peculiar cases of Bentall procedure with differentes indications, different scenarios but similar outcomes.
- Case A: A 75-year-old female with MS who underwent Bentall surgery in 1988 due to a severe AR, stable and asymptomatic since then. In a routine check-up in November 2017, a dilatation of 65mm in her native ascending aorta was detected on a computed tomography scan (CT), visualizing a half-moon shaped space between the ascending aorta and the aortic tube of 21x46mm and a leak from de aorto-ostial union, being possible to confirm with the TEE its origin in the left coronary ostium, which was also dilated (10mm), due to a dehiscence in the aortic tube suture on that level.
- Case B: A 43-year-old male who underwent Bentall surgery in 2014 due to a severe AR and aortic root aneurysm that in January 2017 was admitted to our hospital due to chest pain with no other symptoms associated. As part of the study and TTE, TEE and CT were performed in which a periaortic haematoma from de aortic root to the beginning of the aortic arch was found, visualizing a leak from a 5mm hole in the ostium of the right coronary artery. In addition, the left coronary artery had a severe stenosis (85%) due to the compression of the haematoma on that level.
Even though the Bentall procedure has excellent outcomes we discovered unusual either long and short-term complications due to dehiscence of the sutures, causing a huge peri-prosthetic tube haematoma, compressing the left main coronary artery in one of our patients which was the cause of the angina he presented with. We think these images could help the diagnostic process in future cases since these complications are not only found in the immediate postoperative period and should always be in our minds.
Abstract P692 Figure.