bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1758 Global left ventricular myocardial work efficiency as a prognostic marker for clinical responders one year after edge-to-edge mitral valve repair in patients with functional mitral regurgitation
Authors: Papadopoulos K , Ikonomidis I , Chrissoheris M , Chalapas A , Kourkoveli P , Vardas P , Spargias K 
Published: January 2020

Abstract

Background
Percutaneous edge-to-edge mitral valve repair (PMVR) has been proven to be effective for treating patients with functional MR (FMR). However it remains to be answered which patients will benefit more from this method. Novel echocardiographic markers like myocardial work efficiency can be quantified non-invasively and have never been analyzed in this subgroup of patients before.

Purpose
The purpose of this study is to analyze the myocardial work efficiency in patients treated with PMVR for FMR and identify predictors of clinical response.

Methods
We retrospectively analyzed 22 high surgical risk (logistic EuroSCORE 28.9 ± 18.2%) consecutive patients (aged 72 ± 8yrs) with functional moderate-to-severe and severe mitral regurgitation (EROA 28.6 ± 14.6mm2, RV 41.7 ± 15.8ml) and reduced LV contractility (EF 32.7 ± 7.5%, GLS -8.8 ± 3.4%). At baseline and 1-year after PMVR or optimal medical treatment (OMT) we assessed echocardiographic parameters such as MR severity, Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE), along with BNP levels and NYHA class status.

Results
One year after PMVR there was a significant reduction of MR (3.6 ± 0.5 vs 1.8 ± 0.8, p = 0.009) and BNP levels (901 ± 610pg/ml vs 479 ± 385pg/ml, p &lt; 0.001) and significant improvement of NYHA class status (3.0 ± 0.6 to 2.2 ± 0.4, p &lt; 0.001). On the other hand, patients treated with OMT didn’t have any significant change of their MR (3.6 ± 0.5 vs 3.3 ± 1.0), BNP levels (296 ± 114 vs 241 ± 183pg/ml) or NYHA class status (2.6 ± 0.5 vs 2.4 ± 0.5). In device group, there was a preservation of GWI (572 ± 290 vs 609 ± 299mmHg%) and GCW (757 ± 310 vs 789 ± 316mmHg%) and non significant change of GWW and GWE (140 ± 70 vs 150 ± 73mmHg% and 79 ± 9 vs 79 ± 10% respectively, p &lt; 0.05 for all comparisons). On the other hand in medical treatment group there was a significant impairment of GWI (635 ± 263 vs 564 ± 267mmHg%, p = 0.08) and GWE (83 ± 9 vs 76 ± 11%, p = 0.03) and significant increase of GWW (123 ± 90 vs 162 ± 74mmHg%, p &lt; 0.001). Further, baseline GCW was reversely associated with the difference in BNP (r=-0.559, p = 0.038), NYHA class (r=-0.501, p = 0.06) and 6MWT (r=-0.577, p = 0.08) after PMVR, meaning that patients with worse energetics will respond better.

Conclusions
PMVR is an effective method for treating patients with FMR and preserves myocardial work index after one year of FU in contrast to medically treated patients in whom deterioration is observed.
P1765 Cardiac myxomas: echocardiographic findings and clinical correlation, a 15-years single-center experience
Authors: Gripari P , Giambuzzi I , Fusini L , Saccocci M , Mantegazza V , Tamborini G , Muratori M , Ricciardi G , Zanobini M , Pepi M 
Published: January 2020

Abstract

Background
Cardiac myxomas, the most frequent primary benign cardiac tumours, are in some cases lethal due to impaired cardiac dynamics and thromboembolic potential. When tumors are diagnosed and surgically resected in a timely manner, they lose their deleterious potential and patients are cured, except for rare cases of recurrence.

Purpose
We sought to describe the association of clinical presentation, course and echocardiographic findings, dividing myxomas on the basis of location, morphology, size, mobility, echocardiographic appearance.

Methods
We reviewed the medical records and retrospectively analyzed the transthoracic echocardiograms of 51 patients (31female, aged 63 ± 14), who underwent cardiac surgery and were diagnosed at histology with myxoma, between 2004 and 2019. Myxomas were classified according to their location (typical when attached to the interatrial septum in the left side, or atypical), diameters, shape (solid and round shape, or irregular and multilobulated), echocardiographic appearance (homogeneous or heterogeneous), mobility (high mobile pedunculated, or nonmobile), obstruction (no or impaired mitral/ tricuspid dynamics). Depending on symptoms patients were referred to emergency or elective surgery.

Results
In 28 patients (55%) myxomas were incidental echocardiographic findings (Figure 1 A), 23 patients (45%) reported symptoms at presentation (dyspnea in 15 cases, embolic symptoms in 5 cases, syncope in 3 cases) (Figure1 B). A total of 41 myxomas (80%) were tipically located on the interatrial septum in the left side, followed by the left atrium (5 patients,10%), the right atrium (4 patients, 8%) and the tricuspid valve (1 patient).
Symptoms were associated with large size (41 ± 15 mm vs 29 ± 15 mm, p = 0.004 ), high mobility (76% vs 24%, p&lt; 0.001, ), obstruction (75% vs 25%, p = 0.004), heterogeneous aspect (75% vs 25%, p = 0.006) and were not related to location and shape. A maximum diameter &gt; 39 mm distinguished patients with or without symptoms.
In patients with symptoms surgery was based only on echo. In the other cases cardiac CT (20 cases) or MRI (8 cases) was performed.
All patients received a complete surgical resection, recurrency was observed in one case.

Conclusions
Clinical presentation relates to the ultrasound characteristics of myxomas: small, non mobile, homogeneous lesions probably benefit of elective surgery. Large size, high mobility, heterogeneous aspect and impaired valves dynamics correlate with symptoms at presentation and emergency surgery is mandatory.
Abstract P1765 Figure 1
P1773 Cohort of HER2 positive breast cancer and subclinical cardiotoxicity by speckle tracking echocardiography. Does chemotherapy sequence matter?
Authors: Guzman Ayon A M , Aceves Velazquez E D , Armengol Alonso A , Vasquez Ortiz Z Y 
Published: January 2020

Abstract
A cohort of patients with breast cancer HER2 positive are exposed to chemotherapy with cardiotoxic drugs like anthracyclines (A) and trastuzumab (T). The decrease in longitudinal strain is a helpful tool to predict clinical cardiotoxicity. The purpose of this paper is to determine if echocardiographic parameters like longitudinal strain with speckle tracking predict subclinical cardiotoxicity compared to conventional echocardiographic parameters.
This was a retrospective, observational cohort study that involved 20 patients with breast cancer HER2+ who were treated with a chemotherapy reverse sequence (TH-A). We made a basal echocardiogram, 3, 6, 9 and 12 months after chemotherapy with a cumulative dose of 240mg/m2 of doxorrubicin. Cardiotoxicity was defined as a decrease in left ventricular ejection fraction of 10% below 53%, and subclinical cardiotoxicity as a decline of &gt;15% of longitudinal strain.
5 patients (25%) developed decline in longitudinal strain (subclinical cardiotoxicity) 3 months after initiation of chemotherapy, despite 2 of them had normal LVEF (p = 0.01), with the use of heart failure medication they showed partial reversibility. Lineal regression analysis showed that patients with GLS &gt;-19% at baseline did not present cardiotoxicity during the follow up (p = 0.03). Changes in GLS were independent of left ventricular mass, E/A and peak s’ wave velocity (p = 0.01).
The diagnosis of subclinical cardiotoxicity by the decrease of GLS is a useful tool with possible therapeutic implications and possible reversibility of cardiotoxicity in patients with reverse chemotherapy sequence.
Significant results Binary analysis of echocardiographic variables Value LVEF p GLS p Basal 62.4 ± 6.7 -19.8 ± 1.8 3 months 59.4 ± 11.1 0.615 -18.1 ± 3.9 0.01 6 months 60.2 ± 8.7 0.354 -18.9 ± 3.3 0.185 9 months 61.6 ± 6.0 0.862 -19.65± 1.9 0.408 12 months 61.1 ± 5.7 0.379 -19.8 ± 1.9 0.859 Binary analysis of echocardiographic variables
Abstract P1773 Figure. Sequence of chemotherapy
P1777 Circulating microRNAs are associated with myocardial damage in patients with coronary artery disease: implications for a role of microRNA in myocardial matrix remodeling
Authors: Gheorghiu L , Ciobanu A , Macarie R , Vadana M , Ciortan L , Tucureanu M , Butoi E , Simionescu M , Vinereanu D 
Published: January 2020

Abstract

Background
Recent studies have reported that circulating microRNA (miR) can target different metalloproteases involved in matrix remodelling and plaque vulnerability. Consequently, they might have a role in the diagnosis and prognosis of cardiovascular diseases.
Aim. To quantify circulating miRs (miR126, miR146) which are suggested to have possible cardiovascular implications, as well as levels of MMP-1 and MMP-9, and to determine their association with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and arterial function, in patients with stable and unstable coronary artery disease (CAD).

Methods
90 patients with CAD (61% men, 58+/-12 years), including 60 patients with ST elevation acute myocardial infarction (STEMI) and 30 patients with stable CAD were assessed within 24 hours of admission by serum microRNA quantification (TaqMan PCR analysis), and serum MMP-1 and MMP-9 analysis (ELISA kits). 2D and 3D echocardiography were used to assess LVEF; speckle tracking was used to asses GLS; echo tracking, CAVI, and peripheral Doppler were used to assess arterial function (Young"s elastic modulus - EP and β index, arterial stiffness, and ABI).

Results
Circulating levels of miR146, miR126, MMP1, and MMP9 were significantly increased in patients with STEMI vs. stable CAD (95% CI 1.92-8.43, p = 0.002). miR126 correlated with LVEF (r=-.41, p = 0.03) and arterial stiffness (r=.44, and r=.42, p = 0.02 for L-CAVI and R-CAVI respectively) in patients with STEMI, and with arterial stiffness (r=-.72, p = 0.04, r=-.72, p = 0.01 for L-CAVI and R-CAVI respectively) and ABI (r=-.62, p = 0.04, r=-.62, p = 0.03 for L-ABI and R-ABI respectively) in patients with stable CAD. miR146 did not have any significant correlations. Both MMP-1 and MMP-9 correlated with LV function, LVEF ( r=-.27, p = 0.04, r=-.40, p = 0.01) and GLS (r=-.27, p = 0.03, r=-.26, p = 0.04) in patients with STEMI, and with arterial stiffness (r=.40, p = 0.03, for L-CAVI and r = 0.42, p = 0.02 for R-CAVI) in patients with stable CAD.

Conclusion
miR126 and both MMP1 and MMP9 are potential biomarkers of LV function in STEMI patients. Meanwhile, they correlate with arterial function in patients with stable CAD. However, further studies are needed to establish whether these new biomarkers have diagnosis and prognosis significance.
Abstract P1777 Figure.
P1779 Myocardial work is a predictor of exercise tolerance in patients with dilated cardiomyopathy and left ventricular dyssynchrony
Authors: Galli E , Schrub F , Schnell F , Hubert A , Donal E 
Published: January 2020

Abstract

Background
the assessment of myocardial work (MW) by pressure-strain loops is a recently introduced tool for the assessment of myocardial performance. Aim of the present study is to evaluate the relationship between myocardial work and exercise tolerance in patients with dilated cardiomyopathy (DCM)

Methods
51 patients with DCM (mean age 57 ± 13 years, left entricular ejection fraction : 32 ± 9%) underwent cardiopulmonary exercise test (CPET) to assess exercise performance. Trans-thoracic echocardiography (TTE) was performed CPET. The following indices of myocardial work (MW) were measured regionally and globally: constructive work (CW), wasted work (WW), and work efficiency (WE). Left ventricular (LV) dyssynchrony (DYS) was defined by the presence of septal flash or apical rocking at TTE.

Results
LV-DYS was observed in 16 (31%) patients and associated with lower LV ejection fraction (LVEF), GLS, global and septal WE, and higher global and septal WW (Table 1). In patients with LV-DYS, septal WE was the only predictor of exercise peak VO2max at multivariable analysis (Figure 1), whereas LVEF (β=0.47, p = 0.05) and age (β=-0.42, 47, p= 0.04) were predictors of exercise capacity in patients without LV-DYS.

Conclusions
In patients with DCM, LV-DYS is associated with an heterogeneous distribution of myocardial work. Septal WE is the best predictor of exercise performance in these patients.
Table 1 All n = 51 No-dyssynchrony n = 35 (69%) LV-Dyssynchrony n = 16 (31%) p-value LVEF, % 32 ± 9 34 ± 10 28 ± 7 0.04 GLS, % -12 ± 3 -13 ± 3 -10 ± 3 0.001 GCW, mmHg% 1325 ± 398 1342 ± 354 1287 ± 491 0.65 GWW, mmHg% 201 ± 147 154 ± 95 304 ±191 &lt;0.0001 GWE, % 85 ± 9 88 ± 7 78 ±10 &lt;0.0001 CWsept, mmHg% 1172 ± 459 1274 ± 398 949 ± 516 0.017 CWlat, mmHg% 1518 471 1472 ± 386 1620 ± 622 0.30 WWsept, mmHg% 283 ± 275 174 ± 98 522 ±376 &lt;0.0001 WWlat, mmHg% 135 ± 88 117 ± 81 176 ± 92 0.02 WEsept, % 78 ± 16 84 ± 9 62± 18* &lt;0.0001 WElat, % 90 ± 7 91 ± 7 88 ± 7 0.16
Abstract P1779 Figure.
P1780 Left ventricular golbal longitudinal strain in acute myocardial infarction and incidence of in hospital heart failure
Authors: Ebeid H , Abd El Hady R , El Khashab K , Husein M 
Published: January 2020

Abstract

Background
The occurrence of in-hospital heart failure in the acute phase of myocardial infarction carries an ominous prognosis and is often preceded by abrupt loss of functioning myocardium. However ,In hospital heart failure may occur in patients with apparently only minor myocardial injury and preserved or only moderately reduced left ventricular ejection fraction and still carries a significantly increased risk of adverse outcome. In patients with clinical symptoms of heart failure despite preserved left ventricular ejection fraction(heart failure with preserved ejection fraction), abnormalities in longitudinal myocardial mechanics have been reported suggesting that the discrepancy between near normal left ventricular ejection fraction and clinical symptoms may be partially explained by theses indices.

Purpose
Evaluation of the role of global longitudinal strain in prediction of the occurrence of in hospital heart failure in patients presenting with acute myocardial infarction particularly in patients with normal ,or moderately impaired ejection fraction.

Methods
forty patients with first attack of acute myocardial infarction were ranked according to killip class during their hospital admission and course. The patients were divided into two groups: Group 1: patients having in-hospital heart failure (killip class &gt; 1).Group2: Patients not having in–hospital heart failure (killip class = 1). Echocardiogaraphic examination was done for them including global longitudinal strain within 72 hours after successful reperfusion .Comparison of different echocardiographic parameters between the two groups was done. Patients with mildly impaired ejection fraction (Ejection fraction &gt; 40%) were studied for echocardiographic parameters correlated significantly with the occurrence of in-hospital heart failure .

Results
Patients with in-hospital heart failure had significantly impaired global longitudinal strain(-8.63%+1.57% vs -12.41%+1.31%, p = 0.000), lower left ventricular ejection fraction (34.17%+8.17% vs 42.92 %+7.98%,p &lt; 0.001) and higher wall motion score index (1.57 + 0.32 vs 1.31 +0.24 ,p &lt; 0.006). In patients with left ventricular ejection fraction &gt;40% experienced in-hospital heart failure also exhibited significantly impaired global longitudinal strain p= 0.035 .

Conclusion
Global longitudinal strain can offer accurate, feasible, and non invasive predictor of hemodynamic deterioration in patients with myocardial infarction. Global longitudinal strain was superior to left ventricular ejection fraction , wall motion score index in evaluation of myocardial dysfunction specially in those with preserved left ventricular ejection fraction(EF &gt; 40%).Global longitudinal strain was also superior to left ventricular ejection fraction , wall motion score index in detection of patients with Killip class II ( those without overt heart failure ,and who can be easily missed).
P1786 Impact of exercise on platelet activity in patients with significant ischemic mitral regurgitation qualified for cardiosurgery treatment
Authors: Piatkowski R , Kochanowski J , Budnik M , Huczek Z , Scislo P , Kosior D A , Opolski G 
Published: January 2020

Abstract

Purpose
Platelet activity is believed to play an important role in patients (pts)after myocardial infarction (MI). This study sought to examine a change in platelet activity after 2D echocardiography semi-supine exercise test (ExE) in pts with at least moderate ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABG) or CABG with mitral reconstruction (CABGmr).

Methods
We collected venous blood samples from 70 patients (M 41, 66 ± 9 years) with at least moderate IMR, 3-24 weeks after MI. Platelet activity was estimated with the use of rapid, point-of-care platelet analyzer as the time (in seconds) for flowing whole blood to occlude a collagen-epinephrine ring, with shorter closure times, indicating greater activity (CEPI-CT- for assessing the thromboxane A2 –dependent activation pathway). CEPI-CT was evaluated before (CEPI-CT rest) and 20 min after ExE (CEPI-CT ExE). All the patients received 75-100 mg of aspirin daily (without clopidogrel treatment). Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (moderate ≥10-20, severe ≥ 20 mm²). All the pts were referred for CABG (multivessel coronary disease, ejection fraction (EF) 42,6 ± 10,1%, wall motion score index (WMSI) 1.65 ± 0.36).

Results
We observed a significant decrease in CEPI–CT’s in all analyzed group (rest vs exe: 202 sec vs 124 sec, respectively; p &lt; 0,0001) and in pts with moderate IMR as well as in pts with severe IMR, despite aspirin treatment. The results of the analysis of CEPI-CT and IMR size at rest and after ExE in both groups of pts are shown in Table 1. A negative correlation was found between CEPI-CT ExE and ERO ExE (r=-0,752, p = 0,0042).

Conclusions
1. Significant increase in platelet activity after exercise was observed in patients after MI with IMR qualified for cardiosurgical treatment.
2. The increase in platelet activity after exercise is correlated with exercise changes of IMR size.
3. Aspirin may have a limited antithrombotic effect after physical exercise in patients after MI with significant IMR.
Table 1. CEPI-CT rest CEPI-CT ExE p ERO rest ERO exe p All 202 124 &lt; 0,0001 17 22 &lt;0,001 Moderate IMR 201 124 0,0001 15 20 &lt; 0,0001 Severe IMR 235,5 123,5 &lt; 0,0001 25 31 &lt; 0,0001
P1789 Stress echocardiography in patients with pulmonary arterial hypertension - a pilot study
Authors: Ptaszynska-Kopczynska K , Mickiewicz K , Oleksiuk M , Michalski T , Lisowska A , Kaminski K , Sobkowicz B , Knapp M 
Published: January 2020

Abstract

INTRODUCTION
Pulmonary arterial hypertension (PAH) is a rare, progressive disease with poor prognosis. Stress echocardiography (SE) gives an important data on hemodynamic response to exercise. In patients with PAH SE may be useful for the diagnosis and risk assessment but data are lacking.

AIM OF STUDY
The aim of the study was to analyze exercise-induced response of right heart function and pulmonary artery pressure in patients with PAH.

MATERIALS AND METHODS
Study group consisted of 15 hemodynamically stable patients, 9 women, aged 22-73 (median- 50), diagnosed with PAH treated at Cardiology Department. The patients were subjected to stress echocardiography on supine cycloergometer and underwent assessment before and at peak-exercise. Moreover the standard parameters of clinical assessment: NT-proBNP, WHO functional class, and 6-minute walk test were analyzed.

RESULTS
Nine patients were in WHO class III, 4 of them- WHO class II and 2- WHO class I. The median NT-proBNP concentration was 169.3 (IQR 151.2-989.5) pg/ml. 6-Minute Walk Test distance was 455 (428-489) meters. The median workload was 75 (IQR 50-100) Watts and it was the median 54% (IQR 37-62%) of predicted.
The echocardiographic parameters assessed in SE at rest and shortly after peak-exercise revealed that RV systolic volume did not significantly differ: 70 (49.8-112.3) vs 71.5 (36.6-110) ml, p = 0.3. Right atrial area decreased from median 21.9 (17.4-27.3) to 19.8 (16.4-22.1) cm2, p = 0.05, whereas right atrial volume did not significantly changed - 80 (47.5-99.5) vs 68 (47.3-78.8) ml, p = 0.13. Further, shortly after exercise tricuspid regurgitation peak gradient (TRPG) significantly increased - 43 (25-76.5) vs 71 (50.5-102) mmHg, p = 0.002.

CONCLUSIONS
In stable PAH patients supine SE is feasible. Even in advanced WHO functional classes patients were able to exercise. Among echocardiographic parameters TRPG reflecting systolic pulmonary artery pressure showed the biggest difference between baseline and peak-exercise values. SE and seems to be a valuable tool in PAH patients’ assessment.
P1795 Active acromegaly is associated with enhanced left ventricular contractility - A three-dimensional speckle-tracking echocardiographic study
Authors: Kormanyos A , Domsik P , Kalapos A , Gyenes N , Valkusz Z , Lengyel C , Forster T , Nemes A 
Published: January 2020

Abstract

Introduction
Acromegaly is a relatively rare, chronic hormonal disease resulting in disfigurement. In 90% of the cases, acromegaly is caused by a benign pituitary monoclonal human growth hormone-secreting tumor. Hypertension and left ventricular (LV) hypertrophy are the most common cardiovascular comorbidites, but serious valvular regurgitation and heart failure could also develop at the end-stages. The aim of the present study was to determine the presence of LV deformational abnormalities using three-dimensional speckle-tracking echocardiography (3DSTE) in a group of acromegaly patients.

Methods
Thirty-eight acromegaly patients were involved in the present study. Thirteen patients were excluded due to inadequate image quality. The mean age of the remaining patients were 57.2 ± 13.6 years (7 males). The active acromegaly subgroup consisted of 14 patients (mean age: 58.6 ± 14.6 years, 5 males), while the inactive group contained 11 patients (mean age: 54.0 ± 12.9, 2 males). Their data was compared to an age- and gender matched control population, which comprised of 34 healthy volunteers (mean age: 52.7 ± 4.9 years, 15 males). All subjects have undergone complete two-dimensional Doppler echocardiography extended with 3DSTE.

Results
Significant differences in left atrial diameter and volume, LV end-diastolic diameter and volume, interventricular septum and LV posterior wall thickness could be demonstrated between the acromegaly group and healthy controls. Global and mean segmental 3DSTE-derived LV radial strain (RS)(33.2 ± 13.4% vs. 25.2 ± 10.8%, p =0.01 and 36.0 ± 12.1% vs. 28.2 ± 10.0%, p =0.009, respectively) proved to be significantly higher in acromegaly patients compared to controls. Active acromegaly patients had a significantly higher global and mean segmental RS (35.5 ± 14.4% vs. 25.2 ± 10.8%, p =0.03 and 37.9 ± 13.3% vs. 28.2 ± 10.0%, p =0.03, respectively) as compared to that of controls. Between active and inactive acromegaly groups only basal LV circumferential strain (-30.2 ± 4.8% vs. -26.7 ± 4.1%, p =0.02) was found to be significantly different.

Conclusion
With presented clinical, demographic, therapeutic and echocardiographic features, active acromegaly is associated with enhanced LV-RS as compared to the healthy population.