bluuebunny/crossref_metadata_2025_split huggingface dataset:
P258 Giant coronary arteriovenous fistula with significant left-to-right shunt in symptomatic patient - a multimodal diagnostic approach and successful surgical treatment
Authors: Novak M , Nemec P , Sebo M , Veteskova L , Rezek M 
Published: January 2020

Abstract

Funding Acknowledgements
none

OnBehalf
none
Coronary arteriovenous fistula (CAF) is a rare usually congenital defect that occurs in 0.1-0.2% of patients undergoing coronary angiography. A left-to-right shunt exists in more than 90% cases. In approximately 20% of patients CAF is accompanied with coronary artery aneurysm (CAA).
We describe a case of 65-years-old woman with history of murmur from childhood, who presents with symptoms of slowly worsening dyspnea on exertion and strong pericardial pain. A suspicion for CAF was made from echocardiography and finally confirmed by other diagnostic modalities (coronary angiography and computed tomography with 3D reconstructions). We have diagnosed a complex case of a giant CAA involving left main and a periphery of left circumflex artery, accompanied with CAF terminating in the right atrium, responsible for a significant left-to-right shunt and coronary steal phenomenon.
Patient was successfully treated by surgical ligation of the distal part of CAF in the right atrium. There were no signs of an acute myocardial ischemia on beating heart (ECG, perioperative echocardiography) when CAF was temporary occluded by tourniquet and so definitive surgical ligation of CAF was performed back on cardiopulmonary bypass. The postoperative course was uneventful without complications and the patient was discharged 6 days after surgery.
One year after surgery patient is doing well with no complaints. Control echocardiography showed a regression of left and right ventricle volume overload. Coronary angiography showed normal perfusion in the left coronary artery territory, and no more visible collaterals flow right coronary artery.
Abstract P258 Figure. complex coronary artery aneurysm
P903 Myocardial work in moderate to severe aortic versus primary mitral regurgitation
Authors: Bouziane M , Dulgheru R E , Marchetta S , Khaddi S , Cozza F , Habbal R , Lancellotti P 
Published: January 2020

Abstract

Funding Acknowledgements
None

OnBehalf
None

BACKGROUND
Myocardial work is an emerging non-invasive technic based on echocardiographic pressure-strain loops that assess left ventricular (LV) function. The method was studied in a large variety of pathologies, but its role in the assessment of valvular regurgitations is still unknown.

PURPOSE
To compare myocardial work indices in moderate and severe aortic and primary mitral regurgitation.

METHODS
Seventy-eight patients with moderate and severe aortic regurgitation (AR) or primary mitral regurgitation (MR) and preserved LV ejection fraction (LVEF &gt; 50%) were retrospectively analyzed.. Patients with significant valvular stenosis were excluded. Demographic, clinical and echocardiographic data, including LV global longitudinal strain (GLS) and myocardial work indices, were assessed.

RESULTS
The mean age was 58 ± 14 years, and 46 patients (59%) were men. Thirty seven patients had moderate or severe AR and 41 patients had moderate or severe MR. The two groups were homogeneous in terms of demographic and clinical data, except for age. As expected, diastolic blood pressure was lower in patients with AR compared to MR group (67 ± 8 mmHg vs. 73 ± 10 mmHg, p = 0,003), patients with MR had a higher LVEF compared to AR group (63 ± 6% vs 59 ± 6%, p = 0,03), and a higher left atrial indexed volume (53 ± 16ml/m² vs 34 ± 12ml/m², p &lt; 0.0001). Overall, GLS, myocardial work index (GWI) and myocardial constructive work (GCW) were significantly lower in patients with moderate or severe AR compared to MR ( -18,1 ±3% vs -21,3 ±3,3%, p &lt; 0,0001; 1849 ± 393 vs 2285 ± 499, p &lt; 0,0001; and 2194 ± 395 vs 2576 ± 594, p = 0,003, respectively). Global wasted work (GWW) and global work efficiency (GWE) were similar. When comparing only asymptomatic patients, results were similar, with higher GLS, GWI and GCW in moderate to severe MR vs. AR (-22,9 ± 3,4 vs.-18,4 ± 3,4%, p &lt;0,001; 2446 ± 570 vs. 1927 ± 338, p = 0.001 and 2767 ± 688 vs. 2236 ± 377, p = 0.005). Interestingly, when comparing asymptomatic patients with a LVEF &gt; 50% for AR, and LVEF &gt; 60% for MR, GWI and GCW were significantly lower in MR group, despite higher GLS values (1852 ± 398 vs. 2322 ± 527, p &lt; 0.001; 2194 ± 400 vs. 2615 ± 638, p = 0.005; -22,1 ± 3,3% vs. -18,2 ± 2,9, p &lt; 0.001).

CONCLUSION
Patients with moderate to severe MR have higher values of GLS, global work index and global constructive myocardial work. This could translate into the fact that in moderate or severe MR, the myocardium develops a higher amount of work than in AR, maybe to account for the loss of stroke volume into the left atrium. In asymptomatic moderate to severe MR with LVEF &gt; 60%, LV myocardium develops less work than in moderate to severe AR with a LVEF &gt; 50%, suggesting maybe a compensated state.
P974 Sacubitril/valsartan is well tolerated in patients with heart failure and a history of cancer
Authors: Frey M K , Han E , Arfsten H , Pavo N , Huelsmann M , Gyoengyoesi M , Bergler-Klein J 
Published: January 2020

Abstract

Introduction
Sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalisations due to heart failure in patients with reduced ejection fraction when compared to enalapril. Until now, sacubitril/valsartan has not been evaluated in patients with a history of cancer, as these patients were excluded from the pivotal trial, PARADIGM-HF. The aim of the current study was to assess tolerability of sacubitril/valsartan in patients with a history of cancer.

Methods
We retrospectively enrolled all patients at our heart failure out-patient unit who fulfilled the indication criteria to receive sacubitril/valsartan and had a history of cancer. Fifteen patients receiving sacubitril/valsartan had a diagnosis of histologically confirmed cancer: 26.7% breast cancer (n = 4), 13.3% osteosarcoma (n = 2), 13.3% colorectal cancer (n = 2), 13.3% renal cell carcinoma (n = 2), 6.7% non-Hodgkin lymphoma (n = 1), 6.7% lung cancer (n = 1), 6.7% prostate cancer (n = 1), 6.7% bladder carcinoma and 6.7% myeoloproliferative syndrome (n = 1). Surgery due to cancer was performed in 80% of patients (n = 12), 26.7% previously received chemotherapy (n = 6) and 40% radiation therapy (n = 4).

Results
Sacubitril/valsartan was withdrawn in 2 patients (13.3%) because of dizziness and pruritus respectively. After a mean follow-up of 13 ±8 months, NYHA functional class improved significantly (mean -0.5, p = 0.001), ejection fraction as assassed by echocardiography increased (mean +6.8%, p = 0.018) and NT-proBNP was significantly decreased (mean -1552pg/ml, p = 0.026). There was no significant change in creatinine levels (+0.046 mg/dl, p = 0.564 ).

Conclusions
In this pilot study we were able to show that sacubitril/valsartan is generally well tolerated in patients with a history of cancer. Patients with cardiotoxicity induced heart failure can be treated and uptitrated with sacubitril/valsartan to usual dosages similarly as in other causes of heart failure. Larger studies are needed to confirm these findings in cancer patients with cardiotoxicity.
P1592 Papillary- annular continuum is a dynamic component of obstruction in outflow tract of left ventricle in patients with hypertrophic cardiomyopathy
Authors: Pavlyukova E N , Evtushenko A V , Kanev A F , Karpov R S 
Published: January 2020

Abstract

The aim to study was to assess Strain of papillary muscles (PM) and their apical displacement with 3D mitral valve (MV) parameters with maximal size of gradient of obstruction in the left ventricle outflow tract (LVOFT) and the volume of mitral regurgitation (MR) in hypertrophic cardiomyopathy (HCMP) patients.
Material and methods. 72 HCMP patients (aged of 56.9 ± 11.1 years and gradient in LVOFT 70.83 ± 14.83 mm Hg at rest) were investigated. 3D TEE of MV was performed in all patients with follow up
reconstruction. Strain of anterolateral (AL) and posteromedial (PM) papillary muscles (PM) was assess by TTE.

Results
Strain of both PM was decreased in 45 (62.5)% patients. Positive Strain PM PM were found in 20 (27.8%) patients and AL PM -in 7 (9.7%) patients. Apical displacement of PM PM were registered in 19 (38.0%) pts and ALPM in 6 (12.0%) pts. Apical displacement of both papillary muscles was found in 10 (20.0%) patients.
Pts with positive Strain of PM PM had remodeling fibrous ring of MV as compared to patients who had negative Strain of this PM (anteroposterior diameter - 1.97 ± 0.23 sm/m² vs 1.63 ± 0.20sm/m²; p = 0, 01; the perimeter of the ring - 6.92 ± 0.69 sm/m2 vs 6.09 ± 0.93sm/m2; p = 0.02; the area of the ring (3D) - 6.91 ± 1.23sm²/m² vs 5,14 ± 1.31 sm²/m²; p = 0.005). These patients had large areas of the MV leaflets (anterior 4.83 ± 1.03 sm²/m² vs 3.19 ± 0.81 sm² /m² ; p = 0.007; posterior - 4.39 ± 0.42 sm²/m² vs 3.39 ± 1.18 sm²2/m²; p = 0.004), the area of the tenting of leaflets (2.98 ± 1.64 sm²/m² vs 1.24 ± 0.61 sm²/m²; p = 0.04) and the fraction of the tenting (69, 04 ± 24.9% vs 41.27 ± 17.59; p = 0.03). Patients with positive Strain had a greater volume of mitral regurgitation (24.20 ± 11.91 ml vs 14.04 ± 7.58 ml p = 0.004) and the peak gradient in LVOFT was 88.90 ± 37.90 mm Hg vs 66.35 ± 27.00 mm Hg; p = 0.02).
Thus, the parameters of 3D MV and strain of PM represent a fixed papillary – annular continuum causing a dynamic component of the obstruction in the LV OT and the volume of mitral regurgitation in patients with HCMP.
P269 When sudden cardiac death is the first symptom
Authors: Abdala Lizarraga J , Sanchez Alvarez S , Garcia Gonzalez P , Trejo Velasco B , Vidal Urrutia V , Gradoli Palmero J , Simon Machi J M , Fernandez Diaz C , Vano Bodi J , Cardenas Tealdo J P , Paya Serrano R 
Published: January 2020

Abstract

A 43-year-old male was brought to the emergency department due to a recovered sudden cardiac arrest that occurred while performing physical exercise of moderate intensity.

The patient was admitted in a coronary care unit and performed complementary tests to rule out immediate causes of cardiac arrest
electrocardiogram showed sinus rhythm, no repolarization abnormalities and normal QTc interval. Echocardiogram revealed no evidence of cardiac tamponade, massive pulmonary embolism (PE), ventricular dysfunction or valvular heart disease. Absence of pneumothorax in chest X-ray. Arterial blood gas test revealed a high lactate concentration with other parameters in normal range. Cerebral tomography showed absence of an acute hemorrhagic event.
To continue with the study an emergent coronarography was performed showing epicardial arteries with no significant obstructive coronary artery disease associated with an anomalous origin of left main coronary artery in the right sinus of Valsalva with possible interarterial course.
Coronary tomography confirmed the origin of the right coronary artery and the left main coronary artery in the right sinus of Valsalva with an interarterial course, proceeding to the reconstruction of the images with the volume rendering (VR) technique (Figure 1).
Congenital anomalies of the coronary arteries are a rare but life-threatening condition. Most coronary abnormalities are asymptomatic and follow a benign course, however, in some cases they present with ischemic symptoms, heart failure, myocardial infarction, syncope or sudden death. The anomalous origin of the left main coronary artery in the right sinus of Valsalva can cause myocardial ischemia and should be ruled out in young patients who present sudden cardiac arrest induced by physical exercise.
Abstract P269 Figure 1
P274 Continous echocardiographic monitoring in intensive cardiac care unit with external probe stabilizer - preliminary experience
Authors: Wdowiak-Okrojek K , Lipiec P , Kasprzak J D 
Published: January 2020

Abstract

Background
The role of transthoracic echocardiography (TTE) in the intensive cardiac care unit is crucial. Imaging is currently performed at the bedside for diagnosis but TTE has also potential to noninvasively provide critical views to assist in patient monitoring. Continuous monitoring would be especially helpful when the patient is unstable; however, continuous availability of skilled sonographers to obtain appropriate views represents a limiting factor.

Purpose
Recently, an innovative external fixation device allowing prolonged stabilization of transthoracic ultrasound transducer was introduced. The ring-shaped device fitted for TTE probes is attached to the patient by elastic straps to hold the probe in contact with the skin at a fixed but adjustable angle. We developed a research project to assess for the first time the feasibility of continuous TTE imaging with external probe fixation in the intensive cardiac care unit.

Methods
12 patients (10 men, mean age 66,5 ± 15 years) hospitalized in intensive cardiac care unit due to cardiac arrest, myocardial infarction, pulmonary embolism, end-stage heart failure or respiratory failure were included in the study. The echocardiographic probe be was fixed in the apical window providing a four-chamber view to monitor left ventricular function. We assessed the patient’s tolerance and comfort as well as the quality of images acquired at baseline and at the end of monitoring.

Results
Fixation of the probe was successful in all patients (figure 1). The mean time of fixation was 10 ± 1 minute, with a clear learning curve. The quality of obtained images was sufficient for evaluation and was maintained throughout the entire period of monitoring in all patients. Monitoring was stopped at patients’ request when discomfort caused by the compression of the skin by the probe and the fixation device became significant (figure 2). The mean duration of monitoring was 85 + 64 minutes (range 15 to 240 minutes).

Conclusions
In this preliminary series we have demonstrated for the first time the feasibility of echocardiographic continuous monitoring of patients in the intensive cardiac care unit using TTE probe with the external fixation device. The design of the fixation device opens the evident field for optimization to extend monitoring duration at acceptable levels of discomfort in conscious intensive care patients. We hope the improved version of the fixator will decrease the pressure on the body.
Abstract P274 Figure. Fixation of the device
P289 Aortic valve resistance risk-stratifies low-gradient aortic stenosis
Authors: Cho J , Uejima T , Nishikawa H , Yajima J , Yamashita T 
Published: January 2020

Abstract

Background
Grading the severity of aortic stenosis (AS) is challenging, since there is a discrepancy between aortic valve area (AVA) and mean pressure gradient (mPG). Arotic valve resistance (RES) has been proposed as a usuful descriptor of AS severity, but it is not commonly used for clinical decision-making, because its robust validation of clinical-outcome efficacy is lacking. This study aimed to investigate whether RES holds an incremental value for risk-stratifying AS.

Methods
This study recuited 565 AS patients (AVA &lt; 1.5cm²) referred to echocardiography for valve assessment. The patients were divided into three different groups, according to the guidelines: high-gradient AS (HG-AS, mPG≥40mmHg, n = 157), low-gradient AS (LG-AS, mPG &lt; 40mmHg + AVA ≤ 1.0cm², n = 155) and moderate AS (Mod-AS, mPG &lt; 40mmHg + AVA &gt; 1.0cm², n = 253). RES was calculated from Doppler measurement of mPG and stoke volume. The diagnositic cutoff point for RES was determined at 190 dynes × s×cm-5 by substituting AVA = 1.0cm² and mPG = 40mmHg into the definition formula of RES and Gorlin formula. The patients were followed up for 2 years. The endpoint was a composite of cardiac death, hospitalization for heart failure and aortic valve replacement necessitated by the development of AS-related symptoms.

Result
Kaplan-Meier analyses showed that LG-AS exhibited an intermediate outcome between HG-AS and Mod-AS (event-free survival at 2 years = 20.9% for HG-AS, 59.7% for LG-AS, 89.9% for Mod-AS, p &lt; 0.001, figure A). When LG-AS was stratified by RES, the survival curves showed a significant separation (event-free survival at 2 years = 35.3% for high RES, 70.7% for low RES, p &lt; 0.001, figure B). This trend persisted even when analysed separately for norml (stroke volume index &gt; 35ml/m²) and low (stroke volume index ≤ 35ml/m²) flow state ((normal flow) event-free survival at 2 years = 38.7% for high RES, 70.4% for low RES, p = 0.023, figure C; (low flow) event-free survival at 2 years = 26.7% for high RES, 74.6% for low RES, p &lt; 0.001, figure D).

Conclusion
This study confirmed the clinical efficacy of RES for risk-stratifying LG-AS patients.
Abstract P289 Figure.
P290 Differences in cardiac dimensions in mitral valve prolapse with or without Barlow phenotype
Authors: Kamoen V , Calle S , De Backer T , Timmermans F 
Published: January 2020

Abstract

Background
Mitral valve prolapse (MVP) is a common cause of chronic mitral regurgitation (MR). Barlow’s disease (BD) and fibro-elastic deficiency (FED) are two major entities of MVP affecting the connective tissue of the mitral valve, but both have a different underlying pathophysiology and phenotype. In some connective tissue diseases (CTD), it has been suggested that ventricular dysfunction occurs despite absence of MR, suggesting that CTD directly involve the myocardium. We therefore investigated whether patients with BD have different cardiac dimensions compared to FED, after correcting for MR severity grade.

Methods
134 patients with MVP and chronic MR were prospectively included. MR was graded carefully by echocardiography using a multi-parametric approach. The morphology of the mitral valve prolapse was specified as definite Barlow (n = 45) or non-Barlow (n = 89; FED, flail leaflet or unspecified etiology) by two experienced echocardiographers.

Results
In our cohort, MR was significantly more severe in the non-Barlow group compared to typical BD group (regurgitant volume (RV) 51 vs 33 ml, p = 0.021; right ventricular systolic pressure, 40 vs 34 mmHg, p= 0.05, left atrial volume index, 51 vs 42 ml/m², p = 0.07, respectively).
However, there was a trend towards higher left ventricular end-diastolic diameter index (LVEDDi, 27.7 vs 29 mm, p = 0.07) and a significantly higher end-diastolic volume index (LVEDVi, 62 vs 71 ml/m², p= 0.02) in the Barlow group, despite similar ejection fractions and much less MR in the Barlow group. This resulted in a significantly higher RV/LVEDV ratio in the non-Barlow group compared to the Barlow group (42% vs 23%, p = 0.001). Similarly, the LA volume/LVEDV ratio was significantly lower in the Barlow cohort (63 vs 79%, p= 0.026). There were no significant differences in aortic dimensions between groups.

Conclusions
We describe for the first time that compared to non-Barlow (mostly FED), patients with MVP due to typical Barlow disease have larger ventricular dimensions and volumes, which are disproportionate to the degree of MR. We therefore hypothesize that the connective tissue alterations in these patients may also involve the myocardium resulting in LV dilation independent of MR. Further investigation and clinical implications of these findings is mandatory.
P293 Assessment of right ventricle parameters during stress in patients with asymptomatic primary mitral regurgitation
Authors: Zvirblyte R , Tamulenaite E , Merkyte I , Saniukaite A , Vaskelyte J J 
Published: January 2020

Abstract

Background
Evaluation of right ventricle (RV) function and pulmonary artery pressure (PAP) during stress, plays an important role in identifying worse prognosis for patients with chronic mitral regurgitation (MR) and may help to optimise the time of surgical interventions.

Purpose
The aim of the study was to evaluate changes of RV function and systolic PAP in patients with asymptomatic primary MR during stress echocardiography.

Methods
Resting and stress (veloergometry as per protocol 25 + 25 W every 3 minutes) echocardiography were performed in 63 asymptomatic patients (age 56.12 ± 13.97 years) with preserved left ventricle (LV) ejection fraction (EF) (&gt;50%) at rest. 39 (61.9%) patients with moderate (grade 2-3) MR (MR group) and 24 (38.1%) patients without significant heart valves disease (control group) were included in the study. Statistical analyses were performed using the SPSS 20.0 software. The value of p &lt; 0.05 was considered as statistically significant.

Results
Anthropometric and clinical characteristics, LV EF (64.96 ± 9.14% vs. 64.87 ± 6.46%, p = 0.97) and LV global longitudinal strain (GLS) (-19.24± 3.12% vs. -19.28 ± 3.36%, p = 0.055) at rest were not significantly different between MR and control groups. Diameter of RV was larger in MR group (36.07 ± 5.34 mm vs. 33.13 ± 3.48 mm) however difference was not significant (p = 0.971). Parameters of RV function (longitudinal myocardial velocity - S’, fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE)) were similar in both groups at rest, during stress and at recovery phase (Picture 1). However TAPSE and S’ at rest (p = 0.037 and p = 0.205, respectively) and minimal stress (p = 0.006 and p = 0.035, respectively) were significantly lower in patients with MR who had highly increased (&gt;60 mmHg) systolic PAP during stress. Also TAPSE (p = 0.002) and S’ (p = 0.017) during recovery phase were significantly lower in subjects with reduced LV contractile reserve (whom LV EF increased &lt;4% or GLS &lt;1.9% during stress). Systolic PAP during stress was growing much faster in patients with MR (Picture 1).

Conclusions
Patients with asymptomatic moderate primary mitral regurgitation had higher systolic PAP during stress even though at rest it was similar as in controls. Prominent severe pulmonary hypertension during stress was related to worsening parameters of RV function.
Abstract P293 Figure. Parameters of RV during stress