bluuebunny/crossref_metadata_2025_split huggingface dataset:
39 Overview of tricuspid regurgitation (tr). new classification of tr. when severe tr is too severe?
Authors: Vieitez Florez J M , Monteagudo J M , Mahia P , Perez L , Lopez T , Marco I , Perone F , Gonzalez T , Sitges M , Bouzas A , Gonzalez V , Li P , Alonso D , Fernandez-Golfin C , Zamorano J L 
Published: January 2020

Abstract

Introduction
Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, it is not know how many of the patients classified as severe TR, corresponds to the new Torrential or massive classification that for sure will lead to different treatment strategies. Also few published studies have addressed the aetiologies, mechanisms and severity in large cohorts.

Purpose
To evaluate the burden of TR in a large cohort of patients referred for an echocardiography.

Methods
Prospective study where consecutive patients undergoing an echocardiographic study in 10 Spanish hospitals within a three-month period were included. All studies with at least moderate TR were selected for analysis. The evaluation was conduced according to the usual practice of the laboratory. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR was quantified according to Hanh & Zamorano new published classification.

Results
A total of 35088 consecutive echocardiographic studies were performed in the participant hospitals during the recruitment period. TR of at least moderate degree was detected in 2124 studies (6,05%). Mean age was 77,1 years and 62.8% were women.
Mitral or aortic valvulopthy was the most common cause, present in almost half of cases (48.4%). The second cause of TR was idiopathic with 22.2% of cases. Primary TR was found in 7.2% of patients, the most frequent aetiology in these group was cardiac implantable devices with 4.2% of total of TR. Aetiology and severity according to the new classification can be seen in the figures
Atrial fibrillation was present in 47.6% of cases. 56.4% of patients had symptoms at the time of the study (NYHA≥2 at the time of study).
Right ventricle (RV) was dilated (telediastolic basal diameter &gt;42mm) in 39.4% of patients). RV function was impared (TAPSE &lt;17mm) in 30.6% of patients.

Conclusions
In these larger multicentre study, significant TR may is present in up to 6% of the echocardiographic studies and is often symptomatic[m1] . 4,91% of patients had a massive or torrential grade. Most TR are secondary to mitral or aortic valvulopathy. Idiopathic TR has taken the second place.
Abstract 39 Figure. Severity and aetiology of TR
44 Determinants of functional tricuspid regurgitation progression
Authors: Aronson D , Lessick J , Agmon Y , Mutlak D 
Published: January 2020

Abstract

Background
Tricuspid regurgitation has been the focus of increasing interest and research in recent years. However, few data are available with regard to risk factors associated with the evolution of TR.

purpose
The aimed to determine the risk factors for the development of hemodynamically significant functional TR.

Methods
We studied 1552 subjects with an index echocardiogram demonstrating trivial or mild TR. Risk factors for TR progression to moderate or severe TR during a median follow-up time of 38 months (IQR 26 to 63 months), were determined using logistic regression.

Results
In the multivariable logistic regression model, older age, female gender, pacemaker electrode and indicators of left heart disease (LA enlargement, increased pulmonary artery pressure (PAP), atrial fibrillation, and left-sided valvular disease) were associated with future development moderate or severe TR (Table). The strongest predictors of TR progression were PAP, LA size, AF, and age.
The final echocardiographic examination demonstrated a marked worsening in the severity of left-sided myocardial and valvular disease, that was more prominent in subjects with TR progression (Figure). Compared with subjects in whom TR did not progress, subjects with TR progression demonstrated an increase in PAP and in the severity of mitral and aortic valve disease, larger increases in LA and reductions in LVEF (Figure). Lager proportions of subjects progressing to significant TR developed AF, were implanted with pacemakers or defibrillators or underwent valvular interventions (Figure). The mean PAP change between the baseline and final echocardiographic examination was 16 ± 15 mm Hg and 3 ± 11 mm Hg with and without TR progression, respectively (P &lt; 0.0001).

Conclusion
Predictors of TR progression are mostly indicators of more advanced left heart disease. In addition, progression to significant TR is associated with a more acceleration course of left hear disease.
Independent Predictors of TR Progression Characteristics HR (95% CI) P value Age (per 10 years increase) 1.35 (1.31-1.50) &lt;0.0001 Female sex 1.50 (1.13-1.99) &lt;0.0001 Heart failure 2.76 (1.43-5.32) 0.002 LA enlargement ≥ Moderate 1.86 (1.29-2.67) 0.001 Atrial fibrillation 2.34 (1.57-3.49) &lt;0.0001 Pacemaker/ICD 2.93 (1.48-5.78) 0.002 Pulmonary artery pressure (per 10 mm Hg increase) 1.47 (1.29-1.69) &lt;0.0001 Valvular heart disease≥ Moderate 1.50 (1.11-2.04) 0.009
Abstract 44 Figure. Proportion of new abnormalities
46 Classic or new echocardiographic parameters in the evaluation of the right ventricular function after tricuspid valve surgery?
Authors: Segura Rodriguez D , Torres-Quintero L , Rodriguez-Torres D J , Moreno-Escobar E , Garcia-Orta R 
Published: January 2020

Abstract

Background
Tricuspid valve regurgitation(TR) is frequent in patients undergoing to valvular heart disease surgery, particularly joined to mitral valve surgery. Classically, it was considered that left valve disease surgery would regress the TR without requiring any surgery on it, which has not been confirmed during follow-up. There is no consensus about which tricuspid lesions need to be operated neither which is the best surgical technique.

Purpose
In this study, we have evaluated the right ventricle(RV) function by advanced transthoracic echocardiography before to surgery and three months later.

Methods
Prospective cohort including 43 patients with valve surgical indication and some degree of tricuspid insufficiency. An advanced echocardiographic study was performed to determine the RV function measured by the following variables: basal diameter, Tricuspid Annular Plane Systolic Excursion(TAPSE), end-systolic RV area, fractional area change(FAC), systolic tricuspid valve lateral annular velocities by tissue Doppler(s’) and global longitudinal strain(GLS). Variables were tested to normality with Kolmogorov-Smirnoff test. Wilcoxon test was performed in order to compare measures previous and after surgery.

Results
43 patients were analysed. Mean age 64.7 ± 8.3 years, 31(72.1%) were female, 36 patients(83.7%) with functional TR which was associated to a left valvulopathy in 31(72.4%)cases. 17 patients(39.5%) had severe TR, 19 patients(44.2%) had moderate TR and 7 patients(16.3%) had mild TR. Twelve patients(27.9%) had isolated tricuspid surgery. The most frequent TR surgery was simple annuloplasty with 27 patients (62.8%). The classic RV echocardiographic parameters at initial evaluation and three months after surgery showed the following values respectively:Mean RV basal diameter was 48.3 ± 8.0mm vs. 41.7 ± 4.7 mm(p &lt; 0.001), TAPSE was 19.0 ± 4.4mm vs. 15.7 ± 3.4mm (p &lt; 0.001), peak systolic lateral annular velocity (s") was 0.12 ± 0.11cm/s vs. 0.11± 0.14cm/s(p = 0.001), FAC was 39.2 ± 13.2% vs. 38.2 ± 11.8%(p = Not significant), end-systolic RV area was 15.8 ± 10.2cm² vs. 14.4 ± 4.0cm²(p = Not significant). Nonetheless, there had not worsening in RV function based on myocardial deformation, with no significant differences between RV GLS(-20.0 ± 5.4% vs. -19.6 ± 4.9%; p = Not significant).

Conclusions
In our sample, 3 months post-surgery, the classic echocardiographic parameters based on the translational motion of the heart showed worsening of RV function. The parameters based on myocardial deformation do not show changes in RV function post-surgery, being better indicators of RV function in recently operated patients. These differences could be explain because tricuspid surgery is focus on the annulus that affects its motion while it does not affect to the global RV myocardial function evaluated by GLS.
47 Identification of threshold values to define right chamber enlargement consistent with severe tricuspid regurgitation
Authors: Previtero M , Bottigliengo D , Guta A C , Ochoa-Jimenez R C , Figliozzi S , Palermo C , Baritussio A , Cecchetto A , Aruta P , Iliceto S , Badano L P , Muraru D 
Published: January 2020

Abstract

Background
Right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation, are listed among the supportive signs to grade severe tricuspid regurgitation (TR) according to current EACVI and ESC guidelines. However, at present, there is no cut-off value to define RV, RA and TA dilatation associated to severe TR.

Purpose
Accordingly, we sought to identify the threshold values of RV, RA and TA size associated to severe TR.

Methods
302 patients (59 ± 13 years, 54 % women) with functional TR underwent three- (3D) and two-dimensional (2D) echocardiography to obtain: 3D RV end diastolic volume (RVEDVi) indexed for body surface area (BSA), 3D RV end systolic volume indexed for BSA (RVESVi), 3D RA max volume indexed for BSA (3DRAi), 2D RA systolic volume indexed for BSA (3DRAi), 2D RV basal diameter (2DRVd), 2D RV basal diameter indexed for BSA (2DRVdi), 2D TA measured in the apical 4-chamber view and 2D TA measured in the apical 4-chamber view indexed for BSA. To identify the threshold values of the parameters that discriminate patients with right chamber enlargement associated to severe TR, we selected the probability which returns the best sum of sensitivity and specificity on the ROC curve of the model.

Results
According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. As shown in Figure, 3DRAi &gt; 45 ml/m2 and 2DRAi &gt; 45 ml/m2 identified patients with RA enlargement associated to severe TR. RVEDVi and RVESVi did not show any predictive value for severe TR. Conversely, 2DRVd &gt; 52 mm (or &gt;30 mm/m2) was associated to severe TR. 2DTA &gt; 42 mm ( or &gt;24 mm/m2) was the selected threshold value for TA dilatation.

Conclusions
Our study provided the threshold values to define the right chamber and TA dilatation associated to severe TR. Implementation of those values in current guidelines can help clinicians to improve their accuracy to identify patients with severe TR.
Abstract 47 Figure.
104 Left ventricular stroke volume differences among echocardiographic methods in healthy adults from the World Alliance of Societies of Echocardiography (WASE) Normal Values Study
Authors: Miyoshi T , Addetia K , Blitz A , Lang R , Asch F 
Published: January 2020

Abstract

Funding Acknowledgements
WASE Normal Values Study is sponsored by American Society Echocardiography Foundation.

OnBehalf
the WASE Investigators

Background
Left ventricular (LV) stroke volume (SV) can be determined by multiple ultrasound methods, including Doppler, two- (2D) and three-dimensional (3D) echocardiography. However, how methods compare to each other is not well understood. In this report from the WASE study, we aim to examine and compare normal reference ranges for SV and SV index (SVI) obtained from healthy adults by Doppler, 2D Simpson’s and 3D methods.

Methods
WASE Normal Values Study is a multinational, observational, cross-sectional study. Individuals free from known cardiac, lung and renal disease were prospectively enrolled with even distribution among age groups and gender. Doppler, 2D and 3D datasets were acquired at the enrolling centers, following a standardized protocol. LV SV was measured by three methods: Doppler (LV outflow tract diameter and velocity time integral), 2D biplane Simpson’s rule and 3D volume method. SV was indexed by body surface area (SVI). All measurements were analyzed (TOMTEC) in two core laboratories (for 2D and 3D) following ASE Guidelines. Methods were compared by Friedman test and Bland-Altman analysis.

Results
As of May 2019, 646 cases have been analyzed in both 2D and 3D datasets. In this population, age was 45 ± 16 years old (range 18-85) and body surface area was 1.76 ± 0.22 m² (range 0.95-2.44). LV EF by 2D Simpson’s rule and 3D method were 63.2 ± 2.9 and 62.3 ± 5.0 %, respectively (p &lt; 0.0001, Wilcoxon test). SVI by Doppler, 2D and 3D were 39.6 ± 7.6, 33.8 ± 6.5 and 41.0 ± 9.4 ml/m², respectively. There were significant differences between the three methods (p &lt; 0.0001, Friedman test). 2D underestimated SVI compared to Doppler by 14.6% (mean of differences 5.8 ml/m², p &lt; 0.0001) and 3D by 17.6% (7.2 ml/m², p &lt; 0.001). The difference between Doppler and 3D was smaller (3.4% lower by Doppler) but still statistically significant (1.4 ml/m², p = 0.0008). The results are shown in the figure.

Conclusions
Comparing 3 modalities in a large population of healthy individuals, SV and SVI are underestimated by 2D Simpson’s method. Given the large differences, combining 2D and Doppler or 3D measurements for hemodynamic calculations (such as regurgitant volumes and fraction) should be done with caution.
Abstract 104 Figure.
106 Mitral annulus calcification: potential indicator of vascular disease and higher thromboembolic risk
Authors: Radu S , Al Shurbaji S , Mircea G , Ouatu A , Tanase D M , Floria M 
Published: January 2020

Abstract

Background
In CHA2DS2-VASc thromboembolic risk score, vascular diseases (V) include either prior myocardial infarction, peripheral arterial disease or aortic plaque, summarizing the patient’s atherosclerotic burden. Despite this, thromboembolic risk scores used in atrial fibrillation (AF) patients do not include mitral annular calcification (MAC) as a potential indicator of vascular disease.

Purpose
This case-control study retrospectively assessed the relationship between MAC and thromboembolic risk scores (CHADS2 and CHA2DS2-VASc) in non-valvular AF patients (paroxysmal and non-paroxysmal).

Methods
We compared thromboembolic risk scores value, clinical and transthoracic echocardiographic data in AF patients with and without MAC. The presence and severity of MAC was assessed in parasternal short axis and apical four chamber views. It was qualitatively defined as either mild, moderate or severe based on echodensity and extension in mitral annulus ring. MAC of &gt; 4mm thickness was also considered severe.

Results
We included 103 patients: mean age 72.6 ± 9.9 years, 44.7% male, 83.5% hypertensive, 30.1% diabetic, 79.6% with heart failure, 40.8% were in atrial fibrillation and 7.8% had a history of stroke/transient ischemic stroke. We identified MAC in 50.5% patients: 15.7% severe, 50.3% moderate, 34% mild. Mean CHADS2 and CHA2DS2-VASc were 2,56 ± 1.213 and 4.57 ± 1.61, respectively. In MAC patients, both scores tended to increase with a mean of 2,88 ± 1,114, p = 0.003 and 5,211 ± 1,51, p &lt; 0.001 as compared with control (2,23 ± 1,06 and 3,92 ± 1,46), respectively. The presence of MAC was a risk factor for vascular disease (OR = 2,47, χ2 = 34,32, p &lt; 0,001). Moreover, the AUC for CHA2DS2-VASc, CHADS2, and MAC was 0.73 (95% CI, 0.63-0.82) and 0.65 (95% CI, 0.54-0.75), respectively. Both scores showed higher AUC in women: 0.79 (95% CI, 0.67-0.91) for CHA2DS2-VASc and 0.68 (95% CI, 0.54-0.82) for CHADS2. Left ventricular ejection fraction (LVEF) negatively correlated with the presence of MAC (r=-0.254, p = 0.01). Sinus rhythm patients with MAC showed significantly decreased LVEF as compared to those without MAC (55.73 ± 12.3% vs 46.96 ± 14.5 %, p = 0.013). The difference was not significant in AF patients (46.83 ± 10.6% vs 45.92 ± 11.59, p= 0.79).

Conclusion
The presence of MAC, irrespective of severity, correlates very well with both vascular disease and thromboembolic risk scores. Therefore, we consider that MAC might be a potential indicator of vascular disease and of higher thromboembolic risk. This study raises the question whether inclusion of MAC in thromboembolic risk scores as an indicator of vascular disease (V) might increase their predictive value.
158 Myocardial work exposes afterload-dependent changes in strain
Authors: Sletten O J , Aalen J , Khan F H , Larsen C K , Inoue K , Remme E W , Hisdal J , Smiseth O A , Skulstad H 
Published: January 2020

Abstract

Funding Acknowledgements
Norwegian Health Association

Background
Global longitudinal strain (GLS) is used for detection of subclinical left ventricular (LV) dysfunction, for example when screening for chemotherapy-induced cardiotoxicity. A relative percentage reduction in GLS ≥8% is considered abnormal. However, as GLS is load-dependent, modest increases in afterload can potentially prove sufficient to cause clinical implication. In contrast, global myocardial work (GMW) which incorporates afterload, may be more accurate in detecting LV-dysfunction.

Purpose
We investigated the effect of increased afterload on GLS, and if GMW may be a more accurate parameter of myocardial function during increased afterload.

Methods
In 20 healthy individuals (age 49 ± 11 years (mean ± SD), 10 men), blood pressure was increased by a 3 minute arithmetic mental stress test. GLS was measured by speckle tracking echocardiography and LV ejection fraction (EF) by biplane Simpson. GMW was calculated from LV pressure-strain analysis using a non-invasive estimate for LV pressure (LVP).

Results
During the afterload-elevation, systolic blood pressure increased by 25 ± 16 mmHg (p &lt; 0.01), and heart rate by 16 ± 13 bpm (p &lt; 0.01). This was followed by a decrease in EF from 62 ± 5 to 59 ± 5% (p &lt; 0.01) and GLS from 21.9 ± 2.2 to 20.8 ± 2.0% (p &lt; 0.01). In contrast, GMW increased from 2052 ± 278 to 2382 ± 388 mmHg·% (p &lt; 0.01). In 5 of 20 (25%) individuals, the relative percentage reduction of GLS was &gt;8%, despite an increase in GMW. The figure shows an individual example during rest and afterload-elevation, where an increase in systolic blood pressure of 16 mmHg was associated with a 9% relative percentage reduction in GLS, but a small increase in GMW as illustrated by the loop areas.

Conclusions
This study demonstrated that a modest increase in afterload can result in significant reduction in GLS, that may lead to overdiagnosis of LV-dysfunction. GMW did not decrease, suggesting it has a better specificity in patients at risk for subclinical LV dysfunction. Future studies should investigate if GMW is more accurate than strain in detecting LV-dysfunction.
Abstract 158 Figure.
P182 Bleeding complications in a rendu-osler-weber syndrome patient with atrial fibrillation - challenging serial transoesophageal echocardiography
Authors: Branco Mano T , Moura Branco L , Ramos R , Fiarresga A , Timoteo A T , Galrinho A , Abreu J , Castro L , Duarte Silva N , Ilhao Moreira R , Valentim Goncalves A , Cruz Ferreira R 
Published: January 2020

Abstract
Rendu-Osler-Weber (ROW) syndrome or hereditary hemorrhagic telangiectasia is a rare autossomic dominant disease characterized by vascular dysplasia involving multiple systems and associated with an increased bleeding risk. The presence of atrial fibrillation in this population becomes a challenge, regarding the evaluation of bleeding and thrombotic risks and the best approach for the patient management.
A 72 years-old female with ROW syndrome, atrial fibrillation and a CHA2DS2-VASc risk score of four, was admitted to our hospital for left atrial appendage (LAA) closure after a period of novel oral anticoagulation crowed with multiple haemorrhagic events and blood transfusions. After the implantation of a Watchman LAA number 33 closure device (Image 1A), and because of the concomitant diagnose of chronic pulmonary embolism, she was restarted on anticoagulation therapy in lower doses, with initial tolerance. For evaluation of LAA closure device during follow-up, after an unsuccessful attempt of transoesophageal echocardiography (TEE) because of severe epistaxis subsequent to oropharyngeal anaesthesia, the patient underwent a Cardiac Computed Tomography (CT) that showed a moderate peri-device leak (4.4x11mm, 0.73cm2) – (Image 1B). For better characterization, the patient underwent a new attempt of TEE with the support of an anaesthesiologist and the need of local vasoconstrictor agents and tranexamic acid for epistaxis and oropharyngeal bleeding control. TEE confirmed a moderate posterior device-leak (7.1mm) with absence of cavitary thrombus (Image 1C). After a year of anticoagulation with new significant bleeding events, TEE was repeated with the anaesthetic and pharmacologic preparation. This TEE showed a decrease in peri-device leak (&lt;5mm wide – Image 1D), which was fundamental for supporting the multidisciplinary team decision of interruption of anticoagulation therapy. With this case we want to highlight the challenging decisions regarding patients with ROW syndrome and atrial fibrillation. Specifically, we must be alert about possible complications in trying to perform TEE in this population, once the frequent occurrence of telangiectasias in the oropharynges that may occur, as in this patient.
Abstract P182 Figure. Image 1