bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1480Left atrial strain improves estimation of left ventricular filling pressure
Authors: Khan F H , Andersen O S , Gude E , Skulstad H , Smiseth O A , Remme E W 
Published: October 2019

Abstract

Background
The current algorithm in the 2016 recommendations for echocardiographic estimation of left ventricular filling pressure (LVFP) as normal or elevated, combines traditional indices of mitral inflow velocities, tissue Doppler, left atrial volume and tricuspid regurgitation velocity (Figure A). Some of the patients remain unclassified by this algorithm. Left atrial (LA) strain is a novel index that correlates well with LVFP and may improve estimation of LVFP in these patients.

Purpose
We tested if LA strain can improve estimation of LVFP for the patients that are unclassified by the 2016 algorithm.

Methods
We analyzed data from 100 patients who were referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed simultaneously with or within 24 hours of right heart catheterization. Pulmonary capillary wedge pressure (PCWP) was used as an estimate for LVFP and defined as elevated if above 12 mmHg. Elevated LVFP was first estimated using the 2016 algorithm. In patients who were unclassified by the algorithm due to conflicting indices or unattainable indices, LA strain was subsequently used to detect elevated LVFP using a cut-off found from ROC analysis of the whole cohort.

Results
Six patients were unclassified by the 2016 algorithm. The ROC analysis of all 100 patients showed that at an LA strain cut-off of above or below 16.2%, LVFP was correctly classified as normal or elevated, respectively, with a sensitivity of 83% and specificity of 88%. All 6 unclassified patients by the 2016 algorithm were correctly classified using the LA strain cut-off, effectively increasing the accuracy of the algorithm by 6 percentage points.

Conclusions
LA strain may have a role in non-invasive estimation of LVFP, particularly in patients who remain unclassified when using the conventional echocardiographic indices.

Acknowledgement/Funding
South-Eastern Norway Regional Health Authority
P1481B-lines and left atrial strain in outpatients with suspected heart failure with preserved ejection fraction
Authors: Agoston G , Gargani L , Szabo I , Illes B , Varga A 
Published: October 2019

Abstract

Background
Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing healthcare burden and its prevalence is increasing. Diagnosing HFpEF is challenging. Lung ultrasound (LUS) and left atrial strain are promising tools to assess pulmonary congestion and left atrial dysfunction in outpatient settings in patients with suspected HFpEF.

Aim
To evaluate the correlation of LUS B-lines with left atrial strain in patients with HFpEF.

Methods
Thirty-six consecutive patients (24 women, mean age 70±6 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction <55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-PALS), lung ultrasound assessment of B-lines on the antero-lateral and posterior chest wall, and NT-proBNP levels.

Results
The mean ejection fraction was 65.5±8.6%. In 28 patients (85%) a significant number of B-lines (≥15) was observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p<0.0001, r: 0.76, Figure 1.), left atrial volume (p<0.05, r: 0.45), and PALS (p<0.05, r: −0.5, Figure 2.). We didn't found any correlation between the number of B-lines and E/e'ratio (p=0.1, r: 0.28), or between E/e' ratio and NT-proBNP level (p=0.2, r: 0.2).

Conclusion
LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it seems to better characterize these patients. B-lines correlate well with NT-proBNP values and with parameters of left atrial dysfunction. PALS is a promising too which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameter E/e'.
P1487The additive effect of diastolic dysfunction and renal insufficiency on mortality in patients undergoing coronary angiography
Authors: Teodorovich N , Fabrikant Y , Jonas M , Gandelman G , George J , Swissa M , Shimoni S 
Published: October 2019

Abstract

Background
Coronary artery disease (CAD) is the leading cause of diastolic dysfunction. Diastolic dysfunction is associated with adverse outcomes. Renal insufficiency is also associated with adverse outcomes in CAD patients. The interaction between diastolic dysfunction and renal insufficiency is not completely elucidated.

Aims
We evaluated the prognostic value of diastolic function assessed by echocardiography in patients with and without renal failure undergoing coronary angiography.

Patients and methods
An observational prospective study of 547 consecutive patients undergoing coronary angiography. The median follow up was 30 months. Significant diastolic dysfunction was defined as elevated LV filling pressure with e/e'>12. Renal insufficiency was defined as adjusted GFR<60 ml/min. One hundred seventy-nine patients (32.7%) had significant diastolic dysfunction and 259 (47.3%) had renal insufficiency. Patients were categorized into 4 groups according to the presence of both significant diastolic dysfunction and renal insufficiency (Table 1).

Results
Significant diastolic dysfunction and renal insufficiency had additive effect on mortality (Table 1). A significant association was observed between diastolic dysfunction and mortality in patients with and without renal insufficiency (p<0.0001 & p=0.005, respectively). The presence of either diastolic dysfunction or renal insufficiency was associated with mortality (Figure 1), with the combination of both leading to the highest mortality (p<0.0001). In Cox regression model which combined diastolic dysfunction, presence of AF, LVEF, obstructive coronary disease on angiography, presence of acute coronary syndrome and renal insufficiency, both elevated filling pressure and renal insufficiency were independently associated with higher mortality (HR 2.65, CI 1.65–4.24, p<0.001 and HR 2.92, CI 1.72–4.98, p<0.0001, respectively).
Table 1. Patients divided into 4 groups according to the presence of the significant diastolic dysfunction and renal insufficiency Patients' group N (%) Mortality Normal LV filling pressure / Normal renal function 230 (42.0%) 4.8% Elevated LV filling pressure / Normal renal function 58 (10.6%) 15.5% Normal LV filling pressure / Renal insufficiency 138 (25.2%) 15.9% Elevated LV filling pressure / Renal insufficiency 121 (22.1%) 38.8% P<0.0001 in Pearson Chi-Square.
Fugure 1

Conclusions
In patients undergoing coronary angiography, significant diastolic dysfunction with elevated filling pressure is associated with mortality in patients both with and without renal insufficiency. Both significant diastolic dysfunction and renal insufficiency are independent predictors of mortality.
P14893D strain echocardiography in assessing left ventricular diastolic dysfunction
Authors: Ozer H T , Ozer O , Coteli C , Kivrak A , Sahiner M L , Ozer N 
Published: October 2019

Abstract

Background
Diastolic dysfunction is an important factor in the development of heart failure with preserved ejection fraction (HFpEF). As the ejection fraction is preserved in HFpEF, the diagnosis of this disease with non-invasive methods is difficult.

Purpose
In this study, the relationship of BNP, NT-proBNP, Ghrelin, and echocardiographic 3D strain findings with diastolic dysfunction was investigated in patients undergoing left heart catheterization.

Methods
Our study is a cross-sectional study and included 78 patients in whom echocardiography was performed, and who underwent left heart catheterization based on relevant indications. The patient data recorded for evaluation included the findings from left heart catheterization, follow-up 3D echocardiography; and the levels of blood NT-proBNP, and Ghrelin.

Results
The rate of diastolic dysfunction was 42.3%. Longitudinal 2D and 3D mean strain as absolute values were observed to decrease more in patients with diastolic dysfunction. The median levels of BNP, NT-proBNP, and Ghrelin levels were higher in patients with diastolic dysfunction. The independent predictors of diastolic dysfunction were determined to be the left atrial volume index (LAVI) (OR=1.17; p=0.018), longitudinal 3D strain values (OR=1.88; p<0.001), NT-proBNP (OR=1.11; p=0.001), and Ghrelin (OR=1.40; p=0.001), respectively.
Relationship Between LV EDP and LV Longitudinal Strain LV EDP 2D Strain 3D Strain r p r p r p BNP, pg/ml 0.429 <0.001* 0.115 0.316 0.178 0.118 NT-proBNP, pg/ml 0.484 <0.001* 0.155 0.177 0.186 0.104 Ghrelin, pg/ml 0.478 <0.001* 0.086 0.455 0.157 0.169 SolV DB – – 0.481 <0.001* 0.591 <0.001* dP/dT −0.389 <0.001* −0.283 0.012* −0.307 0.006* Negative dP/dT −0.747 <0.001* −0.337 0.003* −0.458 <0.001* 2D. % 0.481 <0.001* – – 0.852 <0.001* 3D. % 0.591 <0.001* 0.852 <0.001* – – If p value is less than 0.05 shows statistical significance.
Measurement of longitudinal strain

Conclusion
In conclusion, our study found out that the reduced 3D strain absolute values and increased levels of NT-proBNP and Ghrelin biomarkers predicted diastolic dysfunction. If further large-scale studies prove the efficiency of these practical, they may not only allow for making a diagnosis of HFpEF more readily but may also eliminate the confusion in diagnostic algorithms.

Acknowledgement/Funding
None
P1492Is early repolarization pattern only an ion channel disease?
Authors: Colluoglu T , Onalan O , Cakan F 
Published: October 2019

Abstract

Background
Early repolarization pattern (ERP) has been generally described as a benign electrocardiographic (ECG) sign despite it is associated with the development of malign ventricular arrhythmias. Although the pathophysiological mechanism of malign ventricular arrhythmias in ERP has been explained only electrophysiologically, whether the presence of structural changes in myocardium has not been known yet.

Purpose
We hypothesized that ERP is not only an ion channel disease. The structural changes in myocardium begin in individuals with ERP sign on 12 lead surface ECG even if a young person. The aim of the present study was to determine myocardial dysfunction due to early decaying in myocardial structure in individuals with ERP sign by the use of 2D- speckle tracking echocardiography (STE).

Method
We prospectively included 99 individuals who admitted to our clinic between 01.04.2018 and 01.09.2018. 48 individuals had ERP. 12 lead surface ECG was taken from all individuals at admission, all individual's ECG were further analysed for presence of ERP and ERP was divided into three groups which were defined as presence of ST elevation, J wave and QRS slurring. 2D-STE (Philips Epiq 7C Ultrasound System for Cardiology (Andover, USA)) was performed in all individuals. All strain echocardiographic recordings were further analysed off- line by the use of associated software.

Results
ERP had significantly lower left ventricular (LV) global longitudinal strain (GLS), circumferential peak systolic strain rate (CPSSr) in basal segments of LV and left ventricular ejection fraction compared to controls. In addition, LV diastolic function especially in LV basal segments were significantly impaired in individuals with ERP when assessed by circumferential peak diastolic strain rate (CPDSr) compared to controls. GCS, LV- longitudinal peak systolic Sr (LPSSr) and LV- longitudinal peak diastolic Sr (LPDSr) in all of the apical chambers were similar between two groups (Table 1). There was not a relationship between type of ERP and all of these parameters including GLS, GCS, LPSSr, CPSSr, LPDSr, CPDSr. Finally, ST elevation pattern had higher GCS value while QRS slurring pattern had higher GLS value (Figure 1).
Figure 1 and Table 1

Conclusion
Our study firstly demonstrated ERP can be combined of structural and electrical heart disease. LV-GLS can be more closely associated with ERP than LV-GCS. In addition, the either of impaired of circumferential systolic and diastolic function in LV basal segments can be detected in individuals with ERP.
P1493Prognostic significance of right ventricular function during exercise in patients with non-obstructive hypertrophic cardiomyopathy
Authors: Hirasawa K , Izumo M , Mizukoshi K , Suzuki T , Sato Y , Watanabe M , Kamijima R , Ohara H , Harada T , Akashi Y J 
Published: October 2019

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is a heterogeneous condition that may present crucial complication including life-threatening arrhythmia and sudden cardiac death. However, the risk stratification of HCM without left ventricular outflow tract (LVOT) obstruction had not been fully elucidated. Moreover, although recent studies have revealed the right ventricle (RV) involvement of HCM, the prognostic importance of RV function during exercise is unclear.

Purpose
To investigate the prognostic significance of RV function in patients with non-obstructive HCM using exercise stress echocardiography (ESE).

Methods and results
This study conducted on 100 HCM patients (age 62.9±13.6 years, 63% men) with preserved left ventricular ejection fraction who underwent ESE using semi-supine bicycle ergometer. Ten patients with significant LVOT obstruction (≥30mmHg) were excluded and 9 were also excluded because of the inadequate imaging quality or insufficiency of data. Among remaining 81 non-obstructive HCM patients, 9 patients suffered from HCM related cardiac events including cardiac death, unexpected hospitalization, life-threatening arrhythmias, and new-onset of syncope during the mean follow up period of 2.6±1.6 years. A multivariate Cox Hazard analysis revealed that low tricuspid annular plane systolic excursion during exercise (Ex-TAPSE, cut-off: 24mm) was an independent predictor of cardiac events. (hazard ratio: 18.66, 95% confidence interval: 3.66–338.46, P<0.001) The estimated cumulative cardiac event free survival using the Kaplan-Meier method was significantly lower in patients with reduced Ex-TAPSE (<24mm) than those with preserved Ex-TAPSE (Log-rank, P<0.01).
K-M curve according to Ex-TAPSE

Conclusion
Ex-TAPSE had a strong predictive value of clinical outcomes in non-obstructive HCM patients. Right ventricular function during exercise may have crucial role in the risk stratification of non-obstructive HCM.
P1495Energy loss by right ventricular pacing: normal left ventricular function vs. hypertrophic cardiomyopathy
Authors: Arakawa Y , Fukaya H , Kakizaki R , Oikawa J , Matsuura G , Kobayashi S , Shirakawa Y , Nishinarita R , Horiguchi A , Ishizue N , Nabeta T , Igarashi G , Kishihara J , Niwano S , Ako J 
Published: October 2019

Abstract

Background
Right ventricular (RV) pacing causes left ventricular (LV) dysfunction. On the other hand, RV pacing for hypertrophic obstructive cardiomyopathy (HOCM) is an established treatment. LV flow energy loss (EL) is a new hemodynamic index for assessing cardiac function. However, the impact of RV pacing on EL remains unknown.

Objective
The objective of this study was to investigate the EL by RV pacing on normal LV function and hypertrophic cardiomyopathy (HCM).

Methods
A total of 28 patients underwent echocardiography for EL assessment under AAI (without RV pacing) and DDD (with all RV pacing) mode. Among them, 16 were sick sinus syndrome (SSS) patients with normal LV function, and 12 were HCM patients. EL was calculated from color Doppler images using a vector flow mapping.

Results
There were no significant difference in patients' background parameters between the SSS and the HCM groups. In the SSS group, mean systolic EL was significantly increased from AAI to DDD mode (14.9 to 19.2 mW/m, P<0.01, Panel A), whereas diastolic EL was not changed from AAI to DDD mode (22.3 to 18.8 mW/m, P=0.12). In the HCM group, systolic mean EL was significantly decreased from AAI to DDD mode (29.9 to 22.5 mW/m, P<0.01, Panel B) irrespectively of with or without LV outflow obstruction, whereas diastolic mean EL was not changed from AAI to DDD mode (28.6 to 24.3 mW/m, P=0.47).
Change of flow energy loss

Conclusion
RV pacing increased mean systolic EL in normal LV function, but decreased in HCM with or without LV outflow obstruction. In the patients with HCM, the impact of RV pacing on EL is different compared with normal LV function.
P1509The novel application of speckle tracking during dobutamine stress echo for assessment of coronary artery diseases
Authors: Sen N , Tanwar S , Jain A , Kalra B , Mehta A 
Published: October 2019

Abstract

Background
Major cause of death across the world is coronary artery disease. The choice of treatment strategy should be primarily based on the hemodynamic significance of coronary artery stenosis. Two-dimensional speckle tracking provides valuable information for regional wall motion abnormalities. The purpose of this study was to determine the diagnostic value of left ventricular longitudinal strain and torsion to diagnose coronary artery disease during dobutamine stress echocardiography.

Purpose
The purpose of this study was to evaluate the diagnostic value of speckle tracking imaging-derived myocardial deformation parameters at rest and during dobutamine stress to determine the hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of CAD.

Methods
We studied 204 patients (mean age 54.2±9.8 years, 128 male and 76 female) with known or suspected coronary artery disease, excluding those with prior history of transmural infarction. All of them underwent dobutamine stress echo and coronary angiography within one month. Wall-motion score index, left ventricular global longitudinal strain and torsion were measured at rest and peak stress. Optimal cut-offs were derived from receiver operating characteristic curves for strain and torsion values. Additionally, the respective differences between rest and stress were also calculated.

Results
During dobutamine stress echocardiography we revealed mean left ventricular ejection fraction was 53±6.2%. Coronary angiography revealed significant stenotic lesions in 124 patients (60.7%). Values regarding sensitivity, and specificity for wall motion score index difference were 76% and 84% respectively (area under curve 0.84). Global longitudinal strain difference (median 0.6%) illustrated 83% sensitivity and 74% specificity for disease detection (area under curve 0.82, cut-off value ≤0.5%). The respective values for torsion difference (median 5.1°) were 84% and 79% (area under curve 0.80, cut-off value ≤5.9°). Combination of wall motion score index difference and torsion difference for disease detection showed 89% sensitivity and 77% specificity (area under curve 0.84).

Conclusions
Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD. The implementation of speckle tracking during dobutamine stress echo could serve as an adjunct method for coronary artery disease assessment, providing quantitative diagnostic information.
P1510Values of left ventricular area strain during 4D-strain-stress echocardiography with adenosine triphosphate in healthy subjects
Authors: Nelassov N , Morgunov M , Doltmurzieva N , Sidorov R , Arzumanjan E , Eroshenko O , Safonov D , Kreneva E , Zatonsky S 
Published: October 2019

Abstract

Background
Use of adenosine triphosphate (ATP) instead of adenosine in stress echocardiography is more cost-effective. Earlier we have proposed new ATP stress echocardiography algorithm (Figure). This modified algorithm includes 1) stepwise increase in dose of ATP in the absence of signs of adequate vasodilation (decrease in systolic blood pressure and increase in heart rate), 2) triple registration of echocardiographic data sets (before ATP infusion, during phase of adequate vasodilation and 5 minutes after the termination of ATP infusion).

Purpose
In this study we aimed to a) assess the safety of ATP high doses infusion algorithm, b) determine the values of left ventricular (LV) systolic global and segmental area strain (AS) during 4D-strain-stress echocardiography with ATP in healthy volunteers.

Material and methods
13 healthy subjects (male 9, mean age 35.3±11.0 years) underwent ATP LV 4D strain-stress-echocardiography (Vivid E95, AFI technology). Mean values of global and regional (16 segments model) AS were determined.

Results
4 subjects appeared to be “non responders” to initial dose of ATP 140 μg/kg/min. In three subjects it was necessary to increase the dose of ATP to 175 and in one to 210 μg/kg/min in order to achieve adequate vasodilation. No major side effects of ATP infusion (complete heart block, bronchospasm, myocardial infarction) were registered and no aminophylline injections were required. In all cases interpretable 4D LV Echo data sets for automatic strain analysis were obtained. Mean values of global systolic AS in healthy individuals before, at time and after ATP infusion were −25.8±4.8, −27.2±4.4 and −25.7±4.8%, respectively. Mean values of systolic AS in each of 16 segments were also calculated (Table).
LV segment AS before ATP (%) AS ATP infusion (%) AS after ATP (%) LV segment AS before ATP (%) AS ATP infusion (%) AS after ATP (%) 1 −29.6±11.3 −31.2±11.1 −28.6±8.3 9 −27.8±6.5 −29.3±6.8 −30.8±6.0 2 −26.6±8.5 −28.2±4.9 −26.2±7.3 10 −26.1±5.2 −274±5.5 −25.8±6.0 3 −25.6±6.8 −29.6±5.2 −27.2±7.2 11 −25.3±6.1 −26.1±7.5 −24.9±5.3 4 −26.2±7.2 −24.9±9.1 −25.2±6.7 12 −28.1±7.3 −28.5±6.1 −25.3±5.6 5 −26.5±6.8 −29.3±10.9 −24.3±7.7 13 −22.9±6.5 −23.4±6.5 −23.2±6.4 6 −25.2±6.7 −26.0±7.9 −25.5±7.0 14 −25.7±7.6 −28.5±6.0 −26.2±6.8 7 −24.8±7.3 −25.6±6.1 −22.8±6.0 15 −26.5±6.5 −29.8±6.0 −28.5±5.5 8 −25.8±6.6 −26.5±5.6 −25.8±5.5 16 −24.2±7.1 −25.4±6.2 −25.1±6.6

Conclusions
4D strain-stress-echocardiography ATP infusion algorithm is safe and well tolerated by patients. Values of LV systolic global and segmental AS in healthy subjects were determined.