bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1371 The effect of ideal BSA in patients with low-flow, low-gradient severe aortic stenosis
Authors: Matangi M , Cases M , Zhu T , Jurt U , Brouillard D 
Published: January 2020

Abstract

INTRODUCTION
The current obesity epidemic has an impact on calculated BSA, significantly increasing the calculated BSA from what the ideal BSA would be if based on a patient’s ideal body weight.

PURPOSE
To determine the effect of ideal BSA on AV area index in patients with low-flow, low-gradient severe aortic stenosis and normal left ventricular function.

METHODS
Our ECHO database was searched for all patients with an LVEF &gt;50%, a mean aortic gradient of &lt;40 mmHg, an AV area &lt;1.00cm2, AVA index &lt;0.60cm2/m2 and SV index &lt;35ml/m2. Patients with atrial fibrillation, mechanical and bioprosthetic valves, any valve repair, HOCM, Amyloidosis, more than mild aortic regurgitation, moderate mitral regurgitation, any wall motion abnormality despite normal LVEF, Pacemaker or ICD or a moderate pericardial effusion were excluded. Ideal weight was calculated using the Devine formula = Constant + 2.3 x [height in inches-60], where constant= 50Kg in males and 45.5Kg in females). Body surface area in m2 was calculated using the formula = [√ (height in cm x weight in kg)/3600]. The paired t-test was used to determine differences between means and the Fisher’s exact test was used to determine differences between proportions. A p value of &lt;0.05 was considered significant.

RESULTS
There were 73 females (mean age 76.2 ± 11.3 years, mean AV gradient 27.2 ± 7.4 mmHg, mean AVA 0.82 ± 0.11 cm2 and mean LVEF of 64.9 ± 5.4%) and 55 males (mean age 76.1 ± 9.8 years, mean AV gradient 29.9 ± 7.2 mmHg, mean AVA 0.85 ± 0.11 cm2and mean LVEF of 62.2 ± 5.7%). Other important variables are seen in table 1. Based on the corrected ideal BSA there were 0 of 55 male patients who were re-assigned to the moderate AS category, compared to 25 of 73 (34.2%) female patients (P &lt; 0.0001, Fisher’s exact test).

CONCLUSIONS
Use of the corrected ideal BSA has no effect on the hemodynamic diagnosis of low-flow, low gradient, normal LVEF severe aortic stenosis in males, but has a significant effect of the same diagnosis in females. It is therefore recommended that ideal body weight and ideal BSA be used when calculating AVA index in female patients suspected of low-flow, low-gradient severe aortic stenosis with normal ventricular function.
Weight(M) Weight(F) BSA(M) BSA(F) AVAI(M) AVAI(F) SVI(M) SVI(F) Actual 82.6 ± 12.5 70.1 ± 13.5 1.95 ± 0.15 1.71 ± 0.16 0.44 ± 0.06 0.48 ± 0.07 25.9 ± 4.9 23.9 ± 5.1 Ideal 67.5 ± 6.8 49.7 ± 5.4 1.79 ± 0.13 1.47 ± 0.11 0.48 ± 0.07 0.56 ± 0.08 28.3 ± 5.5 27.7 ± 6.3 P value &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 (M)=male, (F)=female, weight in kg, BSA in m2, AVAI in cm2/m2, SVI in ml/m2.
P1390 Myocardial work indices in the assessment of the systolic function of the left ventricle in amateur half marathon runners
Authors: Dankowski R , Szalek A , Tschurl J , Sacharczuk W , Baszko A , Woznicka-Leskiewicz L , Posadzy-Malaczynska A , Szyszka A 
Published: January 2020

Abstract

Background
Myocardial work (MW) has been recently introduced as a tool for non-invasive assessment of left ventricular (LV) systolic function. It is based on myocardial strain analysis but incorporates also data regarding loading conditions, which is potential advantage of this technique.

Purpose
We south to evaluate the impact of a three-month training before the half-marathon on cardiac function using indices of MW.

Methods
The study included 28 young amateur runners (11 women, mean age 32 years). None of the participants had a prior history of cardiovascular disease. The group was assessed at the beginning of training period, after three month (within 48 hours before half-marathon), and within 72 hours after the run. We collected clinical, laboratory and echocardiographic data. All participants underwent echocardiography to assess myocardial mechanics and MW indices using speckle-tracking technique.

Results
23 participants completed the training and all of them finished the race. After the training period we observed significant increase in LV end-diastolic diameter only (49,9 ± 0,94 mm vs 51,6 ± 0,9 mm, p= 0,007) with no significant change after the run. There were no changes in global longitudinal strain (GLS), global work index (GWI) global wasted work (GWW) neither after the training period nor after the run. We observed significant changes suggesting myocardial injury after the race, including slight increase of NT-proBNP and troponin levels, increase in left atrial volume index, and reduction of tissue Doppler lateral e` wave. Global constructive work (GCW) decreased significantly after the training period, with no change after the run (2122,0 ± 299,4 vs 1929,0 ± 227 vs 1986,5 ± 295,7 mmHg%; start of the training vs before the run assessment vs after the run assessment, respectively; p = 0,005). GCW was correlated significantly with systolic blood pressure, which decreased also significantly after the training period.

Conclusion
Three-months training before the participation in half-marathon run was not associated with significant changes in myocardial work indices except the global constructive work, which could be related to decrease of loading conditions. Despite the signs of myocardial injury there was no deterioration in myocardial mechanics parameters, which may indicate the beneficial effects of training before the half-marathon run.
P1397 Rehabilitation in pulmonary arterial hypertension: REHAB-HTP
Authors: Missana A , Azzolini Jacquin M , Baudouy D , Sanfiorenzo C , Leroy S , Sermesant M , Ferrari E , Moceri P 
Published: January 2020

Abstract

BACKGROUND
Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients.
PURPOSE
To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio-pulmonary exercise test.
METHODS
We prospectively included 12 clinically stable PAH patients over a 6 months period. Exercise stress echocardiography (ESE), cardio-pulmonary exercise test (CPET), SF-12 quality of life health survey, 6 minute walking test distance (6MWD), BNP and clinical assessment were performed before and after cardio-pulmonary rehabilitation. Patients underwent 8 weeks of exercise training (3 times a week of aerobic training and at home daily prescribed exercises).
RESULTS
All patients underwent ESE and CPET without any complication. 6 patients experienced a reduction in WHO functional class whereas 6 remained stable. Patients significantly improved their physical quality of life (p = 0.006). They also improved their exercise capacity according to maximum workload during CPET (p = 0.008) and CPET duration (p = 0.001) whereas a trend toward an improved 6MWD was observed (+58m, p = 0.10). Anaerobic threshold and peak VO2 (+1.7 ± 2.7 mL/kg/min) improved significantly (p = 0.01 and 0.03). Regarding imaging data, at rest peak strain improved after rehabilitation (p = 0.05) whereas the RV became more dilated. RV contractile reserve, defined by the change in peak systolic longitudinal RV strain between rest and maximum exercise, significantly improved (-3.9 ± 4.7%, p = 0.03)

CONCLUSION
In this preliminary study, cardio-pulmonary rehabilitation led to an improved quality of life and exercise capacity in PAH. The increased in RV contractile reserve post-rehabilitation might explain, in association with the peripheral muscular effects of exercise training, the clinical benefits of rehabilitation in PAH.
Abstract P1397 Figure. echography peak/rest in a PAH patient
P1403 Prognostic value of B-lines during stress lung ultrasound
Authors: Coviello K , Scali M C , Zagatina A , Zhuravskaya N , Cortigiani L , Gaibazzi N , Borguezan Daros C , Wierzbowska-Drabik K , Kasprzak J D , Djordjevic-Dikic A , Simova I , Morrone D , Lattanzi F , Ciampi Q , Picano E 
Published: January 2020

Abstract

OnBehalf
Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging

Background
B-lines (also known as comets) by lung ultrasound (LUS) are a marker of pulmonary congestion and interstitial pulmonary edema during stress echocardiography (SE).

Aim
To assess the prognostic value of B-lines during SE.

Methods
We prospectively performed transthoracic echocardiography (TTE) and LUS (4-site simplified scan) evaluation at rest and peak stress in 1437 patients (age 63 ± 11 years; 874 males, 61%) referred for exercise (n = 581), vasodilator (n = 819: dipyridamole, n= 809 and adenosine, n= 10) or dobutamine (n = 37) SE for known or suspected coronary artery disease or heart failure. B-lines were assessed by LUS with a 4-site simplified scan (total score from 0-1, dry lung, to 40, alveolar pulmonary edema). Follow-up (median 16 months) was completed in all.

Results
B-lines were 1.14 [0-35] at rest and increased during stress (2.10 [0-40], p&lt;.001). At individual patient analysis, B-lines appeared de novo/increased (≥2 points) during stress in 306 (21.3%), remained absent or fixed in 1097 (76.3%) and decreased/disappeared in 34 (2.4%). At follow-up, there were 174 events: 17 deaths, 14 non-fatal myocardial infarctions, 51 hospital admissions for acute heart failures, and 92 late (&gt; 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced regional wall motion abnormalities (Hazard Ratio, HR, 2.842, 95% Confidence Intervals, CI: 2.016-4.005, p&lt;.0.001) and B-lines change during stress (HR 1.471, 95% CI: 1.054-2.052, p=.022) were independent predictors. Kaplan-Meier curves showed progressively worsening event-free survival for 943 pts with absent (score 0-1), 333 with mild (2-5), 90 with moderate (6-10) and 71 with severe (&gt;10) B-lines at peak stress: see figure.

Conclusion
B-lines by LUS are a useful adjunct to regional wall motion abnormalities for risk stratification during SE. The presence and number of B-lines during stress allow a titration of risk. The outcome is darker with more comets in the SE sky.
Abstract P1403 Figure. Survival curves and peak stress B-lines
P1408 Age and gender dependency of left ventricular and left atrial volume ratio assessed by three-dimensional echocardiography
Authors: Takeuchi M , Otani K , Kitano T , Nabeshima Y 
Published: January 2020

Abstract

Funding Acknowledgements
Dr. Takeuchi was supported by a Grant-in-aid for Scientific Research (19K12853) from the Japanese Society of Promotion of Science.

Background
Left ventricular (LV) and left atrial (LA) volumes may change according to advanced aging. Since both chambers affect each other, their ratio, LV and LA volume ratio (LVLAVR) may sensitively detect age- and gender-related change in left chamber volume and function.

Purpose
We aimed to (1) investigate age and gender dependency of LVLAVR and (2) determine reference values.

Methods
We simultaneously obtained both LV and LA volume curves using 3D echocardiography with novel speckle tracking software (4D LV analysis v.3 LA, TomTec Imaging systems), and generated LVLAVR curve throughout one cardiac cycle, from which we measured LVLAVR at end-diastole (ED) and at end-systole (ES) in 313 healthy subjects (age, 20-85 years; 51% men).

Results
The mean values of LVLAVR at ED and ES in male subjects were 5.74 ± 1.54 and 1.37 ± 0.35, respectively. Corresponding values in female subjects were significantly lower (5.20 ± 1.47, p = 0.003 and 1.13 ± 0.29, p &lt; 0.001) than those in male subjects. Their age and gender dependency are shown in table. LVLAVR at ED step wisely decreased to advanced aging, and had a highest F ratio compared with other left chamber volumetric parameters in both gender.

Conclusions
We proposed new index, LVLAVR which is a sensitive parameter to reflect age- and gender-related change in LV and LA volumes. Further studies should be required to validate clinical utility of this index over traditional volumetric parameters.
Male subjects (n = 160) 3rd decade (n = 35) 4th decade (n = 34) 5th decade (n = 34) 6th decade (n = 21) 7th decade (n = 24) F ratio p-value LVEDVI (ml/m2) 81 ± 12 72 ± 11 75 ± 14 71 ± 11 68 ± 12 4.22 0.003 LVESVI 38 ± 7 33 ± 6 35 ± 8 34 ± 5 32 ± 6 2.93 0.023 Maximum LAVI 25 ± 5 25 ± 4 27 ± 5 26 ± 6 30 ± 8 4.07 0.004 Minimum LAVI 12 ± 3 12 ± 3 14 ± 3 14 ± 3 18 ± 6 12.23 &lt;0.001 LVLAVR at ED 6.80 ± 1.54 6.36 ± 1.31 5.42 ± 1.00 5.23 ± 1.37 3.97 ± 0.85 19.72 &lt;0.001 LVLAVR at es 1.53 ± 0.42 1.39 ± 0.29 1.36 ± 0.31 1.35 ± 0.32 1.09 ± 0.26 5.85 &lt;0.001 Female subjects (n = 153) 3rd decade (n = 31) 4th decade (n = 23) 5th decade (n = 30) 6th decade (n = 22) 7th decade (n = 47) F ratio p-value LVEDVI 69 ± 11 68 ± 10 62 ± 8 60 ± 9 63 ± 9 4.29 0.003 LVESVI 29 ± 6 29 ± 6 27 ± 5 26 ± 7 28 ± 6 1.45 0.220 Maximum LAVI 24 ± 5 24 ± 5 24 ± 5 25 ± 5 27 ± 5 1.73 0.147 Minimum LAVI 11 ± 2 11 ± 2 12 ± 3 13 ± 4 16 ± 4 16.59 &lt;0.001 LVLAVR at ED 6.51 ± 1.36 6.20 ± 1.26 5.43 ± 1.28 4.67 ± 0.96 4.03 ± 0.81 25.46 &lt;0.001 LVLAVR at ES 1.22 ± 0.22 1.22 ± 0.32 1.14 ± 0.33 1.06 ± 0.29 1.06 ± 0.25 2.08 0.087 LVED(S)VI, left ventricular end-diastolic (end-systolic) volume index; LAVI, left atrial volume index; LVLAVR, left ventricular left atrial volume ratio
P1411 Ultrasound-guided transseptal access in catheter ablation of left-sided tachyarrhythmias - single centre experience
Authors: Zizek D , Antolic B , Kajdic N , Zorz N , Breskvar U , Zupan Meznar A , Jan M 
Published: January 2020

Abstract

Background
Transseptal puncture (TSP) for catheter ablation (CA) of left-sided tachycardias is traditionally performed with the aid of fluoroscopy. Compared to fluoroscopy, intracardiac echocardiography (ICE) can provide better orientation and imaging of soft tissue structures that are relevant to TSP.

Objective
Our aim was to evaluate feasibility and safety of ICE-guided TSP in CA treatment of left-sided tachyarrhythmias.

Methods
Consecutive fluoroless CA procedures with combined use of three-dimensional electroanatomic mapping system and ICE requiring TSP were evaluated in 357 patients (269 male, mean age 54 ± 18 years) referred to our hospital from July 2014 to November 2018. Among CA treated left-sided tachyarrhythmias 55 patients had accessory pathway, 16 had focal atrial tachycardia, 276 had atrial fibrillation or atypical atrial flutter and 10 had ventricular tachycardia. Success of transseptal access and complications related to TSP were analyzed. Adverse event requiring additional intervention was defined as major complication.

Results
Double TSPs were performed in 253 patients and single in 104 patients. Additional ablation procedures were needed in 26 patients and the rest had a single CA procedure. Altogether, 661 TSPs (274 double and 111 single) were attempted and 659 were successful (99.7%). Both TSPs failed due to severely thickened interatrial septum after previous cardiac surgery. In 14 patients (21 TSPs, 3.2%) a cardiac implantable electronic device (CEID) was present. ICE provided excellent lead visualisation and no lead dislodgements were recorded. Additional radiofrequency energy application to the transseptal needle was used for 3 challenging TSPs. Minor complications (pericardial effusions managed conservatively) occurred after 7 double TSP procedures (12/661, 1.8%). Major complication with pericardial tamponade (requiring pericardiocentesis) occurred during one double TSP (2/661, 0.3%). No TSP-related embolic complications were observed.

Conclusion
ICE-guided TSP in CA of left-sided tachyarrhythmias is safe with excellent success rates. In addition, ICE could provide additional reassurance in difficult cases and in patients with CEIDs.
P1431 Safety of thoracentesis in patients with refractory heart failure: lung ultrasound guidance is obligatory and blind procedures are not justified
Authors: Lazarevic A , Dobric M , Kantar M , Goronja B , Krivokuca S , Jovanic J , Lazarevic N , Duronjic M , Picano E 
Published: January 2020

Abstract

Background
Pleural effusion refractory to diuretic treatment is frequent in advanced heart failure. Therapeutic thoracentesis (TT) is a time-honored practice, recently made simpler and safer by guidance with lung ultrasound.

Purpose
In order to elucidate safety of lung ultrasound-driven TT in refractory heart failure, we compared incidence of pneumothorax requiring surgical drainage in patients undergoing TT with or without lung ultrasound.

Methods and results
In a single-centre retrospective analysis we recruited 373 patients with heart failure with reduced ejection fraction (26 ± 12%), New York Heart Association class ≥3, and pleural effusion ≥ moderate at lung ultrasound. They underwent overall 493 TT. Evacuated pleural fluid by passive drainage was 1030 ± 534 mL. The maximal interpleural space was 73.6 ± 15.6 mm before, and 12.4 ± 3.1 mm after TT (p &lt; .001). Two groups of TT were identified ex-post: 462 guided by lung ultrasound (Group 1); 31 without ultrasound guidance (Group 2), performed by cardiologist/pneumologist lacking access to ultrasound machine or expertise in lung ultrasound). The rate of complications (pneumothorax) was 0/462 in Group 1 and 3/31 in Group 2 (0 vs 10%, p &lt; 0.001)

Conclusion
Lung ultrasound-driven TT of pleural effusion in decompensated heart failure patients is feasible and safe when performed by cardiologists guided by lung ultrasound. A blind TT without ultrasound guidance is associated with higher rate of pneumothorax, and should be avoided.
P1453 Unfortunate association between obstructive hypertrophic cardiomyopathy and infective endocarditis
Authors: Balauca N , Ianos R , Ulici B , Beyer R , Rosianu H 
Published: January 2020

Abstract
Bacterial endocarditis is an uncommon, but potentially severe complication of hypertrophic cardiomyopathy (prevalence &lt; 1%).
We report the case of a 27-year-old woman, with low socioeconomic status, with hypertrophic cardiomyopathy, presenting with chest pain, dyspnoea at moderate effort, fever and chills. The transthoracic and transoesophageal echocardiography showed obstructive septal hypertrophic cardiomyopathy (interventricular septum of 38 mm, systolic anterior motion of the mitral valve, maximum gradient in the left ventricular outflow tract of 80 mmHg), vegetations of 10 mm, on the atrial and ventricular mitral leaflets sides, mitral valvular abcess, severe mitral regurgitation, flail of the noncoronarian aortic cusp (with a 10 mm vegetation), severe aortic regurgitation, basal SIV vegetation, pericardial effusion. The blood cultures were positive for Streptococcus mitis. The thoracic, abdominal, pelvin CT scan confirmed the diagnosis of mitral-aortic infective endocarditis , revealing also an abcess of the aortic root and multiple embolisations (spleen and right external iliac artery). The cranial CT scan was normal. At the evaluation of the foci sites, multiple dental foci were discovered and treated by multiple extractions. The endocarditis team recommended antibiotic treatment (with ampicillin), urgent bivalvular replacement (aortic and mitral valve) and septal myectomy. The surgical procedure was denied by the patient, which was after that voluntarily discharged from the hospital. The patient died from cardiac arrest (asystole) 11 days after the initial diagnosis.
A severe association between obstructive hypertrophic cardiomyopathy and infective endocarditis with multiple complications can have an initial paucisymptomatic clinical presentation.
The low socioeconomic status of the patient was correlated with inadequate oral hygiene, that was a negative prognostic factor in the outcome of the patient. It is possible that the integration of oral health in our national general health programs for people with low socioeconomic status, will decrease morbidity and improve the quality of life.
Abstract P1453 Figure. picture clinical case
P1474 Right or left; which sided the infective endocarditis is?
Authors: Baskurt A A , Ozpelit E , Kumral Z , Akdeniz B 
Published: January 2020

Abstract

ABSTRACT
Treatment and management of infective endocarditis (IE) depends on the side of involvement. Involvement of both sides of heart is rarely encountered. We describe one case of both sided infective endocarditis caused by staphylococcus auerus. In this case, the vegetation is thought to be on the right side of the heart at first examination by transthrorasic echocardiography (TTE). However; when examined more carefully with transoesophageal echocardiography (TEE), nothing was as it seemed.
CASE PRESENTATİON
A 86-year-old woman, who underwent mechanic aortic valve replacement surgery 11 years before, was admitted to emergency room with fever, dispnea and cough. Physical examination showed a temperature of 38.6. Electrocardiography showed a atrial fibrillation of 112 beats/min. Laboratory tests revealed an elevated C reactive protein of 211 mg/l. The patient was empirically treated with intravenous piperacillin-tazobactam and teicoplanin, by the recommendation of infection disease unit. Staphylococcus aureus grew in both bottles of blood cultures.
A TTE showed severe tricuspid regurgitation with vegetation, mild aortic regurgitation and moderate mitral regurgitation with no clear vegetation. We decided perform TEE and realised the vegetation in the right atrium was originated from the right atrial wall not from the tricuspid valve. Then we also noticed a thickening in the walls of aortic root with systolic expansion. This finding was consistent with paraaortic abscess formation. The 3D TEE examination helped us to understand the origin of the vegetation in the right atrium. Because the wall of the right atrium which the vegetation arised from was in direct continuity with the infected aortic root. We conclude that the paraortic abscess was spread to the right atrium by neighborhood. After one week of IV antibiotics treatment, the patient undergone open heart surgery. The surgical inspection confirmed the echocardiographic diagnosis.

DISCUSSION
Echocardiography helps us in diagnosis, determination of side of involvement, and complications of infective endocarditis. Usually the endocarditis invole only one side of the heart: left or right. We have found only four cases of double-sided endocarditis in literature. Our case is the first one , in which we describe a direct extension of aortic root abscess to the right atrium.
Abstract P1474 figure 1