bluuebunny/crossref_metadata_2025_split huggingface dataset:
P295 Impact of Pre-existing Mitral Regurgitation on the Mid-Term Left Ventricular Mass Regression following Transcatheter Aortic Valve Implantation for Aortic Valve Stenosis
Authors: Horinouchi H , Nagai T , Ohno Y , Murakami T , Miyamoto J , Sakai K , Okada K , Nakazawa G , Yoshioka K , Ikari Y 
Published: January 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) results in an immediate and greater aortic pressure gradient improvement in patients with severe aortic valve stenosis (AS), and induces early left ventricular (LV) mass regression, which may be related to favorable effects on the mid to long term outcomes. However, the extent of LV mass regression after unloading of chronic pressure overload is varying, and its determinants are still unknown. Thus, the study aims to identify echocardiographic determinants of LV mass regression following TAVI.

Methods
We retrospectively screened all TAVI procedures in symptomatic AS from 2017 to 2019, and selected 74 successful TAVI cases that had serial echocardiographic studies both at the baseline and at the mid-term follow-up (4 to 6 months after the procedure). Through the digitalized medical records, clinical and echocardiographic data as well as angiographic grading (0-3) of post-procedure paravalvular leakage (PVL) were obtained. LV mass was calculated by using Cube formula. Thus, the extent of LV mass regression was defined as the differences of left ventricular mas index (LVMI) between at the baseline and at the follow-up (ΔLVMI). Quantification of the baseline mitral valve regurgitant volume was performed by stroke volume method with pulmonic site measurement on the assumption of no pre-existing intra/extra cardiac shunt. Cases with prior mitral valve replacement were excluded.

Results
At the post-procedure angiogram, only 3 cases had significant PVL (grade 2≤). At the mid-term follow–up, average LVMI decreased significantly from the baseline (165 ± 38 g/m2vs 140 ± 37 mg/ m2, P &lt; 0.0001) and 57 cases (70%) experienced the reduction of LVMI, although average relative wall thickness (2 × posterior wall thickness/left ventricular diastolic dimension) did not change (0.565 ± 0.135 vs 0.586 ± 0.168, P = 0.314). Among the baseline clinical and echocardiographic variables, the baseline peak A wave velocity, E/A ratio, mitral valve regurgitant volume and LVMI revealed simple correlation with ΔLVMI (γ=-0.298, p = 0.0188;γ=0.251, P = 0.0417;γ=0.354, p = 0.0041;γ=0.375, p &lt; 0.0010; respectively), whereas no correlation was observed in angiographic PVL grade. Stepwise multiple regression analysis demonstrated baseline mitral valve regurgitant volume and LVMI as the determinants of ΔLVMI (β=0.344, p = 0.032; β=0.335 P &lt; 0.0001; respectively).

Conclusions
Pre-existing mitral regurgitation has an impact on the mid–term left ventricular mass regression following TAVI. In severe AS, mitral regurgitation might be functioning as an afterload adjuster, and thus, produces protective effects on LV structure.
P299 Acute effects of Levosimendan on myocardial function in patients with severe mitral regurgitation and left ventricular dysfunction undergoing MitraClip repair
Authors: Cammalleri V , Tavernese A , De Vico P , Macrini M , Gismondi A , Muscoli S , Mauceri A , Stelitano M , Uccello G , Mollace R , Marino M M , Romeo F 
Published: January 2020

Abstract

Background
MitraClip system has developed as a valid therapeutic option in patients affected by moderate to severe and severe mitral regurgitation, low left ventricular ejection fraction (LVEF) and high surgical risk. Often, after the procedure occurs afterload mismatch, an acute and transient worsening of LVEF. Inotropic drugs can improve hemodynamic values at the prize of severe side effects. Levosimendan increases myocardial contractility without an elevation of intracellular calcium concentration, tachyarrhythmia and cardiomyocytes necrosis.

Purpose
Aim of our study was to assess the acute Levosimendan effects on LVEF of patients who underwent MitraClip procedure

Methods
Among 160 patients who underwent MitraClip procedure in our institute, 99 patients, with LVEF ≤35%, were included in the study. Transthoracic echocardiogram was performed in all patients, at moment of hospital admission and at discharge; transesophageal echocardiogram was performed during the procedure. We recorded the LVEF by modified Simpson’s rule. Periprocedural hemodynamic parameters were also recorded. 59 patients received Levosimendan during and early after the procedure (L-group) and 40 patients did not (no-L-group). Levosimendan perfusion was started at 0.01 μg/kg/min 1 h before the procedure without a loading dose, and maintained for 12h, according to hemodynamics.

Results
In the overall population, patients suffered from a severe reduction of LVEF (29.5 ± 5.3%) and high systolic pulmonary arterial pressure (sPAP) (51 ± 14.2 mmHg), without significant difference between the two groups. Acute procedural success was achieved in 98% of the study population, with 2 procedural failures in no-L-group (p = 0.16). During the procedure we observed a significant improvement of LVEF compared to baseline values only in L-group (from 29.6 ± 5.7% to 32.1 ± 7.6%, p = 0.046); in no-L-group the LVEF improved from 29.4 ± 5% to 30.2 ± 4.9% (p = 0.47); at discharge the LVEF was 31.3 ± 4.9% and 30.8 ± 5.7%, in L-group and no-L-group, respectively (p = ns compared to baseline and procedure). At discharge the sPAP significantly reduced in the overall population to 46.3 ± 12.7 mmHg (p 0.015): from 50.8 ± 12.3 mmHg vs 48.7 ± 11.9 in L-group (p = 0.35); from 51.2 ± 16 to 44.3 ± 13.2 mmHg (p = 0.04) in no-L-group. In-hospital mortality was 1.7% in L-group (1 patient die) and 0% in no-L-group. No relevant arrhythmias were reported in any patient during the hospital recovery.

Conclusion
In MitraClip patients with severe reduction of LVEF, Levosimendan has proven to improve hemodynamic outcome, increasing myocardial contractility during and early after procedure.
P300 Reappraisal of aortic stenosis severity grading inconsistencies using 3D aortic valve area
Authors: Capogrosso C , Beneduce A , Stella S , Ancona F , Ingallina G , Falasconi G , Pannone L , Melillo F , Ancona M , Montorfano M , Agricola E 
Published: January 2020

Abstract

Funding Acknowledgements
no fundings

Background
Different 3D imaging modalities have been proposed to overcome the limitations in aortic stenosis (AS) grading derived from underestimation of left ventricular outflow tract (LVOT) area by 2D transthoracic echocardiography (2D-TTE). Transesophageal echocardiography manual and software measurements (3D-TEEm and 3D-TEEs) and multidetector computed tomography (MDCT) have been recently been shown as valuable tools for AS grading using a combined approach incorporating 3D LVOT measurements and 2D Doppler parameters in the continuity equation (CE). This approach results particularly useful in cases of 2D-TTE grading inconsistence. As all these 3D imaging modalities provide larger AVA compared to 2D-TTE, we have recently proposed a 1.2 cm2 AVA cut-off could to define AS severity with 3D-TEE and MDCT.

Purpose
To compare AVA measurements with 3D-TEEm and 3D-TEEs using MDCT as gold standard in order to assess inconsistencies and evaluate the impact of a 1.2 cm2 AVA cut-off on AS severity grading.

Methods
288 patients (80 ± 11 years, 52.4% male) with symptomatic AS underwent 2D-TTE, 3D-TTEm, 3D-TEEs and MDCT within the same hospitalization. 3D-TEE LVOT reconstruction was performed manually and with semi-automated software (EchoPAC version 201). 3D-TEEm, 3D-TEEs and MDCT LVOT areas were combined with 2D-TTE Doppler parameters to calculate AVA by CE. The grading of AS was reassessed in patients with low flow-low gradient AS using a 1.2 cm2 cut-off for severity.

Results
Patients were classified according to flow state (stroke volume index ≥35 ml/m2 or &lt;35 ml/m2) and mean pressure gradient (MPG ≥40 mmHg or &lt;40 mmHg) into 4 groups: normal flow-high gradient (NF-HG; n 173, 60%), normal flow-low gradient (NF-LG; n 45, 15.5%), low flow-high gradient (LF-HG; n 39, 13.5%), and low flow-low gradient (LF-LG; n 31, 11%) AS. Among patients classified as LF-LG AS, 95%, 55%, 29% and 55% of cases were classified as severe by 2D-TTE, 3D-TEEm, 3D-TEEs and MDCT respectively using a 1.0 cm2 AVA cut-off. When the proposed severity AVA cut-off of 1.2 cm2 was applied using 3D imaging modalities, the proportion of severe AS significantly increased to 84% (p = 0.012) (3D-TEEm), 52% (p = 0.046) (3D-TEEs) and 71% (p &lt; 0.001) (MDCT) respectively.

Conclusion
The use of a 1.2 cm2 AVA cut-off for 3D-TEE and MDCT significantly reduces the number of cases of inconsistently graded AS, increasing the proportion of patients with severe AS.
P304 The importance of echocardiographic pulmonary flow notch ratio in the assessment of patients with acute pulmonary embolism
Authors: Kurnicka K , Furdyna A , Goliszek S , Lichodziejewska B , Ciurzynski M , Dzikowska-Diduch O , Kostrubiec M , Palczewski P , Pruszczyk P 
Published: January 2020

Abstract

Background
There are several echocardiographic features such as right ventricle dilatation, interventricular septum flattening, McConnel sign and 60/60 sign reflecting the extent and severity of acute pulmonary embolism (APE). In quite a large number of APE patients we can observe a pulmonary flow (PF) profile abnormality in the form of a mid-systolic notch (MSN).

Purpose
To assess the profile of pulmonary Doppler flow in consecutive patients with acute pulmonary embolism and to establish its clinical utility.

Methods
We reviewed pulmonary Doppler flow profiles from 127 consecutive patients (m. age 64 years,72 F) with symptomatic APE managed in our department. APE was confirmed by contrast-enhanced multi detector computed tomography when thromboemboli were visualized at least in segmental pulmonary arteries. Individuals with preexisting pulmonary arterial hypertension were excluded. The pulmonary flow notch ratio (PNR) defined as the time from onset of PF until mid-systolic notch divided by the time from notch to the end of pulmonary ejection was evaluated. The comparison of patients with PNR &lt; 1 (Group 1) and PNR &gt; 1 (Group 2) was performed.

Results
We found the MSN in 50 patients (39.4%). Seventy seven patients had a normal shape of Doppler PF envelope. The presence of MSN was associated with more pronounced echocardiographic signs of right ventricle overload (RVOT diameter 32.4± 5.2 vs 29.1 ±3.3 mm, p &lt; 0.001; TRPG 42.3 ± 14.4 vs 24.8 ±9.5 mmHg, p &lt; 0.0001; RVSP 49.4 ±14.9 vs 31.2 ±10.6 mmHg, p &lt; 0.0001; TAPSE 20.3± 4.1 vs 23.4 ±4.0 mm, p &lt; 0.001; PF Acceleration Time 64.5 ±13.7 vs 109.8 ±24.6 ms, p &lt; 0.001, and a presence of septal flattening). Obviously, patients with MSN presented more proximal location of thrombi in comparison to those with symmetrical shape of PF envelope (in MPA 18% vs 5.2%, p = 0.038 and in both LPA + RPA 22% vs 9%, p = 0.08, respectively). The PNR &lt; 1 was found in 35 (70%) of 50 patients with MSN (Group 1). In these patients thrombi were located more proximally than in patients with PNR &gt; 1 (Group 2), and angio-CT confirm anatomically massive PE. A percentage of patients with thrombi in both, left and right pulmonary arteries, in both lobar pulmonary arteries and lobar+ segmental arteries was higher in Group 1 (PNR &lt; 1) than in Group 2 (PNR &gt; 1): LPA + RPA: 28.6 vs 6.7%, lobar L and R: 57 vs 26.6%, lobar + segmental: 31 vs 20%. A number of patients with thrombi in the MPA was similar in both groups.

Conclusion
A noninvasive pulmonary flow notch ratio (PNR) may be useful for indicating APE patients with more extensive disease and proximal location of thrombi, at least in lobar pulmonary arteries.
P306 Left ventricular volumes during 3D transesophageal echocardiography in comparison to those obtained by 3D transthoracic echocardiogram. A feasibility study
Authors: Saha S K , Kiotsekoglou A , Gopal A S 
Published: January 2020

Abstract

Background
Three dimensional (3D) transthoracic echocardiogram (TTE) has been validated to have good agreement with cardiac magnetic resonance for the assessment of left ventricular ejection fraction (LVEF) with good interobserver reproducibility. Despite the increased use of perioperative transesophageal echocardiogram (TEE), TEE assessment of left ventricular (LV) function and volumes have never been validated against 3D TTE.

Objective
To evaluate whether 3D TEE measurement of LV function shows better agreement with 3DTTE, compared to 2DBiplane and X-plane TEE.

Methods
A total of 60 patients were included from a single large volume tertiary center, the mean age of 71.9 years, 40% were female; TTE and TEE studies were performed within one week. LV function parameters including LV EF, LV end-diastolic (LVEDV) and end systolic volumes (LVESV), stroke volumes (SV) were calculated with Qlab version 9, and 3DQ advanced software, with semi-automated endocardial contours for 3D TTE and 3D TEE. LV function parameters for 2D X-plane and Biplane TEE data sets were assessed using AGFA with manual endocardial contours. Mean differences were compared with paired, two-tail T-test, and limits of agreement were determined using the Bland-Altman analysis. Correlation between TTE and TEE values were tested using Pearson’s correlation test.

Results
3D transthoracic LV EDV, ESV, SV, and EF respectively were 112± 46 ml, 57 ±32 ml, 55± 55 ml, and 51 ±11%. Comparisons and correlations between TTE and TEE for the four measures were: for EDV bias = 9.94 ml and 95% lower and upper limits of agreements being -68.7 and 88.5 ml, and r= 0.7; for ESV the bias was -0.3 ml with 95% lower and upper limits of agreements being -55 to 55 ml, and r = 0.7: for stroke volume bias= 0.2 with 95% lower and upper limits of agreements being -37 to 67 ml, and r = 0.2; for LVEF the bias was 2.7% with 95% lower and upper limits of agreements being -18.9% to 24.3%, and r= 0.7 (Fig)

Conclusion
Left ventricular volumetric assessments during 3D transesophageal echocardiography is not only feasible but also comparable to 3D transthoracic echocardiography obtained LV volumes and EF. Data from multicenter studies with a larger number of subjects are needed to corroborate our findings.
Abstract P306 Figure. Fig. 3D LV volumes by 3D TEE vs. 3D TTE
P308 Changes in the echocardiographic phenotype during the evolution of cardiac amyloidosis from preserved to reduced left ventricle ejection fraction
Authors: Faga V , Mora Llabata V , Roldan Torres I , Saad A , Cuevas Vilaplana A M , Perez Gil M M , Arbucci R , Callizo Gallego R , Esteban Esteban E , Lowenstein J 
Published: January 2020

Abstract

Introduction
Cardiomyopaties like Cardiac Amyloidosis (CA), are an important cause of Heart Failure (HF). They can cause endocardial or transmural involvement. It is possible to characterize the kind of affectation thanks to different phenotypes identified by 2D speckle tracking echocardiography. Purpose: To study the pattern of myocardial involvement in patients (p) affected by CA and HF. Methods: Comparative study of 30 p with CA and HF, in NYHA class ≥II/IV, of which 16 had preseved left ventricle ejection fraction (pLVEF) and 14 had reduced LVEF (rLVEF), considering as cut point a LVEF &gt; 50%. There was a control group (CG) of 16 healthy subjects. Twist, radial strain (RS), circunferential strain (CS) and longitudinal strain (LS) were determined using 2D speckle-tracking echocardiography, along with mitral annulus plane systolic excursion (MAPSE) and basal-apex distance (B-A). The following indexes were calculated: Twist (apical rotation + basal rotation, °); Torsion (twist/B-A, °/cm); Torsion Index (TorI: twist/MAPSE, °/cm), and Deformation Index (DefI:twist/LS,°). The last indexes are dynamic parameters that allow for a more realistic assessment of LV torsion, since they include longitudinal shortening measures such as MAPSE and LS, describing in a more complete and physiological way the global LV systolic movement.

Results
There were differences of age between the three gropus, being older the p with rLVEF and younger the ones in the CG (63,7 ± 2,8; 68,2 ± 11,5; y 73,9 ± 12,9 years respectively). LS and CS were lower in rLVEF group when compared with pLVEF group, as well as in pLVEF group compared with the CG. The p with pLVEF showed increased values of the dynamic torsion parameters (DefI and TorI), indicating a compensatory increase of LV twist that disappears in p with rLVEF. Twist and Torsion are significantly lower only in the rLVEF group (see table).

Conclusions
In both CA groups, LS and CS deterioration indicates endocardial and transmural involvement. The loss of compensation given by the increased LV twist, reflected by DefI and TorI, marks the transition to the deterioration of LVEF.
Results Table LVEF (%) LS (%) CS (%) TWIST (°) Torsion (°/cm) TorI (°/cm) DefI (°/%) Control Group (n = 15) 68.2 ± 6.3 -20.6 ± 2.5 -22.7 ± 4.9 21.7 ± 6.1 2.7± 0.8 16.4 ± 4.7 -1.0 ± 0.3 CA pLVEF (n = 16) 60,6 ± 5.4* -11.7 ± 4.2* -17.2 ± 4.8* 19.8 ± 8.3 2.5± 1.1 27.7 ±13.5* -1.8 ± 0.9* CA rLVEF (n = 14) 37.2 ± 8.8** -8.7 ± 3.2** -13.0 ± 3.4** 8.3 ± 5.6** 1.0 ± 1.7** 13.4 ± 9.6** -1.0 ± 0.7** *:p value &lt;0,01 between CG and pLVEF group; **:p value &lt;0,01 between pLVEF and rLVEF
P310 The role of the left ventricle deformation parameters determining reverse remodeling due to six months of spironolactone therapy
Authors: Sacharczuk W , Dankowski R , Baszko A , Sowinska A , Ozegowski S , Szyszka A 
Published: January 2020

Abstract

Introduction
Spironolactone is widely used in the pharmacotherapy of patients (pts) with HFrEF. However, there is still little information on the influence of spironolactone therapy on the global and regional left ventricular (LV) function.

Aim
Evaluation of the influence of regional deformation parameters on global LV systolic function as a result of six months of spironolactone therapy.

Methods
The study included 39 pts (mean age 64 years, with stable heart failure; NYHA class II-III, mean LVEF 37,4%, mean wall motion index score, WMSI 1,62). All pts received optimal standard treatment before entering the study. Then therapy of spironolactone 25mg daily was introduced. Clinical status, treadmill exercise test (compilation time and effort level), NT-pro-BNP and speckle tracking echocardiography (STE) assessment were analyzed. Two groups were created according to LV reverse remodeling (PRR -responders, 10% increase in LVEF and/or 15% decrease in LVESV; NRR- nonresponders). Differences between NRR I PRR, at the start point and after six months therapy of spironolactone for the above-mentioned parameters, were analyzed.

Results
Reverse remodeling was observed in 21 pts (PRR). There were no differences between PRR I NRR in: exercise test on the treadmill (compilation parameters: 27,86 vs 29,41), NYHA class, Nt-pro BNP levels (1071 vs 1172 pg/ml). WMSI in both groups was similar (respectively: 1,62 vs 1,61), however akinetic region in apical and septal regions of LV in NRR were more often represented (NRR 91,6% vs PRR 35% pts). PRR showed significantly better improvement of peak systolic longitudinal (LS) and circumferential (CS) strain in the apical (AP) and LV septal region of LV (SEP) depending on the post-infarction condition. (table 1)

Conclusions
Improvement of left ventricle systolic function depends on the regional contractility status of the myocardium. Longitudinal (LS) and circumferential (CS) peak systolic strain, regardless of ejection fraction and WMSI are the sensitive parameters determining improvements of the LV systolic function. The study showed that cut-off values to predict reverse LV remodeling must be lower than -10.08% for CS and -11.55% for LS.
Tab.1. CS nad LS value at the end point Region of LV NRR mean strain % PRR mean strain% p value (NRRvs PRR) CS AP -11,42 -15,47 0.03 CS SEP -12,3 -17,04 0.02 LV 3CH -13,42 -16,30 0.04 CA AP-circumferential strain in apical LV region, CS SEP- circumferential strain in septal LV region, LV 3CH- longitudinal strain in three-chamber view of LV
P313 Prognostic value of automated measurement of mitral annular displacement by speckle-tracking echocardiography in asymptomatic aortic stenosis patients with preserved left ventricular ejection fraction
Authors: Hozumi T , Teraguchi I , Takemoto K , Fujita S , Wada T , Kashiwagi M , Shimamura K , Shiono Y , Kuroi A , Matsuo Y , Ino Y , Kubo T , Tanaka A , Akasaka T 
Published: January 2020

Abstract

Background
Management of patients with asymptomatic severe aortic stenosis (AS) and preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies have shown prognostic value of decreased LV global longitudinal strain in AS patients with preserved LVEF. Tissue-tracking mitral annular displacement (TMAD) in single apical four-chamber view (AP4) by speckle-tracking echocardiography provides automated rapid assessment of LV longitudinal deformation (Figure). This simple method may be useful for the prediction of cardiac events in asymptomatic severe AS patients with preserved LVEF.

Purpose
The purpose of this study was to examine the value of TMAD to predict cardiac events in asymptomatic severe AS patients with preserved LVEF.

Methods
The study population consisted of 103 patients with severe AS and preserved LVEF [aortic velocity &gt;4m/s or aortic valve area (AVA) &lt;1.0 cm², LVEF &gt;50%]. After exclusion of 56 patients who met the exclusion criteria (symptomatic, atrial fibrillation, significant mitral valve diseases, history of cardiac surgery, short follow-up period &lt;120 days, and inadequate echocardiographic images), the final study population consisted of 47 patients. Using TMAD analysis software (QLAB 10.5, Philips), the base-to-apex displacement of automatically defined mid-point of mitral annular line in AP4 was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated . We investigated the occurrence of the cardiac events including appearance of symptoms, decreased LVEF (&lt; 50%), and cardiac death.

Results
%TMAD was successfully and quickly evaluated in 44 (94%) of 47 patients. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 1.9 vs 12.1 ± 2.6%, p= 0.002). There were no significant differences in the other parameters including age, LVEF, aortic velocity, AVA, tricuspid regurgitation pressure gradient, early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’ between the patients with and without the cardiac events. Receiver operating characteristic analysis revealed that area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac events (hazard ratio 14.8, 95% CI, 2.75-79.3; p= 0.002).

Conclusions
The present results suggest that automated TMAD measurement by speckle-tracking echocardiography may be useful to predict cardiac events in asymptomatic severe AS patients with preserved LVEF.
Abstract P313 Figure