bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1686 Inverted biventricular takotsubo syndrome: early onset in heart transplanted patient
Authors: Vriz O , Al Humeid M , Adham M , Al Amro B , Galzerano D , Al Admawi M , Al Sergiani H , Al Hussein M , Al Buraiki J 
Published: January 2020

Abstract

Introduction
Takostubo syndrome (TTS) is supposed to be a disturbances of myocardial microcirculation and increased catecholamine concentration (ie, epinephrine, norepinephrine, and dopamine), could be responsible of microvascular spasms or myocyte involvement. Catecholamine increased is related to sympathetic overactivity caused by stress but also as inotropic drugs.
A 39-year-old women underwent heart transplant due to rheumatic heart disease, status post mitral valve repair, in New York Heart Association Class IV heart failure despite optimal therapy. The donor was a 36-year-old young women without significant past medical history. The echocardiogram before explantation was normal and palpation of the epicardial coronary arteries did not reveal any gross pathology, areas of atheromatous disease, or calcium.
An orthotopic heart transplantation was carried out using the bicaval technique without any complication. The postoperative course was in post-surgery intensive care unite with the patient on mechanical ventilation and inotropic support. Within the first 24-hours, changes in T wave were observed and the echocardiography revealed normal left ventricle (LV) size, LV systolic function was mildly reduced (Ejection Fraction 45- 50%), presence of wall motion abnormalities characterized by akinesia of the basal septum, dyskinesia of the basal segment of the lateral wall and hypokinesia of the basal segments of the other walls and akinesia of the basal segments of the right ventricle (RV) suggesting TTS. Because of the donor’s age and risk profile, epicardial coronary artery disease was not considered to be the causing factor of the wall motion abnormality, coronary catheterization plus biopsy was done 7 days later with no evidence of coronary obstruction and biopsy result showed 1R rejection. The echocardiogram performed in the same day showed complete recovery of the wall motion abnormalities while the global strain was still low for the basal segments either for LV or RV.
The rest of the hospitalization was uneventful and she was discharged after 10 days from heart transplant and the echocardiographyic study showed an additional improvement of the global strain for both ventricle but not complete recovery.

Conclusion
This is a rare case of TC that happened the first day after heart transplant, when the heart is denervated. We hypothesized that the present case of TTS was more related to the drug inotropic support and by epinephrine released by suprarenal medulla rather than endogenous catecholamines released locally by the systemic nervous.
Figure 1.
First echocardiographic exam during the acute phase of TTS, LV GLS was – 6.5% and RV free wall GLS -4%. After 7 days the LV GLS was -9.1% and RV free wall was -7.6%. After 3 weeks the LV GLS was – 10.5% and the RV free wall was – 11%.
Abstract P1686 Figure.
P1689 Mitral valve prolapse secondary to ischemic cardiomyopathy
Authors: Babur Guler G , Kilicgedik A , Zencirkiran Agus H , Kahveci G 
Published: January 2020

Abstract

Introduction
Mitral valve prolapse is the most common form of degenerative mitral valve disease. However, ischemic mitral valve prolapse is a rare cause of mitral regurgitation. The mechanism was initially thought to be papillary muscle dysfunction, but more complex mechanisms were suggested recently.

Purpose
Try to understand the pathophysiology of ischemic mitral valve prolapse on a case example.

Case Report
A 42-year-old male with a history of inferoposterior myocardial infarction was admitted from outpatient clinic due to NYHA class 3 heart failure symptoms. On physical examination, a 4/6 holosystolic murmur was heard in the apex.
He had a permanent pacemaker implanted for sick sinus syndrome. Transthoracic echocardiography showed 1-global dysfunction of the left ventricle (posterior segment akinetic and thinned), 2- prolapse of the posterior mitral leaflet (suspicion of ruptured chordae) 3-severe mitral regurgitation (with anterior eccentric jet), 4- moderate tricuspid regurgitation and high systolic pulmonary artery pressure (65 mmHg), 5- pacemaker lead in the right heart chambers. 6- normal right ventricular systolic function. Transesophageal echocardiography showed P2 scallop prolapse and chordae were intact, there were no redundant or myxamous components of the leaflets. It was observed that the posteromedial papillary muscle was elongated and did not contract. We commented that these echocardiographic findings represented ischemic mitral valve prolapse. Other echo findings in favour of this hypothesis were the posteromedial papillary muscle prolongation in systole and reduced the free strain of papillary muscle in the the apical long axis view. The patient underwent mitral ring anuloplasty and surgical neocord implantation. Surgery also reported the aetiology as ischemic mitral prolapse secondary to chordal extension in accordance with echocardiography.
Conclusion(s): Ischemic mitral prolapse is a complex pathology involving multiple components of the mitral valve apparatus as left ventricle, papillary muscle, chordae, annulus, leaflets. The diagnostic criteria for ischemic mitral valve prolapse and its management are not defined. The presence of myocardial infarction and the exclusion of other possible valve pathologies with transesophageal echocardiography are important steps in the diagnosis.
Abstract P1689 Figure.
P1694 Prosthetic mitral valve infective endocarditis complicated by left ventricle to right atrial fistula
Authors: Abayazeed R M , Shehata H , Elgebaly O , Abdel-Aziz M A , Abdel-Hay M A 
Published: January 2020

Abstract

Left ventricle (LV) to right atrial (RA) shunt is a rare type of ventricular septal defect. Acquired LV-RA shunt is rare and may occur as complication of cardiac surgery, endocarditis, thoracic trauma or myocardial infarction. Infective endocarditis is the second most important cause of this type of shunt.

Case presentation
A 44 year old female patient presented to our hospital complaining of progressive exertional dyspnea and palpitations for 6 months, and high grade fever for 2 weeks. The patient had history of mitral valve replacement with mechanical prosthesis 16 years ago. The patient had no history of recent invasive procedures or dental interventions. General examination revealed an irregular pulse at rate of 100 beats per minute (bpm), blood pressure of 100/60 mmHg, temperature of 38.5 ͦ C and congested neck veins. Cardiac examination revealed an audible prosthetic mitral click with a harsh pansystolic murmur heard on the apex and left sternal border, and an accentuated P2 over the pulmonary area. Her resting electrocardiogram (ECG) showed atrial fibrillation with ventricular response of 110 bpm. Her laboratory investigations revealed normochromic normocytic anemia with Hemoglobin level of 8 g/dl (13-16), and leucocytosis with white blood cell count of 16.24 103 cell/ ul (4.00-11.00); as well as elevated C-reactive protein (CRP) level of 73 (0-3). Her international normalized ratio (INR) was 3 (1-1.3) on warfarin 5 mg.
Transthoracic echocardiography (TTE) revealed a dehiscent prosthetic mitral valve with severe paravalvular regurgitation, severe tricuspid valve regurgitation and pulmonary hypertension with predicted resting pulmonary artery systolic pressure of 60 mmHg. It also showed an abnormal jet passing from the LV into the RA above the tricuspid valve during systole, both right and left ventricular systolic functions were preserved. Subsequent 2D/3D transoesophageal echocardiography (TEE) confirmed the TTE findings with detection of LV-RA fistula with significant left to right shunt; it also visualized multiple vegetations attached to the mitral annulus at the site of the valve dehiscence.
The patient was diagnosed with prosthetic mitral valve infective endocarditis, empirical antibiotics were started and the patient was referred for another center for urgent surgery. Redo mitral valve replacement, tricuspid valve repair and closure of the defect were done; the patient developed complete heart block postoperatively and permanent pacemaker was inserted.

Conclusion
Infective endocarditis remains a major health problem with high mortality and severe complications. It is important to keep high index of suspicion in high risk patients for infective endocarditis as delayed diagnosis increases the risk of serious complications and mortality, and makes surgical intervention, if indicated, more demanding with increased incidence of perioperative complications.
Abstract P1694 Figure. TTE&TEE of prosthetic mitral IE
P1695 Late mycobacterium abscessus endocarditis, a case report
Authors: Aguilar-Aguilar L F , Guzman-Ramirez D , Gaxiola-Cadena B A , Farias-Vergara S K 
Published: January 2020

Abstract
Endocarditis due to mycobacterial pathogens is a very rare entity, linked with hospital environment and early after valve replacement, with only a few cases reported of Mycobacterium abscessus.
To our knowledge, there are 13 case reports in the literature, with only one case on native valve.
A 66-year old male patient, with no previous intravenous drug use, and mechanical aortic valve replacement with myocardial revascularization (posterior descendent artery) eleven years ago, presented with fever and dyspnea, transthoracic echocardiography showed a 7x5 mm-sized vegetation in the aortic prosthetic valve, and thickness in mitral-aortic fibrosa extended to mitral anterior leaflet (Panel A). Blood cultures reported fast growing mycobacteria, and microarray genetic testing revealed Mycobacterium abscessus. HIV, B and C hepatitis testing results were negative. Antibiotic therapy started with imipenem, cotrimoxazole and amikacin, and after culture guided adjustment, continued with amikacin and tygecicline. One month after, patient presented persistence of positive blood cultures and a new transthoracic echocardiography reported abscessus in mitral-aortic fibrosa (Panel B), after that finding, surgery was planned, the aortic valve was replaced by another mechanical prostheses. Patient was discharged after multiple negative blood cultures and clinical stablility. Three months after, patient presented fever, empirical antibiotic treatment was tigecicline and amikacin, blood cultures reported Mycobacterium abscessus, new transthoracic echocardiography revealed 11x8 mm-sized vegetation, and new abscessus on mitral-aortic fibrosa (Panel C). Blood cultures remain positive, and new valve replacement is decided by Heart Team with bad prognosis, after surgery patient died. Pathology department reported valve prosthesis with inflammatory infiltrate, with presence of grampositive bacilli, and positive Ziehl-Neelsen stain (Panel E,D). Non-tuberculous mycobacteria is an emergent pathogen group, with wide spectrum of infections, specially reported in lung, soft tissues and eyes, with few cases reported of cardiac disease. These pathogens showed multidrug resistance, and high mortality. The most large series report 50 patient affected with mycobacterial endocarditis, and seven caused by Mycobacterium absccesus. There are several problems regarding treatment, with a lack of consensus among it; literature suggest early susceptibility test for macrolides (clarythromicin), aminoglucosides, quinolones, cotrimoxaole, tygecicline and carbapenem antibiotic. Treatment usually involves initial combination antimicrobial therapy with macrolide plus intravenous agents for at least 2 weeks to several months followed by oral macrolide-based therapy. In vitro MIC of tygecicline are low, and the drug should also be considered in treatment regimen.
Abstract P1695 Figure. Echocardiography and pathology images
P1705 Is mitral stenosis per se worthy of anticoagulation therapy?
Authors: Suma S , Gaibazzi N 
Published: January 2020

Abstract
We present the case of a 76-year-old man with hypertension and previous mitral valve repair (MVR) due to severe mitral valve regurgitation. He had never experienced atrial fibrillation (AF), and therefore he was not anticoagulated.
He had been asymptomatic for 15 years, however, recently he reported the onset of dyspnoea and a transthoracic echocardiogram showed moderate to severe mitral valve stenosis (MVS) in the context of previous MVR. A transesophageal echocardiogram was then requested and it confirmed the degree of MVS (panel A Color flow on mitral valve, panel B CW Doppler), but, astonishingly, it also showed the presence of a giant thrombus in the roof of the left atrium (Panel C,D,F 2D TOE, Panel E 3D TOE). The maximal dimensions of the mass were 3.3 to 4.5 centimetres and, surprisingly, no thrombus was found in the left appendage, which nevertheless had low-flow.
MVS is very often associated with severe left atrial dilation and with the onset of atrial fibrillation. However, when a patient has at least moderate MVS and he is in sinus rhythm, there is no robust evidence supporting the initiation of anticoagulants. Though, this case underlines the tight correlation between MVS and thrombus formation regardless of the detectable presence of AF. Moreover, in contrast to usual AF patients, in this particular case left appendage was not involved and the huge mass occupied most of the left atrium, showing that MVS provokes significant low-flow in the atrium too.
Abstract P1705 Figure.
P1706 Trilogy of stroke
Authors: Koenig A , Moser M , Dannenberg V , Bergler-Klein J , Binder T , Gabriel H , Schneider M 
Published: January 2020

Abstract
A 53 y/o female patient presented with clinical signs of stroke. Substantial cardiovascular risk factors were present with arterial hypertension, hyperlipidemia, impaired glucose tolerance, and a history of smoking. Transthoracic echocardiography revealed a suspicious structure on the aortic valve. Consequently, transesophageal echocardiography (TEE) was ordered.
In TEE, the structure proved to be highly suspicious for fibroelastoma. In addition, significant plaque of the aortic arch, and a persistent foramen ovale (PFO) were diagnosed in this examination.
The patient was referred to cardiac surgery for excision of the mass on the aortic valve and for PFO closure.
This case stresses the importance of echo in patients presenting with stroke. Apart from left atrial thrombus, several other possible embolic substrates can be diagnosed.
Abstract P1706 figure 1
P246 Exercise E/e refines diagnosis of diastolic impairment in patients with chronic kidney disease
Authors: Gan G , Kadappu K , Bhat A , Fernandez F , Chen H , Eshoo S , Thomas L 
Published: January 2020

Abstract

Background
Diastolic dysfunction is common in chronic kidney disease (CKD) patients and is associated with reduced exercise capacity. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) correlates with invasively measured left ventricular pressures, both at rest and during exercise. The aim of our study was to evaluate the relationship of resting and exercise E/e’ to exercise capacity in patients with stage 3 and 4 CKD.

Methods
CKD patients were prospectively recruited. All patients were required to be in sinus rhythm, without previous cardiac disease and with normal LVEF. The E/e’ ratio was assessed at rest and patients were stratified into 3 groups based on conventional clinical classifications (normal: ≤8, indeterminate: 8-14, raised: &gt;14). Patients then underwent a symptom limited exercise stress echocardiogram whereby patients with resting E/e’ &lt;14 additionally had post exercise E/e’ measured. Exercise capacity was assessed as metabolic equivalents (METs). A raised exercise E/e’ was defined as exercise E/e’ of ≥13. Lastly, we grouped patients based on abnormalities of baseline and exercise E/e’ (resting E/e’&lt;14 & exercise E/e’&lt;13, resting E/e’&lt;14 & exercise E/e ≥13, resting E/e’ ≥14) and the relationship to METs achieved was evaluated.

Results
The cohort consisted of 156 CKD patients (62.8 ± 10.6 yrs, male 62%). 85% had hypertension and 39% had diabetes mellitus. 52/156 (34%) CKD patients had resting E/e’ of ≥14. Of the 104/156 (66%) CKD patients with normal/indeterminate resting E/e’, 66/104(63%) had normal exercise E/e’ &lt;13 whilst 38/104(37%) had exercise E/e’ ≥13. Patients with resting E/e" & raised exercise E/e’ ≥13 achieved significantly lower METs compared to CKD patients with resting E/e’ &lt;14 & exercise E/e’ &lt;13 (5.0 ± 2.2 vs 8.8 ± 2.5, p&lt; 0.01). Of note, METs achieved in this group were comparable to that achieved by CKD patients with raised resting E/e’ ≥ 14 (5.0 ± 2.2 METs vs 5.3 ± 2.6 METs, p = 0.55).

Conclusion
In CKD patients with normal/indeterminate resting E/e’, there is utility in performing exercise E/e’, which was increased in 37% of patients. Raised exercise E/e’ is associated with poorer exercise capacity and is a potential tool to refine diastolic abnormalities in patients with CKD.
Group Total (n,%) METs Achieved Exercise Duration (minutes) Resting E/e’ ≤ 14 & Exercise E/e’ ≤ 13 66/156 (42%) 8.8 ± 2.5 8.4 ± 3.1 Resting E/e’ ≤ 14 & Exercise E/e’ ≥ 13 38/156 (24%) 5.0 ± 2.2 6.0 ± 3.1 Resting E/e’ ≥ 14 52/156 (34%) 5.3 ± 2.6 5.6 ± 2.2
P1737 Echocardiographic estimation of pulmonary artery pressure in young non-complicated patients with type 1 diabetes: results from a single-center observational study
Authors: Schiavone A , Bergamini C , Trombetta M , Sabbagh L , Mantovani A , Targher G , Rinaldi E , Bonora E , Zoppini G 
Published: January 2020

Abstract
OBJECTIVE Right ventricle and pulmonary artery pressure have received less attention in type 1 diabetes compared to the left ventricle. The aim of the present study was to compare right heart performance and the estimated peak systolic pulmonary artery pressure in young non complicated patients with type 1 diabetes with healthy controls.
RESEARCH DESIGN AND METHODS Ninety-three patients with type 1 diabetes without cardiovascular and respiratory diseases were recruited and compared to 56 healthy controls. All subjects were evaluated with a comprehensive trans-thoracic echocardiography and pulmonary peak systolic arterial pressure was estimated with an established formula based on pulmonary artery acceleration time.
RESULTS None of the subjects showed alterations of either systolic or diastolic function of the left ventricle. The estimated peak systolic pulmonary artery pressure was significantly higher in patients with type 1 diabetes compared to controls (38.5 ± 8.6 vs 35.4 ± 6.7, p = 0.019). The highest value of EPSPAP was observed in smoker female patients with type 1 diabetes. Basal and mid cavity diameter of the right ventricle were higher in patients with type 1 diabetes. In the multivariate analyses, factors associated with EPSPAP were female sex, body mass index, mid cavity diameter and, with an inverse correlation, HDL cholesterol.
CONCLUSIONS The present study suggests that young, uncomplicated patients with type 1 diabetes have a higher estimated peak systolic pulmonary artery pressure. Future studies are needed to better define the mechanisms underlying this alteration and its clinical consequences.
P1740 Normal values for TAPSE in the HUNT study of subjects without evidence of heart disease
Authors: Stoylen A , Molmen H E , Dalen H 
Published: January 2020

Abstract

Background
TAPSE is a simple and robust measure of RV function, but only in the absence of regional dysfunction and translational effects from the LV. Normal values from large normal studies are scarce, however. The aim of this study was to present normal values from the HUNT 3 study.

Methods
The HUNT study examined 1266 subjects without evidence of heart disease, from a mixed urban / rural population of North Tøndelag county in Norway. TAPSE was measured by reconstructed M-mode through the lateral tricuspid ring of the RV, in apical four-chamber view as shown in figure 1.

Results
Age and gender related values are given in table 1. TAPSE was normally distributes with a skewness of 0.42. Mean TAPSE was 2.8 cm (SD = 0.5), TAPSE declined with increasing age (p &lt; 0.001), but the correlation with age was moderate (R=-0.15, p &lt; 0.001). There was only a small gender difference (p &lt; 0.001), and a moderate correlation with BSA (R = 0.24, p &lt; 0.005). In linear regression with BSA and gender, only BSA was significant.

Conclusions
As all long axis measures, it declines with age, but this is moderate, so the relevance of age-specific measures can be discussed. TAPSE is near gender independent, and gender differences are only due to body size.
Age and gender related values for TAPSE Age (years): &lt;40 40-60 &gt;60 All Women TAPSE(cm) 2.9 (0.5) 2.7 (0.5) 2.5 (0.5) 2.8 (0.5) Men TAPSE(cm) 3.0 (0.6) 2.9 (0.6) 2.8 (0.6) 2.9 (0.6) All TAPSE(cm) 2.9 (0.5) 2.8 (0.5) 2.7 (0.5) 2.8 (0.5)
Abstract P1740 Figure. Fig. 1
P1749 Does treatment with sacubitril/valsartan improve ventricular function?
Authors: Ramis Barcelo M F , Mas Llado C , Valadron Sucasas C I , Pericas Ramis P , Morcuende A , Pasamar L , Noris Mora M , Forteza Alberti J F , Gonzalez Codino R , Rodriguez Fernandez A , Peral Disdier V 
Published: January 2020

Abstract

Introduction
Sacubitril/valsartan (S/V) has shown to reduce the risk of death and hospitalizations for heart failure in patients with reduced ejection fraction (HFrEF). Very few studies have described changes in ventricular function and in reverse remodelling parameters. The aim of this study is to describe the changes in echocardiographic parameters in patients with HFrEF before and after treatment with sacubitril/valsartan

Methods
Our study is a prospective observational study performed with patients with HFrEF who, according to the ESC guidelines, had indication to initiate S/V. An echocardiographic examination previous to start the treatment and 6 month after having been treated with S/V was performed.

Results
A total of 96 patients with HFrEF, in an ambulatory situation and with optimal medical treatment, were included (figure 1). After six months of treatment with S/V it was found an improvement in LVEF, a reduction in end-systolic and end-diastolic diameters and left ventricular end-systolic volume (LVESV) that achieves the statistical significant (Results in table 1). The results also showed a trend in a reduction of left ventricular end-diastolic volume (LVEDV) without achieving the statistical significance. The E/e" relation was also improved after the instauration of treatment. The grade of mitral regurgitation dropped from grade I-II/IV to 0-I/IV. Not significant changes were observed on the right ventricle function and on pulmonary pressure. Finally it was observed an improvement in the value of NT-proBNP that reaches the statistical significance.

Conclusion
Treatment of patients with HFrEF with S/V improves left ventricle function and size, the relation E/e’ and NT-proBNP levels in our population. More follow-up and data is needed to correlate these results with a better prognosis of these patients.
Figure 1: Population characteristics Gender (male, %) 78.6 Dyslipidaemia (%) 58.2 Age (mean) 62.2 Rhythm (%) Cardiomyopathy (ischemic, %) 55.1 Sinus Rhythm 75.5 Functional class (%) Atrial fibrilation 17.3 I 3.2 Pacemaker 5.1 II 66.3 Treatment (%) III 30.6 Beta blockers 95.9 Smokers (%) 16.3 Aldosterone antagonists 90.8 High blood pressure (%) 59.2 Diuretics 74.5 Diabetes Mellitus (%) 42.9 Resynchronization therapy (%) 10.2
Abstract P1749 Table 1