bluuebunny/crossref_metadata_2025_split huggingface dataset:
P335 Evaluation of systolic right ventricular function with 3D echocardiography in patients with isolated right ventricular pacing induced left ventricle dysfunction
Authors: Jenei C , Kadar R , Clemens M , Csanadi Z 
Published: January 2020

Abstract

Background
Right ventricular (RV) pacing may worsen left ventricular (LV) systolic function causing heart failure, but the exact mechanism of the LV dysfunction is unknown. The purpose of this study was to examine the right ventricle by three-dimensional echocardiography in patients with LV dysfunction accompanied by long-term RV pacing.

Methods
We analysed consecutive patients receiving permanent pacemaker (PPM) due to atrioventricular block from 2015 January to 2017 March (n = 335). During the mean follow-up period (27 months) 4 patients were selected with at least 5% decrease in the LV ejection fraction measured by two-dimensional echocardiography (B group). Control (K) group contains 4 age-, sex-, concomitant disease matched patients without the sign of LV dysfunction from the same time interval. Right ventricle function was assessed by 3D echocardiography.

Results
In both groups, there were 3 men, and the mean age was similar (B: 68 ± 6 y vs. K: 66 ± 10 y; p = 0.65). Right ventricular ejection fraction (EF) was significantly higher in controls compared to patients (K: 49 ± 7.8% vs. B: 36 ± 3.1%; p = 0.02), while the right ventricular volumes [end-systolic (K: 79 ± 47 ml vs. B: 71 ± 7 ml; p = 0.77), end-diastolic (K: 151 ± 73 ml vs. B: 111 ± 11 ml; p = 0.36) and stroke volumes (K: 58 ± 44 ml vs. B: 40 ± 6 ml; p = 0.5)] did not differ significantly. We did not find any important differences between the groups regarding the permanent right ventricle pace rate (K: 93 ± 5.6% vs. B: 84 ± 19.5%; p = 0.5), systolic pulmonary pressure (K: 34 ± 6 mmHg vs. B: 35 ± 18 mmHg; p = 0.92), or the severity of tricuspid regurgitation.

Conclusion
The left ventricular dysfunction after permanent right ventricular pacing results in right ventricular systolic dysfunction. The decrease of RV ejection fraction is not associated with RV enlargement or increase of pulmonary pressure.
P357 Remote ischemic post-conditioning may prevent cardiac remodeling within two years of STEMI by cardioprotective microRNA upregulation
Authors: Ikonomidis I , Vlastos D , Katsanos S , Gazouli M , Thymis J , Triantafyllou C , Varoudi M , Andreadou I , Triantafyllidi H , Makavos G , Kapelouzou A , Vrettou A R , Frogoudaki A , Cokkinos D , Iliodromitis E K 
Published: January 2020

Abstract

Background
Remote ischemic post-conditioning attenuates ischemia-reperfusion injury in patients with STEMI. However, its biochemical mechanisms, including micro-RNA expression, and effects on cardiac remodeling have not been deﬁned.

Methods
We examined 80 patients with STEMI and 20 healthy controls. All patients had been evaluated by cardiac echocardiography. The conditioning protocol utilised a single ischemic stimulus by brachial cuff inﬂation of both arms at 200mmHg for 5 minutes, while 20 patients underwent a sham conditioning procedure by way of cuff inﬂation omission after its placement. Blood samples were taken before and after the conditioning protocol; thus, the expression of microRNA-144,-150,-499 (cardioprotective action), -21, and -208 (remodeling stimuli) was quantiﬁed at baseline and after the ischemic conditioning procedure, by polymerase chain reaction. Additionally, cardiac remodeling was evaluated by repeat echocardiography after a 2-year follow-up period, in 40 patients.

Results
Our conditioning protocol resulted in a statistically signiﬁcant increase in miR-144,-150, -499, -21, and -208 expression (55.9 vs 7.4/U6sn, p &lt; 0.001; 3.4 vs 1.8/U6sn, p &lt; 0.05, p = 0.01; 3.5 vs 1.6/U6sn, p &lt; 0.001; 2.1 vs 1.2/U6sn; 2.4 vs 1.9/U6sn) compared to baseline; none of the aforementioned measurements was affected by the sham procedure. Furthermore, both left-ventricular end-diastolic (LVEDV) and end-systolic volume (LVESV) were decreased after the 2-year follow-up period (from 99.3 ± 6.7 to 85.9 ± 5.7, p= 0.004, and from 55.3± 6.1 to 48.6± 5.2, p= 0.04, respectively). In addition, the increase in mir-144 and mir-499 was signiﬁcantly correlated with a decrease in LVESV (r=-0.355, p &lt; 0.05; r=-0.368, p &lt; 0.05, respectively), while the increase in mir-499 was also signiﬁcantly correlated with a decrease in LVEDV (r=-0.374, p &lt; 0.05) at follow-up.

Conclusion
Remote ischemic conditioning may prevent adverse myocardial remodelling within 2 years of the index ischemic event, likely by up-regulation of cardio-protective microRNAs expression.
P361 Assessment of accuracy and reproducibility of coronary flow reserve measured by SPECT in patients with known or suspected coronary artery disease
Authors: Do Amaral Henrique De Souza A , Harms H , Campbell L , Bibbo C , Harrington M , Hainer J , Dorbala S , Blankstein R , Taqueti V , Kijewski M , Barbagelata A , Breault C , Park M , Di Carli M 
Published: January 2020

Abstract

Funding Acknowledgements
Spectrum Dynamics

Background
Traditional relative assessment of regional myocardial perfusion by single photon emission computed tomography (SPECT) has limited ability to identify multivessel coronary artery disease, as well as diffuse atherosclerosis and coronary microvascular dysfunction. Current gamma cameras with cadmium-zinc-telluride (CZT) detectors have higher temporal resolution and sensitivity and allow the acquisition of multi-frame images and quantification of absolute myocardial blood flow (MBF) and coronary flow reserve (CFR

Purpose
The aim of this study was to assess the accuracy and reproducibility of quantitative measurements of MBF and CFR obtained with a CZT SPECT system compared to PET in a cohort of patients with known or suspected coronary artery disease.

Methods
Accuracy was assessed in 22 patients who underwent dynamic rest/stress 99mTc-sestamibi-SPECT and 13N-ammonia PET myocardial perfusion imaging within two weeks of each other. Fourteen patients comprised the reproducibility cohort and underwent two dynamic 99mTc-sestamibi SPECT scans within two weeks. A rest/pharmacological stress single-day SPECT protocol was performed, using a 1:3 dose ratio. SPECT image reconstruction was performed using a spline-fitting method and SPECT MBF was quantified using a net retention kinetic model in commercially available software. Rest MBF and CFR were adjusted for heart-rate pressure product.

Results
Global MBF at rest and stress showed a good correlation between SPECT and PET (r = 0.814, p &lt; 0.001). For global rest MBF the mean difference between the two techniques was -0.25 ± 0.24 ml/min/g, while for stress MBF mean difference was -0.21 ± 0.40 ml/min/g. We also observed a significant correlation between global SPECT and PET CFR measurements (r = 0.745, p &lt; 0.001), with no significant difference between the two (mean difference: 0.16 ± 0.50). Regarding the reproducibility cohort, the correlation between global CFR measured by two SPECT scans was also significant (r = 0.616, p = 0.019), with a mean difference of 0.14 ±0.51. The mean difference between scans for rest MBF (-0.05 ± 0.19) and stress MBF (0.01 ± 0.42) were also not significant.

Conclusion
MBF and CFR quantification is feasible using a CZT gamma camera and provides accurate and reproducible results that correlate with 13N-ammonia PET. This may be of special relevance in sites where PET is not available, enabling MBF and CFR quantification with CZT SPECT cameras.
Abstract P361 Figure.
P371 Right ventricle end-systolic remodeling index in patients with atrial septal defect and severe pulmonary arterial hypertension
Authors: Selegny M , Fournier E , Amsallem M , Tortigue M , Kara M , Benmoussa N , Cohen S , Isorni M A , Jais X , Humbert M , Hascoet S 
Published: January 2020

Abstract
Background Outcome of patients with atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH) relates to right ventricular (RV) function.
Magnetic resonance imaging (MRI) remains the gold standard for evaluating the RV function but it is not used routinely. We investigated the relationship between MRI and multiple echocardiography parameters, including the Right Ventricle End-Systolic Remodeling Index (RVESRI), a new prognostic marker in patients with PAH.
Methods 23 patients with ASD and severe PAH (median age 49y.o.[39-59], Sp0 2 92% [90-95], WHO functional class II or III, mean pulmonary artery pressure 51mmHg [40-59]) were included between 2014 and 2018. All patients underwent MRI and echocardiography assessment. Echocardiographic measurements of RV remodeling and function included TAPSE, RV fractional area change (RVFAC), peak systolic velocity of the tricuspid valve (S’TV), right atrial (RA) area, RV strain, Systolic to diastolic ratio, eccentricity index and RVESRI, defined by septum length divided by lateral wall length (Figure 1). Pericardial effusion was noted.
Results Median RV ejection fraction (EF) evaluated with MRI was 46 % [34-59]. RV dysfunction (RVEF &lt; 45%) was observed in 43% of patients. Median RVFAC and
RVESRI were 29.6%[23-34] and 1.6[1.4-1.7] respectively. By spearman correlation, RVFAC and RVESRI were significantly correlated to RVEF (Rho 0.62, p &lt; 0.007 and
Rho -0.51,p &lt; 0.02 respectively). By linear regression, RVFAC and RVESRI were also correlated to RVEF (R 2 =0.36, p &lt; 0.003 and R 2 =0.34, p &lt; 0.08). Pericardial effusion was associated with RV dysfunction (p&lt; 0.008) and a lower RVFAC (p &lt; 0.01). TAPSE, S’TV and RV strain were not correlated with RVEF.
Conclusion RVFAC, RVESRI and pericardial effusion were markers of RV dysfunction in patients with ASD and severe PAH. RVESRI appears as a simple and reliable parameter for follow-up. Its prognostic value in patients with CHD remains to be demonstrated.
414 Ventricular-arterial interaction predicts response to cardiac resynchronization therapy: a link with improvement of endothelial function and arterial elastic properties
Authors: Karamichalakis N , Ikonomidis I , Parissis J , Simitsis P , Xydonas S , Letsas K , Manolatos D , Vlachos K , Georgopoulos S , Efremidis M , Sideris A , Filippatos G 
Published: January 2020

Abstract

Background
Endothelial dysfunction (ED) is a hall mark of chronic heart failure and has been linked to disease progression, hospitalizations and mortality.

Purpose
to evaluate the impact of cardiac resynchronization therapy (CRT) in ED and to determine predictors of response to CRT

Methods
CRT recipients from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns.

Results
32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction were enrolled. During follow-up, LVEF, GLS, LVESV and all ED markers exhibited significant improvement (table 1). 23 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p = 0.044).Threshold analysis showed that the best threshold of cfPWV/GLS for response to CRT was 2.75 (specificity: 0.67%, sensitivity: 0.94%).

Conclusions
After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction are improved. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT.
table 1 Baseline Follow-up Change Measurement mean (sd) mean (sd) mean (sd) p-value SBP (mmHg) 126 (19) 128 (16) 2.18 (11.98) 0,465 DBP (mmHg) 79 (9) 80 (9) 1.06 (8.58) 0,618 LVEF (%) 27 (7) 35 (9) 7.50 (4.77) &lt;0.001 LVESV (mL) 151 (42) 120 (46) -26.91 (17.20) &lt;0.001 GLS (%) 6.47 (2.89) 9.33 (4.18) 2.85 (2.28) &lt;0.001 FMD (%) 5.88 (2.79) 10.25 (3.67) 4.37 (3.34) &lt;0.001 Ea/Ees 2.81 (1.10) 2.04 (0.99) -0.77 (0.47) &lt;0.001 cfPWV 11.11 (2.61) 10.01 (2.45) -1.10 (1.56) 0,003 PBR 5-25(microns) 2.26 (0.20) 2.14 (0.24) -0.13 (0.25) 0,028 cfPWV/GLS 2.18 (1.46) 1.45 (1.11) -0.73 (0.55) &lt;0.001 Measurements at baseline, follow-up and their change during study
Abstract 414 Figure. picture 1
419 Revisiting cardiac Doppler index with single heart beat 4D ultrafast echocardiography
Authors: Papadacci C , Finel V , Villemain O , Goudot G , Provost J , Messas E , Tanter M , Pernot M 
Published: January 2020

Abstract

Funding Acknowledgements
European Research Council under the European Union’s Seventh Framework Programme (FP/2007-2013) / ERC Grant Agreement n° 311025 and the ANR-10-IDEX-00
Background
4D echocardiography has the strong potential to improve cardiac index quantification by providing reproducible and user independent measurements. Quantification of left ventricle volume and ejection fraction, for instance, have been shown to be more reliable using 4D echocardiography. However, Doppler index evaluation has not yet benefited from it, due to limited volume rates and single location estimation when assessing spectral Doppler.
Purpose
In this study, we propose to demonstrate the feasibility of performing semi-automatic evaluation of cardiac Doppler indices within a single heartbeat on three human hearts by performing 4D ultrafast echocardiography, a new technique allowing a drastic volume rate increase.
Methods
A 4D ultrafast echocardiography scanner prototype connected to a matrix probe was developed to image the human heart. The probe was positioned on the apical 4-chamber view of N = 3 volunteers. High volume rate (5200 volume/s) acquisitions were performed three times by two different trained cardiologists. 4D color flow and tissue Doppler imaging were computed from the each single heartbeat acquisition. Spectral Doppler were derived at each voxel of the volumes. Region of interest such as LV outflow tract, mitral inflow or basal inferoseptal locations were automatically detected. Doppler index were derived from Doppler spectra and tissue velocity curves at these locations, and were compared against indices obtained using a clinical procedure based on 2D echocardiography.
Results
For each acquisition and the three volunteers, major Doppler indices: E, A, E/A, S, e’, a’, e’/a’, s’, E/e’, cardiac output were successfully assessed during a single heartbeat. A high degree of similarity between the indices assessed by 4D ultrafast echocardiography and clinical 2D measurements were found.(p &gt; 0.05 for each index).
Conclusions
4D ultrafast echocardiography can quantify the major cardiac Doppler indices in a single heart beat acquisition. It promises to improve patient care by accelerating examination time and to improve results reproducibility by removing most of the operator dependency. It also offers a unique feature by enabling E/e’ index assessment in the same heart beat which could be of a great interest for atrial fibrillation patients.
Abstract 419 Figure.
430 Relation of blood pressure to coronary artery calcium and mortality
Authors: Cho I J , Lee J H , Choi S Y , Chun E J , Park S H , Han H W , Sung J D , Jung H O , Chang H J 
Published: January 2020

Abstract

Background
Diastolic blood pressure has a J-curve relation with coronary heart disease and death, but it is debating whether a J-curve association exists in general population. We aimed to assess the relation of blood pressure to mortality, and whether their association is interacted with presence of high coronary artery calcium (CAC).

Methods
The KOICA registry is a retrospective, multicenter observational study designed to investigate the effectiveness and prognostic value of CAC score for primary prevention of cardiovascular disease in asymptomatic Korean adults. The association between CAC score and blood pressure was assessed. Patients were divided into 2 groups according to the baseline CACS (&gt; 300 and ≤ 300), and all-cause mortality was assessed.

Results
The study population composed 48903 subjects with a mean age of 54 ± 9. There were 425 (0.9%) deaths during follow-up. At baseline, SBP (systolic blood pressure) more than 110 mmHg and DBP (diastolic blood pressure) more than 80 mmHg was associated with increased risk for CACS &gt; 300. In patients with baseline CACS ≤ 300, all-cause mortality was increased in patients with SBP of 110-119 mmHg (HR 1.47, p = 0.023), 130-139 mmHg (HR 1.72, p = 0.002) and ≥ 140 mmHg (HR 1.47, p = 0.042) compared to SBP of 120-129 mmHg, whereas DBP did not predict all-cause mortality. In contrast, SBP was not associated to all-cause mortality in patients with CACS &gt; 300, whereas DBP &lt; 60 mmHg (HR 3.53, p =0.018) and 70-79 mmHg (HR 2.21, p = 0.042) was associated with increased risk for all-cause mortality compared to DBP of 80-89 mmHg.

Conclusion
Low DBP was associated with increased risk for all-cause mortality in subjects with high CAC score, suggesting high-risk for coronary artery disease. However, this J-curve relation was not shown in the population with low CAC score.
499 Delayed distal migration of a balloon expandable valve-in-valve transcatheter aortic valve: a clinical case and review of the literature
Authors: Andrikopoulou E , Kim A Y K , Shook D C S , Sobieszczyk P S S , Pelletier M P P , Kaneko T K , Shah P B S , Sun Y P S 
Published: January 2020

Abstract

Case Presentation
A 70 year old man presented with recurrent dyspnea and new decrease in his left ventricular ejection fraction 5 months following valve-in-valve (ViV) TAVR (26 mm). A TEE revealed migration of his ViV TAVR towards the left ventricular outflow tract (LVOT) with resultant severe paravalvular leak (Figure 1A, 1B, 1C; yellow arrow showing the TAVR, red arrow showing the previously implanted bioprosthetic surgical aortic valve). A 29 mm balloon expandable TAVR was placed and deployed higher to ensure anchoring of the device and adequate sealing of the area of paravalvular leak (Figure 1D, 1E, 1F). This resulted in resolution of regurgitation with an intraoperative transvalvular gradient of 10 mmHg. At his 3-month follow-up visit, a TTE showed a well-seated TAVR with mild paravalvular leak and a mean gradient of 17 mmHg. He successfully completed cardiac rehab and his dyspnea improved to mild.
Discussion
As the population ages and younger patients receive surgical aortic bioprostheses (SAVR), the rates of deteriorated SAVR’s is only expected to grow in the future. The use of TAVR is now established as an alternative to redo surgery in patients with deteriorated SAVR"s, therefore, it is crucial to be able to recognize and treat device-related complications in a timely manner. The occurrence of distal migration of TAVR, i.e. displacement of the device towards the LVOT, is rare. The vast majority of cases are noted intra-procedurally; few delayed cases have also been reported, the latest being 3 years after placement. Device migration can lead to various complications, namely obstruction of the coronary ostia and myocardial infarction, severe paravalvular regurgitation and depending on the geometry of the LVOT and the mitral valve, the displaced device may impinge on the anterior leaflet of the mitral valve and cause severe mitral regurgitation. Treatment options include either open surgical removal of the migrated valve and placement of a SAVR or implantation of a ViV TAVR. The decision should be personalized after accounting for patient and device-related characteristics: the patient’s overall STS score, the presence and severity of LVOT calcification, uniformity and extent of aortic leaflet calcifications, height of the coronary ostia, optimal valve sizing and expansion and coaxial positioning of the TAVR. Prompt recognition and management of TAVR migration is critical to ensure optimal short and long-term outcomes in TAVR patients, especially as the indication of use keeps expanding and as TAVR recipients keep getting younger.
Abstract 499 Figure. TAVR migration:pre and post-intervention
501 A common finding with an atypical (rare) presentation
Authors: Rigueira J , Cunha N , Ferreira R , Rodrigues M , Silva J , Junqueira N , Nobre A , Pinto F J , Almeida A G 
Published: January 2020

Abstract

Introduction
Hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia and eosinophil-mediated organ damage. Cardiac thrombosis and thromboembolic complications are common causes of morbidity and mortality in these patients. The echocardiogram is the first method of image in the assessment of cardiac involvement by HES.

Clinical Case
An 81 year-old male, with previous history of hypereosinophilia under investigation without specific treatment, presented to the emergency department after several episodes of syncope and exertional dyspnea. The patient denied fever. He was hemodynamically stable and had a holosystolic murmur (III/VI) audible in the entire precordium.
The ECG was normal. The blood tests showed leukocytosis (26.69 x10^9/L) mainly related to hypereosinophilia (17.5 x10^9/L), thrombocytopenia (134.000/uL), elevation of troponin (hsTnT= 276 ng/L, normal range &lt;14) and reactive C-protein (3.27mg/dL, normal range &lt;0.5).
The transthoracic echocardiogram (limited for the acoustic window) showed a mass in the aortic valve with obstruction of the left ventricle outflow tract (LVOT) during systole (maximum velocity= 3.85m/s, maximum gradient = 59mmHg, mean gradient = 31mmHg), moderate mitral regurgitation, left ventricle hypertrophy with normal ejection fraction and mild pericardial effusion.
A transesophageal echo (TEE) was performed confirming the presence of a hyperechogenic sessile mass, with irregular contours, measuring 23x30 mm, attached to the aortic valve causing obstruction of the LVOT (Figure 1 A and B – TEE midesophageal long axis in diastole and systole, respectively; C and D - TEE midesophageal short axis in diastole and systole, respectively).
The patient was submitted to emergent cardiac surgery for excision of the mass and aortic valve replacement (Figure 1E and F- intraoperative and macroscopic views of the mass, respectively). The anatomopathological diagnosis confirmed an aortic valve thrombus.
Discussion/Conclusion: Native aortic valve thrombosis is a rare situation with severe complications like acute myocardial infarction, peripheral ischemia, stroke, cardiogenic shock and sudden death.
In HES, cardiac involvement is present in up to 40-50% of patients, mainly with endomyocardial fibrosis and mural thrombus formation. Native and prosthetic mitral valve thrombosis has also been described, but aortic valve involvement is very unusual.
Thrombi are one of the most common intracardiac masses, but here we present a rare case of native aortic valve thrombosis with high risk of sudden cardiac death, possibly related to HES. The echocardiogram, particularly the transesophageal echo was essential for the identification of the mass and surgical planning, but as usual in intracardiac masses, the final diagnosis was histological.
Abstract 501 Figure.