bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1433 Antiarrhythmic effects of sacubitril-valsartan therapy assessed by mechanical dispersion index
Authors: Valentim Goncalves A A , Galrinho A , Pereira-Da-Silva T , Moura Branco L , Rio P , Teresa Timoteo A , Abreu J , Soares R , Ilhao Moreira R , Mendonca T , Coutinho Cruz M , Reis J , Mano T , Cruz Ferreira R 
Published: January 2020

Abstract

Introduction
Sacubitril/Valsartan (LCZ696) significantly reduced sudden cardiac death in the PARADIGM-HF trial. However, there is little published data regarding the possible explanations for the antiarrhythmic effects found with LCZ696 therapy.
Previous trials have shown that mechanical dispersion by strain echocardiography can predict arrhythmic events in Heart Failure (HF) patients.
The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index with left ventricular (LV) global longitudinal strain (GLS) analysis before and after LCZ696 therapy.

Methods
Prospective evaluation of chronic HF patients with LV ejection fraction ≤ 40% despite optimized standard of care therapy, in which LCZ696 therapy was started and no additional HF treatment was expected to change.
ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 therapy and 6 months after therapy. A semiautomated analysis of LV GLS was made and mechanical dispersion index was defined as the standard deviation from the 16 time intervals corresponding to each LV segment.

Results
Of the 42 patients, 35 (83.3%) completed the 6 months of follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6 ± 11.1 years.
QTc interval (451.9 vs 426.0msec, p &lt; 0.001) and QRS interval (125.1 vs 120.8msec, p = 0.033) were reduced after 6 months of LCZ696 therapy. Mechanical dispersion index (88.4 vs 78.1msec, p = 0.036) was also significantly reduced after therapy.

Conclusion
LCZ696 therapy is associated with antiarrhythmic effects with a reduction in QTc and QRS intervals in ECG and a reduction in mechanical dispersion index as assessed by LV GLS.
Abstract P1433 Figure.
P1439 Familial dilated cardiomyopathy: assessment of left ventricular systolic and diastolic function by echocardiogram in asymptomatic patients
Authors: Quezada M , Ramos M , Ayala R , Calderon- Dominguez M , Guerrero De La Riva P , Villa Benayas Z , Munoz Carrasco M , Toro R 
Published: January 2020

Abstract

Funding Acknowledgements
Alfonso X El Sabio University

Introduction
Familial dilated cardiomyopathy (fDCM) represents 20% to 30% of idiopathic DCM (iDCM) ethiology. The assessment of cardiac function of these patients is awfully complex. Usually, myocardial fiber damages can not be detected in the early DCM stages. In this sense echocardiogram could be useful to detect incipient changes.

Purpose
The aim of this study was to characterize the systolic function of asymptomatic fDCM, compared within iDCM and control patients.

Material and methods
This study was carried out in 33 fDCM patients. A total of 4 fDCM families with LMNA gene mutation and 3 fDCM families with BLC2-associated athanogene 3 (BAG3) mutation were recruited. Moreover, a total of 30 iDCM and 66 healthy matched controls were enrolled in the study.

Results
58.14% were male. The average age was 45.3 ± 17 years. 72% showed sinus rhythm. Left bundle branch block (LBBB) was observed in 7.8% of patients. The LV ejection fraction (LVEF), sphericity index and mitral annular plane systolic excursion (MAPSE), were significantly improved in the fDCM patients compared to iDCM subjects. However, these parameters were aggravated compared with healthy controls. LVEF was enhanced in fDCM in contrast to iDCM (56% versus 35%; P &lt; 0.001). Nevertheless, LVEF value was deteriorated in fDCM compared to healthy controls (56% versus 65%; P &lt; 0.001). The values of septal and lateral annulus early diastolic velocity measured by DTI, were also diminished. All results are presented in Table 1.

Conclusions
Asymptomatic fDCM shown an intermediate value of LVEF between the iDCM and the control group. This ventricular remodeling process could be the consequence of a slight increase in the end-systolic diameter.
Patients Characteristics Patients Characteristics iDCM 30 patients fDCM 33 patients Control Group 66 Healthy P LVEF 32 (29.78-40) 56.0 (39.7-64.2) 65 (62-69.5) 0.001 EDD 62.5 (59.2-65.7) 53.7 (45.7-57.6) 45.50 (43-48.8) 0.001 ESD 53 (47-58.75) 36 (30.9-54.2) 27.9 (24-31) 0.001 MAPSE 11 (10-12.50) 14 (14-18) 19 (17-20) 0.001 Sphericity index 0.70 (0.66–0.79) 0.69 (0.66-0.79) 0.53 (0.48-58) 0.001 LA volume 61.5 (57-75.1) 32 (23-46.5) 17 (14.2-20) NS Septal annulus Early diastolic Velocity (cm/s) DTI 3.5 (3-4.2) 7.5 (1.6-8.8) 9 (7.9-11) 0.001 Lateral annulus Early diastolic Velocity (cm/s) DT 7.2 (5-8.9) 9.5 (1.8-11.8) 13 (10.37-15) 0.001 Table1. Echocardiografic findings in patients. LVEF: left ventricular ejection fraction; EDD: end-diastolic diameter; ESD: end systolic diameter; MAPSE:mitral annular plane systoluc excursion; LA: left atrium; TDI: Tissue Doppler imagin.
Abstract P1439 Figure. Familial dilated cardiomyopathy
P1445 DORv and window: a case of an uncorrected double outlet right ventricle with d-transposition of great arteries with concomitant aortopulmonary window in a 31-year-old female
Authors: Enero R , Obillos S , Yao P , Dizon E , Choa V , Go L , Cheng A , Carreon A 
Published: January 2020

Abstract

Funding Acknowledgements
none
Double outlet right ventricle (DORV) is a rare type of ventriculo-arterial connection occurring in about 1-3% of congenital heart defects. Moreover, transposition of the great arteries, wherein the aorta is anterior and to the right of the pulmonary artery (D-TGA), accounts for only 26% of cases of DORV. An aortopulmonary window, on the other hand, represents approximately only 0.2% of all congenital cardiac lesions. A case of DORV with D-TGA and pulmonary stenosis with a concomitant aortopulmonary window has never been reported, particularly in an adult in the third decade of life and without any history of surgical repair.
We present the case of a 31-year-old female who had sought consult for left-sided weakness. On physical examination, a grade IV/VI systolic murmur was heard at the left anterior chest and cyanosis of the digits of the upper and lower extremities were noted. Transthoracic echocardiogram revealed a non-restrictive ventricular septal defect (VSD) and segmental approach showed atrial and visceral situs solitus, levocardia, and atrioventricular concordance. However, there was ventriculoarterial discordance with fusiform aneurysmal dilatation of the aorta, which was noted to be at the right of and anterior to the pulmonary artery. Both great vessels arose from the right ventricle. Other echocardiographic findings included dilated right atrium, dilated and hypertrophied right ventricle with volume and pressure overload, global left ventricular hypokinesia with mild systolic dysfunction, and moderate to severe aortic regurgitation. The above complex congenital anomalies were confirmed via transesophageal echocardiogram and cardiac magnetic resonance imaging (MRI). Furthermore, pulmonary valve stenosis and aortopulmonary window, that was 3.5 centimeters in length located at the level of the proximal ascending aorta and main pulmonary artery, were seen on the MRI.
Various cardiac imaging modalities aided in cinching the diagnosis for this very rare complex congenital case in an adult reaching the third decade of life. Palliative care was deemed best for this patient due to the severity of her cardiac condition.
Abstract P1445 Figure 1.
P1466 Pacman heart documented by multimodality echocardiographic techniques
Authors: Cardoso Torres S , Sousa C , Rodrigues J , Nunes A , Araujo P , Grilo P , Resende C X , Macedo F , Maciel M J 
Published: January 2020

Abstract
We report a case of a 78-year old female with hypertension, dyslipidemia, atrial fibrillation under warfarin therapy and previously diagnosed HFpEF. She also had a history of recurrent episodes of bilateral inferior limb acute ischemia requiring urgent embolectomy and one previous cardioembolic stroke. She had no history of ischemic heart disease.
She was admitted to our center due to acute decompensated heart failure (NYHA class III). On physical examination there was evidence of pulmonary congestion with bilateral crackles, without heart murmurs. ECG showed AF rhythm, without any other significant changes.
The transthoracic echocardiogram (TTE) showed moderate biventricular hypertrophy with apical predominance and good systolic function. A partial loss of myocardial tissue in the mid segment of the interventricular septum was noticed, with no left-to-right shunt on color Doppler, apparently without interventricular communication (figure A).
For further elucidation of this finding a contrast-enhanced TTE was performed, revealing a serpiginous route through the septum to a small contained cavity within it (figure B). 3D TTE en face views additionally clarified the semilunar shape of this septal defect and its movement during the cardiac cycle, closing during systole and opening during diastole (figure C).
At this point, clinical history and previous diagnostic exams were reviewed. A thoracic CT conducted 3 years before in another clinical context showed that the ventricular septal defect was already present, with similar characteristics (figure D).
As doubts persisted about the existence of interventricular communication, cardiac catheterization with oximetry and ventriculography was performed and interventricular shunt was excluded. There was no evidence of coronary artery disease. Cardiac MRI was not possible due to lack of patient collaboration.
Final diagnosis was a partial ventricular septal defect (PVSD), probably congenital. The patient was discharged under optimized medical therapy.
PVSDs, which are rarely reported in the literature, are thought to be congenital (sporadic or familial) or a consequence of myocardial infarction. They have been described as "Pacman" heart due to the shape changes during the cardiac cycle, becoming slit-like or even absent during systole, like an opening/closing mouth, resembling the Pacman video game. Related complications include conduction disturbances, rupture and disturbed systolic function.
We describe a rare case of a partial ventricular septal defect, documented by multimodality echocardiographic techniques: 2D TTE first showed an incomplete defect of the mid interventricular septum; contrast-enhanced TTE revealed its serpiginous route to a small cavity; 3D TTE en face views further illustrated its semilunar shape and characteristic movement during the cardiac cycle.
Abstract P1466 Figure.
P1476 Percutaneous paravalvular leak closure after transcatheter aortic valve replacement expedited with multimodality imaging
Authors: Ozden Tok O , Abdelnabi M , Bingol G , Almaghraby A , Goktekin O , Piazza N 
Published: January 2020

Abstract
A 75-year-old male admitted to our hospital with decompansated heart failure symptoms. He had a history of 3 vessel coronary artery bypass grafting 10 years ago and a 29 mm Evolut R bioprosthetic transcatheter aortic valve replacement (TAVR) history 2 months ago. His physical examination revealed a 3/6 diastolic murmur on the aortic valve area. We performed a transeosophagel echocardiography (TOE) as the transthoracic echocardiography (TTE) images were not so clear and didn’t guide enough for the procedure . TOE showed a severe paravalvular leak .
After we found out from his medical reports that postprocedural ad-hoc post dilatation was performed but didn’t work, we decided to close this paravalvular leak percutanaously . According to TOE, the paravalvular leak was at 12 o’clock position. We identified the corresponding location of the leak on previous CT images which was scanned pre-TAVR for selection of the valve size and planning of the procedure. We recognized that the leak location was corresponding to a very calcified part of the aortic annulus and the reason of the severe PVL seemed to be due to this nodular extensive calcification.
We planned the procedure according to TOE-CT integrated analysis and selected the optimal flouroscopic viewing angle.The defect was found and crossed in 20 seconds after the wire passed through arcus aorta.The selected VSD Occluder(No:12) was deployed precisely by extending the device throughout the defect. Succesful complete closure was confirmed with TOE.
In the past 1o years, TAVR has become the treatment of choice for patients with severe aortic stenosis with a higher operative risk. Different studies have depicted a higher incidence of PVR in patients who undergo TAVR compared to SAVR.
Percutaneous postTAVR PVL closure is a technically challenging procedure. Echocardiography remains the primary imaging modality for assessing PVR immediately following TAVR. Finding and crossing the PVL defect is one of the most difficult and time-consuming parts of the procedure. The reason of this difficulty can be different anatomies, bad quality imaging and lack of common language between interventional cardiologist and cardiac imaging expert. To facilitate this part of the procedure integration of echocardiograohy and CT and finding the best angulation for flouroscopy seems to be quite promising.
Abstract P1476 Figure. Step by step approach to PostTAVR
P1477 Features of structural and functional parameters of the right and left heart and their relationship with the spirometry parameters in patients with CHF of ischemic genesis with COPD
Authors: Evdokimov V , Evdokimova A , Yushchuk E , Ivanova S 
Published: January 2020

Abstract

Purpose
Сomparative analysis of structural and functional parameters of the heart, the state of external respiration in patients with CHF II-III FC of ischemic genesis in the absence and in combination with moderate to severe COPD.

Material and methods
The study included patients aged 65.6 ± 3.9 years with LVEF ≤ 45% (according to Simpson). The first group consisted of 87 patients with CHF of ischemic genesis, and the second group - 385 patients with CHF of ischemic genesis and coexisted COPD. All patients were evaluated for clinical condition, TTE, the study of respiratory function with bronchodilation test.

Results
Patients of both groups were comparable by sex, age, FC CHF (NYHA). In patients with COPD, linear and volumetric LV parameters exceeded the normal values and were significantly higher than in CHF patients without COPD. LVIMM, LV sphericity index were significantly higher in the group of patients with COPD, which is associated with more pronounced remodeling of the left heart.
Correlation analysis showed direct moderate and reliable relationships between the RVIDd (internal end-diastolic diameter) and MPAP (r = 0.68, p &lt; 0.01), RVIDd and LVSV (stroke volume) and FEV1 (r = 0.38, p &lt; 0.05), FEV1 and LVMMI (r = 0.33, p &lt; 0.05), FVC and LVMMI (r = 0.34, p &lt; 0.05), LVEF and FEV1 (r = 0.44, p &lt; 0.05) and VC (lung vital capacity) (r = 0.36, p &lt; 0.05). Negative correlations were found between low-level FEV1 and RVIDd (r=-0.29, p &lt; 0.05), FEV1 and SatO2 (r = 0.28, p &lt; 0.05), and a strong degree between MPAP and FEV1 (r=-0.55, p &lt; 0.05), moderate between MPAP and FEF75 (r=-0.57, p &lt; 0.05).
In patients with COPD more pronounced significant increases in RVIDd, MPAP, RA dimension were noted. In patients of this group (n = 385), the IVRT and time of deceleration during the early diastolic filling (DTE) of RV increased more significantly.
RV diastolic dysfunction in patients with CHF with COPD may be due to slower relaxation of the right ventricular hypertrophy and an increase in afterload (evidenced by the relationship between the velocity of early diastolic filling (E) of the RV and the thickness of the anterior wall of the RV; the velocity of late filling (A) of the RV and MPAP (r= 0.3, p &lt; 0.05)).

Conclusion
In patients with CHF of ischemic genesis with COPD, a more pronounced remodeling of the left and right parts of the heart was noted, reliable interrelationships of respiratory function indicators and structural and functional parameters of both the left and right ventricles of the heart were revealed.
P1479 Prognostic value of integrated cardiopulmonary ultrasound in heart failure patients with reduced and preserved ejection fraction
Authors: Gargani L , Pugliese N , Frassi F , Masi S , Landi P , Taddei S , Sicari R 
Published: January 2020

Abstract

Background
Lung-ultrasound B-lines are the sonographic sign of pulmonary congestion and are present in patients with heart failure (HF). Their role as a diagnostic marker is quite established since they can be used for the differential diagnosis of dyspnea to both rule in or rule out HF, whereas their prognostic value at admission is less known.

Purpose
To assess the prognostic value of B-lines at admission in patients admitted to a Cardiology Department with a diagnosis of HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction.

Methods
We enrolled a total of 310 consecutive in-patients (aged 69 ± 12 years, 751 males) who underwent on admission a two-dimensional and Doppler echocardiographic evaluation coupled with lung ultrasound assessment of B-lines, according to standardised protocols. The total number of B-line was obtained by summing the number of B-lines from 28 scanning sites on the anterior and lateral right and left hemithorax, as previously described.

Results
All patients were followed-up for a median period of 15 (interquartile range: 5-28) months for death and HF readmission. During the follow-up, 79 events occurred. Among standard echocardiographic parameters, ejection fraction (EF) &lt;50%, tricuspid annular plane systolic excursion (TAPSE) &lt; 17 mm, pulmonary artery systolic pressure (PASP) ³35 mmHg, inferior vena cava diameter &gt;21 mm and total B-lines ³30 were predictors of events at univariate analysis, whereas only B-lines ³30 (hazard ratio [HR] 2.06; 95% conﬁdence interval [CI] 1.04-4.10) and TAPSE &lt;17 mm (HR 0.53; CI 0.29-0.97) were independent predictors at multivariate analysis. When analysing separately HFpEF patients (105 patients, 33.9%), B-lines ³30 was the only independent predictor of events (HR 6.11; CI 1.49-25.05) (Figure).

Conclusions
B-lines are a simple, user-friendly, bedside echographic sign of pulmonary congestion, that provides useful information not only for the diagnosis but also for the prognosis of HF patients. Their added value among standard echocardiographic parameters is stronger in patients with HFpEF compared to HFrEF. An integrated cardiopulmonary ultrasound assessment at HF admission provides excellent value for both diagnostic and prognostic stratification.
Abstract P1479 Figure
P1481 Embolic infarct in a known coronary artery disease patient
Authors: Ali A H , Alnuaimi U , Lacau S I , Badiu C , Popescu A C 
Published: January 2020

Abstract
A 60 y/o diabetic and hypertensive lady with previous anterior infarction treated by primary PCI with stenting of the proximal LAD (2011) and CABG for stent thrombosis, presented for chest pain. Admission ECG showed ST segment elevation in II, III aVF, ST segment depression in V1-V2 (A). Urgent coronary angiography was performed. It showed non-significant lesions on RCA and LCX, occlusion of the proximal LAD stent, patent LIMA to LAD and first diagonal with non-significant stenosis of the distal anastomosis (B). Transthoracic echocardiography (C) showed calcific mass involving the mitral annulus and posterior mitral leaflet, moderate mitral regurgitation, hipokinesia of the basal segment of the inferior wall with preserved LV ejection fraction. Transesophageal echocardiography (D) confirmed the calcified mass involving the mitral annulus and the posterior mitral leaflet. There was no significant mitral stenosis, and mitral regurgitation was moderate. Thoracic CT showed massive mitral calcification and a possible thrombus attached to it. (E)
Myocardial infarction was confirmed by troponin rise and fall. The patient was discharged on dual antiplatelet therapy, ACE-I, betablocker and statin. At one month follow-up transthoracic echocardiography the central area of the mitral mass became hypoechogenic, and a bilobated hypermobile structure was seen attached to the ventricular side of the mass (F). Blood cultures were negative and there was no inflammatory syndrome. Cardiac magnetic resonance (H) confirmed myocardial infarction and showed massive calcification of the posterior mitral annulus. TEE performed after another month showed a very long hypermobile structure attached to the mitral annulus calcification, which was entering the left ventricular outflow tract reaching the plane of the aortic valve (G). The patient underwent surgical mitral valve replacement and redo CABG and the mass was excised. The pathologic aspect of the excised material was cazeous and friable (I).
The initial presentation was presumably an embolic infarct with cazeous material.
Abstract P1481 Figure.
P1483 Noninvasive multimodality imaging in diagnosis and management of cardiac sarcoidosis (CS)
Authors: Breskvar U , Zupan Meznar A , Kajdic N , Antolic B , Zizek D 
Published: January 2020

Abstract

Introduction
The clinical presentation of cardiac sarcoidosis (CS) ranges from an incidentally discovered condition to heart failure with risk of sudden cardiac death (SCD). As there is no single reliable test for detecting CS, noninvasive multimodality imaging plays a crucial role in establishing the diagnosis and SCD risk-stratification. We present a case of a young patient diagnosed with CS in whom, on the basis of multiple imaging results, dual-chamber ICD for primary prevention was implanted outside practice guidelines.

Case
A 37-year-old woman was admitted to our hospital due to occasional palpitations and incidentally recorded nonsustained monomorphic ventricular tachycardia (VT). One year ago she was diagnosed with pulmonary sarcoidosis and was put on methylprednisolone; ECG, 24-h Holter monitoring and echocardiogram were normal. In the present admission control echocardiogram, with the exception of decreased longitudinal deformation of the basal and mid segments of the infero- and anterolateral left ventricle (LV) wall, was unremarkable. However, cardiac magnetic resonance (CMR) showed sub-epicardial late gadolinium enhancement (LGE) along the lower third of the antero- and inferolateral LV free wall and in the apical lateral segment of LV. Apart from some focal metabolically active lesions in the lungs and liver, fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) displayed increased metabolic activity in the apical half of the antero- and infero-lateral segments of the LV. On the basis of this results CS was confirmed. Given the age, reduced longitudinal strain, notable LV LGE presence and increased cardiac metabolic activity, dual-chamber ICD to prevent SCD and possible bradycardia risk was implanted. The patient continued with immunosupressive therapy; 8 mg of methylprednisolone every other day.

Conclusion
In our case, integrated multimodality imaging played a crucial role in establishing CS diagnosis and SCD risk stratification. A comprehensive evaluation of patients with CS is vital for making the best clinical decisions.