bluuebunny/crossref_metadata_2025_split huggingface dataset:
P763 Asymptomatic severe organic mitral regurgitation: Does the anatomic substrate affect the functional response to supine ergometry?
Authors: Armenis I , Kontonika M , Marinou M , Motsi A , Athanassopoulos G 
Published: January 2020

Abstract

Asymptomatic severe mitral regurgitation (MR) remains a grey zone in decision making for intervention. The predictive role of left ventricular (LV) functional reserve remains uncertain and the potential role of the anatomical substrate has not been elucidated.
Aim of the study was to compare the LV function and hemodynamic changes during supine ergometry (Ex) in asymptomatic severe MR between myxomatous (Myx) and degenerative (Deg) substrate.

Methods
32 patients with Deg (male M/female F = 15/17) and 19 with MyxS (M/F = 7/12) were studied at rest (R) and Ex.

We estimated
heart rate (HR), rate-pressure product (HRxBP), LV endsystolic (LVESV)- enddiastolic volume (LVEDV), ejection fraction (EF), LV longitudinal strain (GLS), transmitral E wave (E), ratio E/e, peak tricuspid gradient (TrPG). To adjust for a potential volume effect on GLS, GLS was normalized to volumes and respective ratios were considered (GLS/LVESV, GLS/LVEDV). Parameters were measured at R and Ex and % changes were calculated : %d (Ex-R).

Results
Myx and Deg had similar chronotropic reserve and HR-BP. Myx were younger, and during Ex they had a greater LVEDV, a greater EF. a smaller E/e, and a smaller TrPG compared with Deg.
Myx group, despite having a better GLS both at R and Ex, revealed a smaller % GLS improvement from R to Ex (15% vs 32%). The normalized GLS/LVESV and GLS/LVEDV were similar at R between Myx and Deg, but they showed a smaller improvement during Ex in Myx. (table-results)

Conclusion
Despite similar severity of MR, asymptomatic patients with MyxS revealed a different dynamic profile during Ex compared with Deg. The underlying MV substrate in organic MR might be related with a different LV adaptation to volume loading combined with subsequent uneven stress induced hemodynamic response.
The disparities found might have implications both in the nature history of MR as well as in the decision making for intervention.
RESULTS Parameter DegS MyxS p Age(years) 65 ± 11 44 ± 12 &lt;0. 001 LVEDV Ex (ml) 85 + 32 117 ± 41 =0. 007 EF Ex(%) 65 + 7 69 ± 8 =0. 05 GLS R(%) -17.6 ± 6.8 -22.2 ± 4.3 =0. 04 GLS Ex(%) -22 ± 4 -25.0 ± 5.7 =0. 05 % d (Ex-R) LV strain/endsystolic volume 0.84 ± 0.4 -0.54 ± 0.5 =0. 05 E/e" Ex 16.7 ± 8.8 9.7 ± 2.2 =0. 004 TrPG Ex(mmHg) 59 ± 11 44 ± 11 =0. 0001
P774 Utility of global longitudinal strain to predict post-operative outcomes in non-cardiac surgery
Authors: Park C J , Tan L S , Huang P , Tan P J , See J H J 
Published: January 2020

Abstract

Background
Pre-operative echocardiography is performed in selected groups of patients for cardiac risk stratification prior to surgery. Many parameters, including Left Ventricular Ejection Fraction (LVEF), are assessed during echocardiography. While many studies have cited association between low LVEF and poor operative outcomes such as perioperative myocardial infarction or cardiogenic pulmonary edema, LVEF has limitations such as left ventricular (LV) cavity border tracing, geometric assumptions and inter-observer variability. LVEF may also appear normal in the presence of LV hypertrophy and a small LV cavity size. Studies have described the routine use of global longitudinal strain (GLS) as an alternative measure of ventricular function, with GLS having been reported to be a reliable marker in detecting subclinical LV dysfunction. This adds incremental value in predicting myocardial function and in risk stratification. In fact, some studies have documented GLS being a useful preoperative parameter in predicting postoperative LV dysfunction after cardiac valve surgery.

Purpose
The aim of this study is to determine the value of GLS in predicting post-operative outcomes in patients undergoing non-cardiac surgeries.
Methods
This was a retrospective study of all patients who had echocardiography performed for a pre-operative indication from February 2017 to October 2017. These patients were screened for those who had normal LVEF, had undergone subsequent non-cardiac surgery, and had post-operative troponins measured. Medical records were traced for baseline demographics, past medical history and echocardiographic features. GLS evaluation was prospectively performed using TOMTEC-ARENA (TOMTEC Imaging Systems GmbH) by assessors blinded to patient outcomes. Outcomes for major adverse cardiovascular events and mortality up to 1 year post surgery were collected. Post-op myocardial injury was defined as a peak Troponin T value of &gt;30 ng/L or a &gt;20% increment from baseline.

Results
A total of 42 patients were included. 61.9% (n = 26) were male and mean age was 72.3 years. Only 75.6% of patients were fully independent with activities of daily living and mean creatinine was 153.4μmol/L. Mortality at 1 year was 16.7% (n = 7) and 28.6% (n = 12) were deemed to have post-operative myocardial injury. 1-year mortality was associated with a lower GLS (-23.8% vs -19.2%, p = 0.001). However, GLS was not correlated with post-operative myocardial injury or hospital readmissions. In our study population, only a history of past myocardial infarction predicted post-op myocardial injury (58.3% vs 16.7%, p = 0.019).

Conclusion
Our study did not demonstrate the utility of GLS in predicting post-operative events, but this is likely because of the small sample size with low event rates. Nevertheless, GLS values did correlate with 1-year mortality and could be a marker of frailty and an increased mortality risk.
P775 Assessment of left ventricular function in patients with atrial fibrillation using real time triplain speckle tracking in comparison with 2D speckle tracking
Authors: Ali Al-Farhan HASAN , Sulaiman T A 
Published: January 2020

Abstract

Background
Atrial fibrillation (AF) is one of the most common cardiovascular diseases in the world, can cause many structural and functional cardiac abnormalities, one of them is left ventricular (LV) systolic dysfunction which may not be detected by conventional echocardiographic parameters (CEP) and need to use a modality of real time triplain (3P) speckle tracking strain for early detection and improvement of prognosis

Purpose
Assessment of LV systolic function in AF patients with normal ejection fraction (EF) using 3P speckle-tracking strain and its role as early predictor of subclinical dysfunction

Methods
A case-control study was conducted at Baghdad Heart Center, Baghdad Medical City since July 2017 to July 2018, including patients with AF and control group. The CEP (EF, diastolic function, mitral annular plane systolic excursion) and speckle tracking longitudinal strain were done for the patients by 3P in comparison with two dimension (2D)
Results
The study included two groups. First group: 100 patients with AF, mean age (48 ± 12.2) ranging between (25-81), (48%) men, (52%) women. Second group: 100 control patients with mean age (46.4 ± 13.1) ranging between (20-84), (58%) men, (42%) women. 3P method showed more easy and accurate in comparison with 2D method in patients with AF. Applying cut off value of (-17.5%), it was found that 71% of AF patients had undetected LV systolic dysfunction even with preserved EF. Global longitudinal strain was reduced significantly in those with AF group and reduced mitral annular plane systolic excursion
Conclusion(s)
Real time triplain speckle tracking can be dependable which is easy, useful, and more accurate in comparison with 2D method in assessment of LV function in patients with AF. 3P method is a useful tool in the early detection of subtle LV systolic dysfunction in AF patients with preserved EF and in whom more aggressive interventions could have a significant impact on prognosis.
3P vs 2D in Patients with AF and Control Average GLS by 3P % Average GLS by 2D % p-value No. Mean± SD No. Mean± SD AF group EF &lt; 52 % 29 -11.23± 3.89 29 -12.05± 3.84 0.01 EF ≥53 % 71 -13.30± 2.55 71 -14.20± 2.64 0.001 Control group EF &lt; 52 % 2 -21.15± 4.45 2 -20.20± 1.84 0.6 EF ≥53 % 98 -19.14± 1.49 98 -19.91± 1.66 0.001 3P, real time triplain; 2D, two dimension; AF, atrial fibrillation; GLS, global longitudinal strain; SD, standard deviation; EF, ejection fraction
P777 Effects of chronic cigarette smoking on left ventricle, left atrium and right ventricle strain parameters with 2D speckle tracking echocardiography
Authors: Yaman B , Cerit L , Kemal Gunsel H , Acikgoz E , Usalp S , Yuksek Ü , Duygu H , Akpinar O 
Published: January 2020

Abstract

Funding Acknowledgements
None

Background
Cigarette smoking effects myocardium with several mechanisms such as sympathetic nervous system activation, oxidative stress and endothelial dysfunction. Chronic smokers have an increased risk of morbidity and mortality associated with adverse cardiac events. Echocardiography is the well-established non-invasive diagnostic tool for the assessment of cardiac systolic and diastolic functions. 2D speckle tracking echocardiography (STE) has been widely used for this purpose in recent years.

Purpose
The aim of this study is to compare the left ventricle, left atrium and right ventricle systolic functions with 2D speckle tracking echocardiography in chronic smokers and non-smoker healthy population.

Method
40 healthy participant (mean age 33.4 ± 10.0) without smoking history, 42 healthy participant (mean age 33.9 ± 9.2) who had smoking history at least 3 years without history of cardiac disease or any other chronic diseases such as hypertension, diabetes mellitus, kidney failure were prospectively included. In addition to Standard 2D echocardiographic measurements, left ventricular global longitidunal strain (LvGLS), right ventricular global longitidunal strain (RvGLS), left atrial strain and strain rate were analyzed with Vivid E9, offline using a customized software package.

Results
Smokers had lower peak early diastolic velocity (E) and E/A (late diastolic velocity) ratio in mitral inflow (0.70 ± 0.13 vs 0.77 ± 0.13, p = 0.023; 1.47 ± 0.44 vs 1.73 ± 0.44, p = 0.011; respectively). Peak early diastolic velocity of mitral valve medial annulus and E’/A’ ratio (0.11 ± 0.02 vs 0.12 ± 0.02, p = 0.023; 1.20 ± 0.37 vs 1.40 ± 0.46, p = 0.039; respectively) was lower in smokers. LvGLS and RvGLS were significantly impaired in smokers (-17.65 ± 3.01 vs -19.21 ± 2.52, p = 0.013; -18.96 ± 4.47 vs -21.06 ± 4.58, p = 0.039; respectively). Although εs, reservoir phase strain of left atrium; εe, conduit phase strain of left atrium; εa, contractile phase strain of left atrium were similar between two groups, εe/εa was significantly lower in smokers than non-smokers (1.32 ± 0.59, 1.63 ± 0.63, p = 0.026).

Conclusion
Impaired RV deformation was found in chronic cigarette smokers. Besides standardized diastolic dysfunction parameters εe/εa might be used for the early indicator of diastolic dysfunction. Although there was no statistically significant difference with left ventricular ejection fraction between smokers and non-smokers, LvGLS which is the early indicator of LV systolic dysfunction in chronic smokers might be used for the early assesment of LV systolic impairment.
Abstract P777 figure 1
P785 Left ventricular geometry and myocardial contractility modulate impact of statins on prognosis in patients with acute heart failure
Authors: Park J B , Park C S , Choi Y J , Kwak S , Moon I , Hwang I C , Park J J , Lee S P , Park J H , Cho G Y 
Published: January 2020

Abstract

Funding Acknowledgements
N/A
Background/Introduction: The benefit of statins in patients with heart failure (HF) remains controversial and the mechanism of action is largely speculative. We investigated whether survival benefit with statins differs according to left ventricular (LV) geometry and myocardial contractility in acute HF patients.

Methods
We enrolled 1792 acute HF patients receiving statins and 2296 patients not receiving statins admitted from 2009 to 2016. The LV and right ventricular (RV) global longitudinal strain (GLS) was assessed as a measure of myocardial contractility. Patients were classified into 2 groups based on ischemic etiology of HF and further divided into 4 subgroups according to the median values of LV-GLS or RV-GLS. The primary outcome was 5-year all-cause mortality. The study protocol was approved by the ethics committee at each institute and complied with the Declaration of Helsinki. The need for written informed consent was waived.

Results
During the 5-year follow-up, 1740 (40.4%) patients died and they had more unfavorable baseline characteristics. Statin therapy was significantly associated with improved survival in overall patients and in both groups with and without ischemic etiology (all p &lt;0.001). Patients with concentric remodeling/hypertrophy and eccentric hypertrophy demonstrated survival benefit with statin therapy (P = 0.033, 0.004, and 0.008, respectively), while those with normal geometry did not (p = 0.123). In the non-ischemic HF group, survival benefit with statin therapy was confined to patients with low LV-GLS (p = 0.045) or those with low RV-GLS p = 0.003). On the contrary, in ischemic HF group, survival benefit with statin therapy was observed in all patients regardless of the values of LV-GLS or RV-GLS. Significant interactions were present between statin use and diabetes mellitus and IHD (p for interaction = 0.027 and 0.003, respectively) regarding mortality.

Conclusions
LV geometry and myocardial contractility may modulate the effects of statins in patients with acute HF. These echocardiographic measures can provide prognostic information to guide tailored statin treatment in this population. Our findings may also help to develop more well-designed prospective studies, in terms of a more homogenous study population, to confirm survival benefit with statin therapy.
Abstract P785 Figure. Multivariate Cox survival curves
P787 Interstudy reproducibility in the real world of speckle tracking echocardiography in direct comparison with cardiac magnetic resonance
Authors: Houard L , Miltaru S , Pouleur A C , Vanoverschelde J L , Gerber B L 
Published: January 2020

Abstract

Funding Acknowledgements
Fond national de la recherche scientifique (FNRS)

Background
New research methods to assess cardiac function such as 2D speckle tracking echocardiography (STE) are emerging in clinical practice after showing incremental prognostic information beyond ejection fraction in a variety of settings. However, comprehensive data regarding the day to day reproducibility is still lacking.

Aim
To assess the inter and especially the day to day intravariability of RV and LV GLS STE in direct comparison with cMR in asymptomatic volunteers and in patients with heart failure.
Methods for the volunteers:30 asymptomatic volunteers ( 34 ± 9years, 33% were women) underwent 2 cMR and 2 echocardiography studies with a maximal interval between each study of 6 days and 20 minutes between each technique. RV strain was performed on a RV focus view and LV strain on 4, 3 and 2 chamber views using the segment software. cMR- RVEF and cMR-LVEF was performed in short axis view.

Preliminary Results: Volunteers
Average values for the the STE measurements was -24.2%±2.3 and -27.4%±2.1 for LV and RV GLS respectively. Average values for the 2 cMR measurements was 61.9% ±4.5 and 56.3%± 6.2% for cMR-LVEF and RVEF respectively. The interstudy varability coefficient of variability was lower in GLS-STE parameters (RV-GLS = 7.7% and LV-GLS = 6.3%) than for the cMR parameters (cMR-LVEF= 8.2% and cMR-RVEF= 12.9%). The superior interstudy reproducibility resulted in lower calculated sample sizes require by GLS compared with cMR to show clinically relevant changes in LV and RV function. (Figure 1)

Conclusion
LV and RV -GLS- STE has excellent interstudy reproducibility in normal hearts and is as good as cMR- LVEF and RVEF.
Echocardiography cMR LV-GLS-STE RV-GLS-STE LVEF RVEF Mean difference ±SD 0.6 ± 1.88 0.5± 1.73 1.14 ± 5.22 0.98 ± 7.23 Coefficient of variation 7.7% 6.3% 8.2% 12.9% Sample Size for 2% absolute change in GLS or 5% absolute change in cMR- EF 18 16 22 44 Sample size required to detect a clinically significant change in global longidutdinal strain speckle tracking (GLS-STE) echocardiographie and cMR - ejection fraction (EF). RV and LV indicate Right ventricular and left ventricular respectively.
P790 Bi-ventricular dysfunction in patients after bone marrow transplant: the value of strain imaging
Authors: Deshmukh T , Geenty P , Geraghty L , Emmerig D , Sivapathan S , Hogg M , Brown P , Panicker S , Altman M , Gottlieb D , Thomas L 
Published: January 2020

Abstract

Background
Cardiovascular events are a significant cause of morbidity and mortality in cancer survivors, particularly occurring at 5-10 years after their cancer therapy.

Purpose
To assess the utility of strain imaging by 2-dimensional (2D) speckle tracking echocardiography in detecting bi-ventricular dysfunction, as compared to traditional measures, in patients post bone marrow transplantation (BMT) with previous anthracycline (AC) therapy for haematological conditions.

Methods
50 consecutive patients post BMT + AC, reviewed at a long-term survivor clinic, were compared to 50 age and gender matched controls. 48/50 patients received AC doses below the recommended cumulative lifetime thresholds set by the European Society of Medical Oncology. 2D left ventricular global longitudinal strain (LV GLS) and right ventricle free wall strain (RV FWS) were compared to conventional measures of bi-ventricular function.

Results
The mean LVEF (58 ± 6% vs 63 ± 6%) and RV fractional area change (FAC) (39 ± 5% vs 44 ± 5%), although reduced in the BMT + AC group vs controls, were within normal limits. LV GLS was reduced in BMT + AC patients as compared to controls (-17.8 ± 3.1% vs -20.5 ± 2.2%, p &lt; 0.01) while RV FWS was also reduced (-23.2 ± 4.0% vs -27.9 ± 2.7%, p &lt; 0.001). In BMT + AC patients with a preserved LVEF (LVEF &gt; 53%), 28% (11/40) had reduced GLS (GLS &lt; -17%) while 52% (24/46) of those with preserved FAC (FAC &gt; 35%) had reduced FWS (FWS &lt; -25%). Major adverse cardiac events (MACE) occurred in 9/50 patients in the BMT + AC group and none in the control group. 8/9 patients had normal biventricular function as assessed by traditional parameters (LVEF and RV FAC) but 5/9 patients had reduced LV GLS and/or RV FWS.

Conclusions
Subclinical bi-ventricular dysfunction is common in patients post BMT + AC therapy, and can be detected using strain analysis, despite preserved LV and RV systolic function using conventional measures. MACE occurred at a significantly higher rate in BMT patients exposed to AC. More than half of MACE events occurred in patients with reduced LV or RV strain, with preserved bi-ventricular function by traditional measures. LV GLS and RV FWS should be utilised for early identification of subclinical dysfunction in BMT patients.
P797 Assessment of right ventricular systolic function with 3D echocardiography following cardiac resynchronization therapy
Authors: Jenei C , Papp E , Clemens M , Csanadi Z 
Published: January 2020

Abstract

Background
In approximately 30-40% of cases, the left ventricular systolic function does not improve following cardiac resynchronization therapy (CRT; non-responders). Currently, the role of right ventricular (RV) systolic function is not yet completely clear in the background. Our aim was to assess the RV systolic function with 3D echocardiography in CRT patients.

Methods
We selected 19 patients who received CRT in our department between May and June 2017, and whose 1-year follow-up data were available. We characterized several 2D parameters of RV systolic function, such as RV free wall strain (RV GLSFW), annular s’ wave velocity (TDI s), tricuspid annulus plane systolic excursion (TAPSE), RV fractional area change (RV FAC). A number of 3D parameters were also assessed, such as RV ejection fraction (EF), end-diastolic (EDV) and end-systolic (ESV) volumes, using a dedicated RV analysis software. Moreover, we measured the LV EF and considered the patients "responder", when the LV EF improved with at least 10% after CRT implantation.

Results
From 19 patients, 12 was identified as responders (R) and 7 as non-responders (NR). No significant difference was seen in the mean age of patients in the two groups (NR: 68 ± 6 year; R: 67 ± 9 year, p = 0.76), however, the proportion of male individuals was higher in the NR group (8/12 vs. 1/7). The RV EF was higher in the R group (41 ± 8% vs.29 ± 10%; p = 0.012), while the EDV or ESV did not differ between the two groups. The RV GLSFW (–21.2 ± 7% vs.–13.9 ± 7%, p = 0.045) and the TAPSE (16.8 ± 5 mm vs.11.4 ± 3 mm, P = 0.03) values were significantly different between the two groups. Based on logistic regression analysis, the RV EF was an independent predictor of non-respondence.

Conclusions
The lower RV EF indicates non-respondence to CRT, however, it is not associated with RV dilation, i.e.adverse remodelling. These results suggest mechanical abnormality of RV function in the background of impaired EF.
P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF
Authors: Sahiti F , Morbach C , Henneges C , Hanke M , Ludwig R , Breunig M , Cejka V , Christa M , Scholz N , Ertl M , Kaspar M , Ertl G , Frantz S , Angermann C , Stoerk S 
Published: January 2020

Abstract

OnBehalf
AHF Registry
Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF &lt;40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF).
Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates.
Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF &lt;40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table).
Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF.
Abstract P803 Figure.