bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1797 Left atrial mechanics in patients with stoke: Implications for emprical anticoagulation
Authors: Sade L E , Keskin S , Colak A , Ciftci O , Can U , Kibaroglu S , Yuce D , Ozin B , Muderrisoglu H 
Published: January 2020

Abstract

Purpose
Detection of atrial fibrillation (AF) after stroke impacts patient management. However, detection of AF is difficult due to its paroxsysmal nature. We sought to test the hypothesis that echocardiographic quantification left atrial (LA) mechanics in patients with stoke can be an imaging biomarker to predict AF.

Methods
We enrolled prospectively and consecutively 131 patients in normal sinus rhythm with a new diagnosis of ischemic stroke. All patients underwent 48-hour Holter monitorization, transthoracic echocardiography with saline injection in addition to routine work-up of stroke evaluation. Two-dimensional and Doppler studies, together with most up-to-date LA quantification tools were performed including 3-dimensional LA phasic volumes (maxiumum and minimum LA Volume index - LAVImax, LAVImin) and LA strain quantification (average strain from apical 4- and 2-chamber during reservoir (Ss) and contraction (Sa) phases). Patients were followed-up and underwent second 48-hour Holter monitorization 6-12 months later if no etiologic cause was found. Any AF episode lasting &gt;30 seconds was considered significant parosysmal AF.

Results
In 49 patients, causes other than AF were identified (Noncryptogenic). In 43 patients no discernable cause was found (NoAF Cryptogenic). Paroxysmal AF episodes lasting longer than 30 sec were documented in 27 patients at first 48-hour Holter and in 12 patients during follow-up (9.2 ± 3.1 months) either by second 48-hour Holter monitorization or clinically (AF cryptogenic). LAVImax and LAVImin were significantly increased, Ss and Sa were significantly reduced in patients with AF as compared to No AF and Noncryptogenic groups (Table). LA volumes and strain measures predicted AF development independently of CHA2DS2-VASc score. Better discrimination between No AF and AF groups was obtained after second Holter monitorization that enabled detection of more cases with paroxysmal AF (Figure).

Conclusions
Our findings underscore the value of echocardiographic assessment of LA function as a marker of AF development and for selection of patients who could benefit from empiric anticoagulation.
Noncryptogenic AF cryptogenic No AF cryptogenic 3D LAVI max (ml/m&sup2;) 30.1 ± 9,4 38.1 ± 12.7 28.9 ± 9.2 3D LAVI min (ml/m&sup2;) 13.9 ± 7.5 20.7 ± 10.7 13.4 ± 5.3 3D LA EF (%) 55.5 ± 9.4 50.0 ± 10.5 53.8 ± 10.0 Ss (%) 17.4 ± 8.5 12.7 ± 5.3 17.5 ± 8.5 Sa (%) 12.7 ± 6.3 9.0 ± 5.0 12.8 ± 6.3 CHA2DS2-VASc 4.0 ± 1.6 5.0 ± 1.6 3.9 ± 1.5
Abstract P1797 Figure.
P1803 Incidence of venous thromboembolism in patients with granulomatosis with polyangiitis (Wegener"s granulomatosis)
Authors: Borowiec A , Kowalik I , Hadzik-Blaszczyk M , Rusinowicz T , Krupa R , Zycinska K 
Published: January 2020

Abstract

Funding Acknowledgements
none

Background
Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) – associated vasculitis. This primary systemic vasculitis is multisystem disorder characterized by inflammation and necrosis of small and medium sized blood vessels. An increased risk of cardiovascular mortality and incidence of various cardiovascular events has been described among GPA patients.

Purpose
The aim of the present study was to assess the incidence of venous thromboembolism (VTE) and its correlation with echocardiographic parameters and laboratory findings in GPA patients.

Methods
The group of consecutive patients with GPA were followed in the study. In all patients echocardiography and laboratory tests were performed.

Results
One hundred four patients with GPA (mean age 51.6 ± 13.2 yrs) were followed for an average of 4,5 ± 1,9 years. In 24 patients venous thromboembolism was diagnosed during observation, however in majority of them (57%) VTE occurred during first year after diagnosis of GPA. There were no significant differences in creatinine, troponin T and CRP levels between patients with and without VTE. In patients with VTE there were larger right ventricle diameter (29.1 ± 4.4 vs. 32.1 ± 5.6; p = 0.04) and higher right ventricle systolic pressure (32.6 ± 5.4 vs. 37.3 ± 5.9; p = 0.02) observed. In this study group D-dimer was elevated in majority (56%) of patients. In patients with VTE D-dimer correlated positively with age (r = 0.5, p = 0.02), right ventricle diameter (r = 0.63, p = 0.001), right ventricle systolic pressure (r = 0.44, p = 0.04), and negatively with pulmonary artery acceleration time (r= -0.43, p = 0.05).

Conclusions
Venous thromboembolism is a common complication in patients with granulomatosis with polyangiitis, especially during first year after diagnosis. This finding is likely to be associated with changes in endothelial function and with induction of hypercoagulability resulting from changes in pro and anticoagulant factors associated with inflammation and its therapy.
P1811 Prognostic impact of different subtypes of severe aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Pal M , Dekany G , Mandzak A , Piroth Z S , Fontos G , Andreka P 
Published: January 2020

Abstract

Background
Outcomes for different subtypes of aortic stenosis defined by transvalvular flow and gradient after transcatheter aortic valve implantation (TAVI) are still subjects of debate.

Purpose
The aim of the study was to evaluate the prognostic impact of the initial transvalvular flow rate and aortic mean gradient on survival and to assess the changes of left ventricular function after TAVI.

Patients and Methods
From 2008. to 2017.06.30. TAVI was performed in 300 cases in our Institute (127 men, 173 women, mean age 80,0 ± 5,8 years) with severe (aortic valve area &lt;1,0 cm²) symptomatic aortic stenosis (AS) and contraindication or high risk for surgery. Median time for follow-up was 28 (0-115) months, Echocardiography was performed before and 12 months after TAVI. Patients were divided into four groups according to flow (F) , aortic mean gradient (Gr) and ejection fraction (EF):

HG
Gr ≥ 40 mmHg (n = 237)
LF-LG : F ≤ 35 ml/m2, Gr &lt; 40 mmHg and EF &lt; 50% (n = 41)
PLF-LG: F ≤ 35 ml/m2, Gr &lt; 40 mmHg and EF ≥50% (n = 9)
NF-LG: F &gt; 35 ml/m2 and Gr &lt; 40 mmHg (n = 13)
Our primary objective was the analysis of 30-day, 1-year and 3-year all-cause mortality of these groups, secondary goal was to observe the changes in EF after 12 months in the survivors.

Results
In the whole patient group 30-day all-cause mortality was 4,3%, 1-year 17,0% and 3-year 62,0%. The NFLG group had the most favourable outcomes (mortality: 30d 0, 1-year: 7,7%, 3-year: 46,2%). Mortality was low in the HG group in the 1st year (30-day: 3,8%, 1-y: 14,3%), but it increased to 62,8% at 3-year. Mortality rates were intermediate in the PLF-LG group (30-day 0, 1-year 22,2%, 3-year 55,6%) and were the highest in LF-LG (30-day 12,2%, p = 0,03 vs HG, 1-year 34,2% p = 0,005 vs. HG, 3-year 75,6%).
Among clinical and echocardiographic variables only moderate or severe paravalvular aortic regurgitation (p = 0,03) and severe renal dysfunction (GFR &lt;30 ml/min, p = 0,02) were independent predictors of all-cause 1-year mortality.
In patients with severe (EF &lt; 30%) , moderate (EF 30-40%) or mild ( EF 41-50%) systolic dysfunction the EF improved after TAVI (23,5 ± 3,5% vs. 30,3 ± 7,9% p &lt; 0,001, 33,6 ±3,6% vs. 43,0 ± 10,5% p = 0,003, 45,5 ± 3,1% vs. 54,3 ± 8,7% p &lt; 0,001) regardless of the initial flow and gradient subtype of AS.

Conclusions
Low flow-low gradient aortic stenosis is associated with worse short or long term prognosis after TAVI, therefore this subtype of AS needs detailed risk stratification before-, and careful management after TAVI. Improvement of initial left ventricular dysfuncion can be expected after TAVI.
P1823 Feasibility of CCTA in assessment of luminal changes and coronary shear stress evolution after implantation of bioresorbable vascular scaffolds
Authors: Cernica D R , Ferent I , Mester A , Opincariu D , Hodas R , Rodean I , Chitu M , Benedek T , Benedek I 
Published: January 2020

Abstract

Funding Acknowledgements
PlaqueImage - financed by the National Authority of Scientific Research and Innovation and the Romanian Ministry of European Funding

Background
Coronary shear stress (CSS) is a well-established local mechanical factor in atherogenesis, progression and destabilization of atherosclerotic plaques. Analysis of CSS after coronary stent placement is still lacking of large clinical studies. Purpose: The aim of this study was to: (1) test the feasibility of Coronary Computed Tomography Angiography (CCTA) for assessment of local hemodynamic and luminal changes after implantation of bioresorbable vascular scaffolds (BVS), and (2) to investigate CSS modifications after BVS implantation. Methods: We conducted a single center, prospective pilot study on 73 patients with coronary artery disease who underwent elective percutaneous coronary intervention (PCI); group 1 (n = 30) – patients with BVS and group 2 (n = 43) – patients with bare metal stent (BMS) implanted. CCTA scanning was performed in all patients prior PCI and at 12 months after PCI. The mean CSS at proximal and at distal part of the stented segment and at the level of the minimal lumen area (MLA) was calculated at baseline and at 12 months after BVS placement. Results: CCTA revealed a higher incidence of severe coronary stenosis in group 1 (73%) than in group 2 (30%) (p &lt; 0.0001). Sensibility of visual evaluation for identification of in-stent restenosis on CCTA was increased in BVS group (94%) than in BMS group (76.19%) (p = 0.0006), hence the group 1 had lower incidence of non-diagnostic evaluations. Mean CSS at the stented site was significantly lower at 12 months (1.9 +/- 0.68 Pa) that average CSS at baseline (2.87 +/- 3.08 Pa) (p = 0.0001). CSS analysis showed also a significantly decreased values at proximal level from 3.39 +/- 1.93 Pa at baseline to 1.91 +/- 0.68 Pa at follow up (p &lt; 0.0001), but not a significant decrease at distal part – 1.3+/-0.72 Pa at baseline and 1.59 +/- 0.65 Pa at 12 months follow up (p = 0.9). Conclusions: CCTA is a feasible technique for assessment of luminal changes following BVS implantation. BVS implantation contribute to the improvement of local hemodynamics by restoring physiological pattern of coronary flow, as demonstrated by the computational fluid hemodynamics assessment of coronary circulation.
P1827 Impact of coronary microcirculatory dysfunction in the impairment of left ventricular deformation parameters by 4D echocardiographic techniques in hypertrophic cardiomyopathy patients
Authors: Aguiar Rosa S , Branco L , Galrinho A , Lopes L , Fiarresga A , Celas M , Silva F , Carvalho A F , Mota Carmo M , Cruz Ferreira R 
Published: January 2020

Abstract

Background
Coronary microvascular dysfunction has been described as an important pathophysiologic feature in hypertrophic cardiomyopathy (HCM).

Objective
To analyse the impact of coronary microcirculatory dysfunction on left ventricular (LV) deformation parameters obtained by 4D echocardiography in HCM.

Methods
HCM patients (P) prospectively underwent dedicated transthoracic echocardiogram for microcirculation study. The evaluation of coronary flow velocity reserve (CFVR) was performed in apical three chambers view for the left anterior descending (LAD) artery and in an apical two chambers view for the posterior descending (PD) artery. Diastolic coronary flow velocity (CFV) was measured at basal conditions and during hyperaemia, induced with adenosine perfusion (0.14 mg/kg/min intravenously, during 2 minutes). Absolute CFVR was calculated as the ratio of hyperaemic to basal peak diastolic flow velocities.
By 4D TTE (GE E95 equipment) LV global longitudinal strain (GLS), global circumferential stain, global radial strain, area strain, twist and torsion were analysed.

Results
23 P were enrolled (57% male, mean age 57.9 ± 13.7 years). Asymmetric septal hypertrophy was verified in 70% of patients, with maximal wall thickness of 21.6 ± 4.3mm. Obstructive HCM was documented in 35% of patients.
CFV was successfully measured in the LAD in all patients, but only in 70% of patients in the PD due to technical issues related to poor acoustic window and anatomical constraints. 78% of P (n = 18) presented CFVR &lt;2, denoting microcirculatory dysfunction. Relative CFVR (CFVR LAD / CFVR PD) was ≥1 in 43% of P.
At baseline conditions, 4D GLS &lt; -8% was associated with lower LAD flow (34.3 ± 8.3 vs 42.7 ± 9.7cm/s; p = 0.037), trend to lower PD flow (35.3 ± 17.8 vs 49.9 ±18.4 cm/s; p = 0.066). 4D GLS &lt; -8% P presented higher CFVR PD (2.0 ± 0.8 vs 1.1 ± 0.2; p = 0.009), with no significant difference in CFVR LAD.
Global circumferential stain &lt;-13% seemed to be associated with lower basal CFV LAD (32.5 ± 8.8 vs 40.4 ± 9.5 cm/s; p = 0.089) and PD (29.8 ± 9.0 vs 45.6 ± 17.4 cm/s; p = 0.054). P with better global circumferential stain (&lt;-13%) presented higher CFVR PD (2.3 ± 0.7 vs 1.4 ± 0.7; p = 0.005), as well as P with an area strain &lt;-18% (CFVR PD 2.0 ± 0.8 vs 1.4 ± 0.8; p = 0.038). P with LV twist &gt;4deg presented higher CFV PD at baseline (49.6 ± 16.5 vs 33,8 ± 12.9 cm/s; p = 0.039) and during hyperemia (68.0 ± 12.2 vs 52.9 ± 12.1cm/s; p = 0.032).

Conclusion
HCM P with greater impairment in LV deformation parameters by 4D echocardiography presented increased basal diastolic CFV, which can be explained by increased coronary vascular resistance and a higher oxygen demand at baseline conditions. Worse LV performance was also associated with decreased CFVR, mainly in PD.
P1829 A middle aged man with pericardial cyst
Authors: Kandil A , Nata R , Felix P 
Published: January 2020

Abstract

Introduction
Pericardial cysts are rare benign congenital anomaly that are usually accidentally discovered as a mass obliterating the costophrenic angle. The reported incidence is one to 100,000 with males are equally affected as females. They are usually asymptomatic; however, they can cause chest pain, shortness of breath and dry cough.

Case report
We present a 62 years old gentleman who presented with increasing shortness of breath. He was a heavy smoker and was known to have COPD. He was also known to have chronic heart failure with an EF of 40% and had a previous history of pericardial cyst that was initially discovered when he was investigated for shortness of breath. The patient had a one-month history of feeling more dyspneic than usual. His chest auscultation revealed scattered rhonchi and no murmurs were heard on auscultation of the heart. His ECG showed no new abnormality and his chest x-ray showed abnormal right cardio mediastinal silhouette with large opaque area adjacent to the right heart border and the size of the opacity the same compared to his previous x rays.
An Echocardiography was done and this showed moderate to severe impairment of left ventricular systolic function with an EF of 30-35%, mild to moderate mitral regurgitation and showed a cystic lesion anterior to the right ventricle. A CT chest was done for evaluation of the pericardial cyst and showed centrilobular emphysema and a mass in the rt lung abutting the right border of the heart with a maximum diameter of 8.7 cm.
The patient was non-compliant to his medications and repeatedly missed his follow up appointments. He also continued to smoke despite progression of his COPD. The cause of his shortness of breath was likely due to progression of heart failure and COPD with the pericardial cyst probably has no or minimal rule.

Conclusion
Pericardial cysts are rarely symptomatic and usually has a benign course. We aimed at increasing awareness of this rare benign animally.
Abstract P1829 Figure.
P1833 Ultrasonic imaging of radial artery reactive response in patients with hypertension with and without left ventricular hypertrophy
Authors: Parol M A , Majka K , Trawinski Z , Gambin B , Krupienicz A , Obiala J , Nowicki A , Olszewski R 
Published: January 2020

Abstract

Background
Endothelium plays an important role in anti-inflammatory process and regulating vascular tone.
It has been shown in numerous studies that increase of vessel dilation after several minutes hyperemia, was induced by mechanical transient flow stimulation of the endothelium. Most of the reported research experiments were conducted on the brachial artery. We proposed to measure the flow-mediated dilation in the radial artery (FMDr) in patients with hypertension (HT). In order to improve the axial resolution affecting the precision of FMDr determination, radial artery imaging was performed using a high frequency 20 MHz ultrasound.

Aim
The aim of the study was assessment of FMDr in patients with HT using 20 MHz probe.

Methods: Our studies involved two groups
group I consisted of 76 pts. 35 men and 41 women (71 ± 5.6 yr. old); with documented HT and group II consisted of 16 healthy volunteers, 12 men and 4 women (51.4 ± 9.4 yr. old). We divided patients with HT in to three subgroups: IA - 25 pts. with HT and left ventricular hypertrophy (VH), IB - 26 pts. with HT without VH, and IC patients with HT without VH but with coexisting coronary artery disease (CAD).

Results
Statistically significant differences in FMDr between the two groups were confirmed by a Wilcoxon-Mann-Whitney test. In group II FMDr was 11.9 ± 4.8%, and in group I FMDr was significantly less at 5.1% ± 4%. We have not observed any statistical differences in FMDr between groups: IA and IB ( 5.05%, 5.55%) respectively. We calculated FMDr for IC 4.21% (p = 0.018). Fig. 1.

Conclusion
The results confirm the usefulness of the proposed measurements of radial artery FMDr to differentiation of normal subjects from those with documented HT. There are no significant differences between males and females in all considered groups of subjects. We did not find the differences in FMDr between patients with and without VH. Patients with HT, without VH and with coexisting CAD had the lowest reactive response of FMDr.
Abstract P1833 Figure. Fig. 1
P1836 Common carotid artery intima-media thickness correlates with the epicardial fat thickness in patients with ischemic stroke
Authors: Serova D , Serov V , Shutov A , Serova S , Kovalenko A , Braun A 
Published: January 2020

Abstract

The relationship between epicardial fat thickness and coronary atherosclerosis is well known, but the value of the increased epicardial fat thickness in cerebrovascular diseases is still unclear.

Purpose
The aim of this study was to determine the relationship between common carotid artery intima–media thickness (CCA-IMT), the resistance index (RI) in the vertebral and carotid arteries and epicardial fat thickness (EFT) in patients with ischemic stroke.

Methods
98 patients with ischemic stroke (31 females and 67 males, mean age was 68.2 ± 12.1 years) were studied. All patients had arterial hypertension (AH). Most of them (96.9%) had grade 3 hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. Forty-two (43.1%) patients had coronary artery disease and 35 (35.4%) - atrial fibrillation (AF). The exclusion criteria was the presence of chronic obstructive pulmonary disease or other diseases associated with pulmonary hypertension. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8) - 54 (55.1%) patients, moderate NIHSS (9–15) - 23 (23.5%) patients, and severe stroke NIHSS (≥16) - 21 (21.4%) patients. Median NIHSS score was 11.2 ± 1.7. All patients underwent a transthoracic echocardiography and a carotid ultrasound examination.

Results
The common carotid artery intima–media thickness correlated with EFT (r =0.78, p &lt; 0.001), the body mass index (r = 0.7, p &lt; 0.001) and systolic blood pressure (r = 0.25, p = 0.045). The resistance index in the vertebral and carotid arteries correlated only with EFT (r = 0.7, p &lt; 0.001 and r = 0.78, p &lt; 0.001, respectively) and body mass index (r = 0.58, p &lt; 0.001 and r = 0.68, p &lt; 0.001, respectively).
A multiple regression analysis in which the CCA-IMT was a dependent variable and age, body mass index, systolic blood pressure, blood cholesterol level and epicardial fat thickness were independent variables, showed that CCA-IMT was independently correlated with blood cholesterol level (β=0.714, р&lt;0.001) and EFT (β =0.255, р=0.002) in patients with ischemic stroke.

Conclusions
The common carotid artery intima–media thickness and parameters of the arterial stiffness of the extracranial vessels of the head are associated with the epicardial fat thickness and blood cholesterol level in patients with ischemic stroke. The common carotid artery intima–media thickness does not depend on age, gender, body mass index, systolic and diastolic blood pressure in patients with ischemic stroke.
P855 Extensive right heart endocarditis in the past
Authors: Dobrzanska E , Tomaszewski M , Zarczuk R , Tomaszewski A , Czekajska-Chehab E 
Published: January 2020

Abstract

A 38y. old woman was admitted to a Cardiology Department due to increased exertional dyspnea and decreased exercise tolerance.
Echocardiography performed in an outpatient setting has found a substantial enlargement of the right ventricle and severe tricuspid regurgitation.

Physical examination
significantly enlarged liver, pulsation of jugular veins and numerous scars in the pits elbow.

ECG
sinus rhythm 85 / min. Right axis deviation. LPH. Hypertrophy of the right atrium. QS in V1-V4.
Transthoracic and Transesophageal Echocardiography (TTE,TEE) EF 64%, a significant increase in a right heart chambers (RVDD 4.1 cm, severe tricuspid regurgitation with completely disappearing of tricuspid valve ( only part of septal leaflet was present, which was a consequence of pressure equalization between the right atrium and the right ventricle). In addition, it revealed the structure connected with the pulmonary valve leaflet and moving between the right ventricular outflow tract and pulmonary trunk (most probably healed vegetation, 1.2 x 0.5 cm ).
Computed tomography (CT) confirmed the significant enlargement of right heart chambers (EDV 335 ml, ESV 143 ml, SV 192 ml, EF ∼ 58%) with displacement of interatrial septum to the left and the flattening of the interventricular septum . Complete destruction of the tricuspid valve leaflets, with the remaining residual part of septal leaflet was observed. The pulmonary valve was connected mobile irregular structure 2,5 cm x 0,5 cm.
Laboratory tests revealed a history of cytomegalovirus infection (p / body IgG&gt; 500,000U / ml). Other tests (HIV, hepatitis B, reaction W-R) - were negative. There was no laboratory and clinical signs of active infection at present.
Patient demanded to be discharged from the hospital and refused operation.
DISCUSSION
Echocardiography did not confirm diagnosis of pulmonary hypertension. D-dimer values of 396 ng / ml (normal &lt;500 ng / ml) excluded suspicion of pulmonary embolism. Left ventricular ejection fraction was normal (EF ∼ 64%), BNP reached the value of 153 pg / ml (normal 0-100pg / ml).
This case deserves attention because it documents severe right heart endocarditis by the person using drugs intravenously with an extremely rare takeover of both right heart valves and septic pulmonary embolism. Despite such a large morphological change in the heart of a patient remains in a relatively good clinical condition (NYHA class II/ III). The observed structure of the pulmonary trunk should be considered as healed vegetation. In the absence of consent to the surgery the patient is still treated pharmacologically.
Abstract P855 Figure. Pic.1