bluuebunny/crossref_metadata_2025_split huggingface dataset:
1025 Global strain rate do not reduce biological variability compared to S", and do not normalize for body size
Authors: Stoylen A , Molmen H E , Dalen H E 
Published: January 2020

Abstract

Background
As the Left ventricular (LV) apex is stationary, and maximum velocities are in the mitral plane, peak systolic annular velocity (S") normalized for wall length (WL) is a measure of peak systolic strain rate (Fig. 1), as is strain rate measured by tissue Doppler. As the normalization presumably corrects for the size of the heart (and thus body), this should reduce biological variability, but this assumption has previously been shown to be faulty for annular displacement (MAPSE) vs global longitudinal strain.

Methods
The HUNT study examined 1266 subjects without evidence of heart disease, from a mixed urban / rural population of North Tøndelag county in Norway. Annular systolic velocity was measured by pulsed-wave Tissue Doppler in the septal, lateral, anterior and inferior points, and averaged. Wall lengths was measured in a straight line in the same points, and S" was normalized (S"/WL) and averaged. Segmental systolic strain rate was also measured by combined speckle tracking / Tissue Doppler and averaged to a global value (GLSR).
Results are given in table 1. All three measures declined with increasing age (R was -0.23, -0.29 and -0.29, respectively, all p &lt; 0.001) The over-all relative standard deviations were similar for S", normalized S" and global strain rate. Both S"/WL and GLSR correlated negatively with BSA, R was - 0.22 and 0.17, respectively (p &lt; 0.001), while S" showed a modest positive correlation; R = 0.13, (p &lt; 0.001)

Conclusion
Normalizing peak systolic mitral annular velocity for length do not reduce biological variability, and introduces a systematic error in the body size relation, due to the one-dimensional nature of the normalisation, and the three-dimensional nature of LV deformation. This is in accordance with what has previously been shown for global longitudinal strain vs. annular plane displacement.
Table 1 Age (years) S" (cm/s) S"/WL (/s) GLSR (/s) &lt; 40 9.1 (1.2) 0.93 (0.13) 1.08 (0.12) 40 - 60 8.3 (1.3) 0.86 (0.13) 1.03 (0.12) &gt; 60 7.7 (1.3) 0.81 (0.14) 0.98 (0.14) All 8.4 (1.4) 0.87 (0.14) 1.03 (0.13) Relative SD (%) 16.7 16.1 12.6 Mitral annular velocity (S"), normalised velocity (S"/WL) and Global strain by age groups. (Standard deviations in parentheses)
Abstract 1025 Figure. Fig. 1
1029 Anthracycline and trastuzumab-induced subclinical cardiac damage and its prevention in the SAFE trial. Myocardial strain imaging and 3D echo interim analysis data
Authors: Barletta G , Livi L , Martella F , Desideri I , Venditti F , Scotti V , Pilato G , Argiro" A , Becherini C , Bacci C , Terziani F , Visani L , Salvestrini V , Meattini I , Del Bene M R 
Published: January 2020

Abstract

Background
Benefit of anthracyclines and trastuzumab therapies on disease-free survival in breast cancer is well known. Cardiotoxicity is a feared potential complication of both drugs. It usually progresses from cardiomyocyte injury to silent left ventricular dysfunction (LVD) which often becomes symptomatic and irreversible. Therefore, its prevention and early detection are of paramount importance in these cancer patients.

Purpose
SAFE trial (CT registry ID: NCT2236806) is a randomized phase 3, four-arm, single-blind, placebo-controlled study that aims to evaluate the effects of Bisoprolol (B) (5 mg, twice daily), Ramipril (R) (5 mg, twice daily) or the combination of the two (R + B), compared to placebo (P), on subclinical heart heart damage. Interim data of left ventricular function monitored with 3D Echo and Myocardial Strain Imaging are presented.

Methods
Out of 225 patients asked to participate, 191 were enrolled (mean age 48.9 ± 9.0 years). Follow-up monitoring (at 3, 6, 12 months[m]) comprised 3D ejection fraction (3D-LVEF) and Global Longitudinal Strain (GLS). One patient had sub-acute anthracyclines cardiotoxicity. Data at one year of 123 patients were available (34 P, 28 R, 31 B, 30 R + B).

Results
At time 0, no significant differences in age, body mass index, hemodynamic parameters were observed among arms. Data of 3D-LVEF and GLS at time 0 and during follow-up are reported in the figure (p level versus time 0 – GLS repeated measures). There was a significant reduction in 3D LVEF and increase in GLS in P arm (3D LVEF: 3m: -3.3%, 6m: - 5.2%, 12m: -3.7%; GLS: 3m: +5,7%, 6m: +7.8%, 12m: + 7,1%). A similar, though less significant, worsening of 3D LVEF (-2.4%,-1.9%,-2.2% at 3, 6, 12m, respectively) and GLS (+2.7%, +3.2% at 3 and 6m, respectively) was found in R arm. In B and B +R arms there was a worsening at 6m (3D LVEF -2.5%, GLS +2.7%), whereas at 12m only GLS increased (+3.2%) in B, not in B + R. Arm differences were significant (repeated measures two ways) both for 3D LVEF (two-way repeated measures ANOVA, p level = 0.038, observed power 0.855) and GLS (p level = 0.002, observed power 0.973).

Conclusions
This interim analysis of the SAFE trial shows that demonstration of subclinical cardiotoxicity is feasible with 3D echo and myocardial strain imaging. Significant subclinical damage potentially leading to LVD is present at one year. Both B alone on in combination with R may be a successful cardioprotective strategy in patients treated with anthracyclines and trastuzumab.
Abstract 1029 Figure. Time course of GLS and 3D LVEF
1047 Increased interstitial fibrosis in patients with mitral valve prolapse and mitro-annular dysjunction
Authors: Pavon A , Hugelshofer S , Rutz T , Pascale P , Pruvot E , Muller O , Schwitter J , Monney P 
Published: January 2020

Abstract

Background
in patients with myxomatous mitral valve prolapse (MVP), mitral annular disjunction (MAD) has been associated with the presence of late gadolinium enhancement (LGE) at papillary muscle level and the risk of sudden cardiac death. However, patients with MAD but no detectable LGE still may have arrhythmia. We investigated the relation between MAD and the presence of interstitial fibrosis in the basal inferior left ventricular myocardium.

Methods
28 patient with MVP and associated MAD underwent Cardiovascular Magnetic Resonance imaging (CMR) at 1.5 T scanner (Aera, Siemens Medical Solutions, Erlangen, Germany). Exclusion criteria were ischemic heart disease, infiltrative cardiomyopathy and contraindication to CMR. 12 patients with mitral valve regurgitation but no MAD and 10 patients without mitral disease served as the control group. MAD severity was measured from LA wall-posterior MV leaflet junction to the top of the LV infero-basal wall during end systole. Insterstitial fibrosis was assessed by calculating the extracellular volume (ECV) from T1 mapping of the left ventricular basal slice acquired before and after Gadolinium injection.

Results
Mean age was 47,5+\-23,3 years and 60% were male. ECV was higher in patients with MVP compared with controls (basal septum: 0.27 ± 0.04 vs 0.23 ± 0.03 p = 0.006; basal inferoposterior wall 0.28 ± 0.03 vs 0.23 ± 0.02 p = 0.003) and there was a significant correlation between MAD severity and ECV of the basal inferior wall (spearman rho 0.68, p &lt; 0.0001) (Figure 1). Among MVP patients, ECV of the basal inferoposterior wall was higher in patients positive for LGE in the papillary muscles (ECV 0.31 ± 0.03 vs 0.27 ± 0.03 p 0,004).

Conclusion
In MVP patients, MAD severity was associated with a higher amount of interstitial fibrosis even in the absence of detectable macroscopic fibrosis in the papillary muscle region.
Abstract 1047 Figure 1
1093 Multi-modality imaging of a rare cause of constrictive physiology: pericardial ring
Authors: Thabet N , Labib D , Samaan A , Shaaban M , Kharabish A , Elsawy A , Mahmoud-Elsayed H 
Published: January 2020

Abstract

Introduction
Proper pathophysiologic diagnosis of constrictive pericarditis (CP) usually mandates utilization of multiple diagnostic tools.
We report a rare cause of constrictive pericarditis in a 33-year-old female presenting with painful epigastric pulsations, easy fatigability, and lower limb edema of 6 months duration. The patient had no past history of trauma, cardiac surgery, or tuberculosis.
Trans-thoracic echocardiography (figure 1, panels A, parasternal long-axis view, and B, apical 4-chamber view) showed an echogenic band (arrow head) across the left (LV) and right (RV) ventricles, with compressed RV cavity. Septal bounce, with shifting of the inter-ventricular septum towards the LV during deep inspiration, was noted; however, Doppler evaluation of the diastolic function was not conclusive of constriction.
Cardiac magnetic resonance (figure 1, panel C) and computed tomography with 3D segmentation, using Materialise Mimics and 3-matic software (figure 1, panel D),showed an 8-mm thick, calcified pericardial ring (arrow head) encircling and indenting both ventricles at mid-cavitary level, resulting in bi-ventricular compression and dumbbell-shaped heart. Both ventricles were of average cavity size, with preserved LV size, systolic function and mildly impaired RV systolic function. Right heart catheterization confirmed the diagnosis of constrictive pericarditis. The patient was referred for surgical pericardiectomy.

Conclusion
Multi-modality imaging is integral for the diagnosis of CP. Our case represents a rare etiology of constrictive physiology.
Abstract 1093 Figure 1
1101 Multimodality imaging in the assessment of pericardial malign disease
Authors: Codina M , Ramirez-Escudero Ugalde G , Manzanal Rey A , Garcia Ibarrondo N , Cisneros Carpio S , Lambarri Izaguirre A , Candina Urizar R , Ugedo Alzaga K , Castellanos Alcalde M , Rodriguez Martinez M , Sande Sardina L , Galve Calvo E , Arcocha Torres M F , Ormaetxe Merodio J , Ruiz Gomez L 
Published: January 2020

Abstract
Metastases to the heart and pericardium are discovered at autopsy in 10%–12% of all patients with malignancies. The most common primary tumor involving the pericardium is lung cancer, followed by breast, melanoma, and lymphoma. Pericardial effusion may be the result of the tumor spreading to the visceral pericardium which increases production of fluid, or accumulation of the fluid due to the obstruction of venous and lymphatic outflow. A malignant pericardial effusion is associated with decreased survival rate.
We present a 72 year-old woman, former smoker with dyslipidemia and psoriatic arthritis as well as previous bladder carcinoma that was healed in 1986. On august 2017 after an acute intestinal obstruction she was diagnosed with stage IV ileum adenocarcinoma treated initially with palliative chemotherapy (Capecitabine and oxaliplatin) that was suspended for poor tolerance and according to patient desire. Few months later the patient complained of rapidly progressive dyspnoea that prevented her normal life activity, arterial pressure and blood oxygen saturation was normal, but she was tachycardic. Echocardiogram was performed (see figure) which showed marked pericardial nodular thickening and severe pericardial effusion with echocardiographic signs of cardiac tamponade. Curiously, pericardial effusion was dense and markedly hyperechogenic. A computed tomography (CT) was performed to rule out pericardial carcinomatosis and find out the pericardial fluid composition and demostrated several pericardial nodular thickenings that suggested metastases. The pericardial fluid was dense (40 hounsfield units) and consistent with blood. After multidispiplinar consultation and in accordance with patients wishes a palliative pericardial window was performed and hematic pericardial fluid was obtained. Pericardial liquid citology demonstrates atipical cells compatible with carcinoma and pericardial biospy showed fibrinous pericarditis and reactive mesothelial hyperplasia.
Pericardial carcinomatosis consists of macroscopic or microscopic affection of pericardial layers. Metastasis from colorectal cancer to the pericardium is uncommon, and usually indicates terminal stage with multiple metastases, only a few cases have been reported. Malignant Pericardial effusions in patients with cancer may also be triggered by other mechanism than cancer itself, including chemotherapy, radiation therapy, and, less commonly, an infectious disease. Whereas echocardiography is most frequently used to examine the heart and pericardium, multimodaliy imaging with magnetic resonance (MR) or/and CT offer advantages when dealing with metastatic disease.
Abstract 1101 Figure. Echocardiogram and CT images
1108 Inferior vena cava diversion into the left atrium after surgical repair of atrial septal defect: a rare case of chronic hypoxemia
Authors: Vidal Urrutia V , Garcia Gonzalez P , Perez Bosca J L , Juan Samper G , Cubillos Arango A , Ridocci Soriano F , Gradoli Palmero J , Cardenas Tealdo J P , Sanchez Alvarez S , Fernandez Diaz C , Simon Machi J M , Vano Bodi J , Abdala Lizarraga J , Paya Serrano R 
Published: January 2020

Abstract
Abnormal inferior vena cava (IVC) drainage into the left atrium (LA) is an infrequent complication after surgical closure of an atrial septal defect (ASD).
We present the case of a 45-year-old woman, with surgical closure of an ASD 8 years before, who consulted for exertional dyspnea and cyanosis. Transthoracic and transesophageal echocardiography showed no residual shunt after contrast administration in both arms, and thoracic CT scan and pulmonary ventilation / perfusion gammagraphy were normal. In the presence of signs strongly suggesting a right-to-left shunt, we decided to complete the study with a CMR,which revealed an anomalous systemic drainage with IVC draining into the LA with right-to-left shunt. Surgical repair of the abnormal IVC drainage was successfully performed. During the intervention cardiac surgeons found a repaired ASD located in the lower portion of the interatrial septum, a large Eustachian valve, which are anatomical features which can sometimes lead to an erroneous suture causing the drainage of the IVC towards the LA.
In conclusion, it is essential to carry out an extensive search for possible residual anatomical shunts in patients who undergo surgery and develop hypoxia. The reported case underlines the importance of being aware of this possible complication of the closure of an ASD and highlights that the absence of passage of agitated saline contrast to left chambers with conventional injection by the arms does not rule out any residual shunt, recommending its administration by the lower limbs, as well as the CMR for the definitive diagnosis.
Abstract 1108 Figure. CMR imaging 3D reconstruction
1179 Echocardiographic signs of aortic atherosclerosis in combination with clinical parameters for prediction of non-obstructive coronary atherosclerosis in men
Authors: Yaroslavskaya E I , Kuznetsov V , Gorbatenko E A 
Published: January 2020

Abstract

Background
Traditionally the gold standard for diagnosis of coronary artery disease (CAD) is detection of significant stenosis by coronary angiography. However, most myocardial infarctions result from ruptures of plaques that did not significantly compromise coronary lumen before the event. It was proved that significant stenosis is associated with stable CAD but non-significant coronary atherosclerosis is associated with unstable angina and acute coronary syndrome.

Purpose
To reveal predictors of non-significant coronary atherosclerosis using echocardiographic and clinical parameters in suspected CAD men without obstructive CAD by coronary angiography.

Methods
Out of 17.784 patients from coronary angiography database we selected 1.957 men without obstructive CAD. Selected men were divided into two groups randomly (1.389 - studied group and 568 – test group). The studied group was divided into subgroups: 304 men with non-significant coronary atherosclerosis (luminal narrowing or stenosis less than 30%) and 1.085 men with smooth coronary artery. Clinical and functional parameters of subgroups patients were compared. For selection of scoring variables, we used the values of the Cramer coefficient and the information value index - IV. All quantitative variables were converted into categorical using the binning procedure. Based on the values of WoE, the model of logistic regression was constructed using stepwise variable selection.

Results
The model includes independent variables with an average and high prognostic ability: echocardiographic signs of atherosclerosis of the ascending aorta, age, atherogenic index, arterial hypertension. By converting the coefficients of the logistic regression equation obtained into scores, a scoring model was developed to assess the probability of non-obstructive coronary atherosclerosis in men. Based on ROC analysis, in the studied group the specificity of the model for detection of nonsignificant coronary atherosclerosis was 67%, the sensitivity was 65%, the area under the ROC curve - 0.711. For the patients of the test group sensitivity was 68% and specificity - 63%, the area under the ROC curve - 0.687.

Conclusion
Nonsignificant coronary atherosclerosis in men with suspected CAD can be predicted before CAG by screening test based on echocardiographic signs of aortic atherosclerosis, age, atherogenic index and arterial hypertension.
1226 Prognostic impact of concomitant cardiac amyloidosis in aortic stenosis patients referred for transcatheter aortic valve implantation
Authors: Ferreira V , Aguiar Rosa S , Rodrigues I , Moura Branco L , Galrinho A , Rio P , Patricio L , Cacela D , Ramos R , Mendonca T , Castelo A , Garcia Bras P , Branco Mano T , Reis J , Cruz Ferreira R 
Published: January 2020

Abstract

Background
The prevalence of cardiac amyloidosis (CA) and aortic stenosis (AS) both increase with age. Transcatheter aortic valve implantation (TAVI) expands the number of patients (P) eligible for treatment of AS, emphasizing the need to understand the prevalence of CA in AS and its prognostic associations. Echocardiography with speckle tracking has emerged as a useful method to enhance the clinical suspicion and to provide prognostic information.

Purpose
To estimate the prevalence of CA in P with severe AS referred for TAVI and to evaluate the impact of concomitant CA in prognosis.

Methods
94 consecutive AS P who underwent TAVI with maximum left ventricular wall thickness (LVWT)&gt;12 mm were retrospectively identified. Clinical data, pre TAVI echocardiographic parameters and follow up (FU) data regarding all-cause mortality and MACE (including all-cause mortality, admission for heart failure, pacemaker implantation and stroke) were analysed. We registered apical sparing pattern in bull’s eye plots (ASPB), calculated relative apical longitudinal strain formula (RALS) [average apical LS/(average basal LS + mid-LS)] and ejection fraction/global longitudinal strain (EF/GLS) ratio.

Results
Mean age was 82.2 ± 5.8 years (Y), with 43 men (45.7%). 27.7% were in NYHA functional class II, 64.9% in functional class III and 7.4% in functional class IV. Median EF was 57 ± 15% and 26.6% presented EF &lt; 50%. Suspected CA evaluated by ASPB was found in 39 P (41.5%) and RALS &gt; 1 was identified in 22 P (23.4%). An EF/GLS ratio &gt; 4.1 was obtained in 53 P (56.4%). Over a median follow-up of 13.4 ± 25.8 months, 28 deaths (29.8%) and 31 MACEs (33.0%) occurred.
The presence of ASPB was associated with increased all-cause mortality (33.3% vs. 5.6%, p = 0.002), new bundle branch block and indication for pacemaker implantation (46.2% vs 37.0%, p = 0.05) and MACE (48.7% vs 22.2%, p = 0.01). All-cause mortality was also higher in P with RALS (31.8% vs. 12.5%, p = 0.04). P with GLS&gt;-14.8% and ASPB had significantly worse prognosis regarding all-cause mortality (p = 0.003) and MACE (p = 0.007). Kaplan–Meier survival analysis showed that survival was significantly worse for P with ASPB (log-rank 0.002). With multivariate Cox regression analysis, ASPB was independently associated with all-cause mortality (HR = 4.49, p = 0.039).

Conclusions
Suspected CA appears prevalent among patients with AS and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation.
Abstract 1226 Figure. Kaplan–Meier curves and ASPB
P1247 Bilateral endogenous endophthalmitis as the initial presentation of hacek prosthetic valve infective endocarditis
Authors: Parr E , Mcaloon C , Morley-Davis A , Ridley P , Duckett S 
Published: January 2020

Abstract

Summary
A 75 year old lady with a prosthetic aortic valve (St Jude mechanical AVR) presented to ophthalmology with a one month history of black spots in the vision of her left eye with a further episode in her right eye two weeks later, leading to a diagnosis of bilateral endogenous endopthalmitis and was admitted to hospital. There was no history of trauma and the chest and abdominal examination was normal. The erythrocyte sedimentation rate (40) and C reactive protein (45.8) were elevated. She had several sets of blood cultures, which were positive for Aggregatibacter actinomycetemcomitans, a HACEK organism and was started on empirical Ceftriaxone. The transthoracic echocardiography was normal. However, the suspicion of Infective Endocarditis (IE) was high, therefore a transoesophageal echocardiography was performed and showed an aortic root abscess (Image 1). An urgent computerised aortogram was performed. Following a planned two week period of intravenous antibiotics the patient was taken to theatre to have a redo AV valve replacement and root repair. Following a prolonged period on intensive care and a six week course of pathogen directed antibiotic therapy she was then fit enough to be discharged.

Conclusion
We present the first case in the literature of a HACEK Prosthetic Valve endocarditis presenting with bilateral endogenous endophthalmitis.
Abstract P1247 Figure. TOE image of Absess