bluuebunny/crossref_metadata_2025_split huggingface dataset:
478 A rare case of right ventricular ischaemia and ventricular tachycardia in neonate caused by intermittent occlusion of origin of the right coronary artery by an echogenic mass
Authors: Padmanabhan S 
Published: January 2020

Abstract

OnBehalf
Cornwall
A term neonate with poor condition at birth was noted to be markedly bradycardic when crying. ECG showed first degree heart block. Echocardiogram demonstrated poor bi-ventricular function. He was treated for Hypoxic ischemic encephalopathy (HIE).
In the next few hours he developed short episodes of ventricular tachycardia with left bundle branch block and non-conducted P waves suggesting an origin of tachycardia from the right ventricle.
His repeat ECHO suggested that he had right ventricular infarction due to a very rare finding of intermittent occlusion of the origin of the right coronary artery by an echogenic mass.
He was transferred for emergency cardiac surgery to remove a clot of 1.6cm, occluding the right coronary artery. Histology findings were in keeping with a thrombus. Thrombophilia screen for both parents and infant were negative. MRI Brain did not show evidence of HIE suggesting his poor condition at birth was secondary to intermittent coronary ischemia. Discussion: Myocardial infarction (MI) in neonates is a rarely encountered and potentially life-threatening condition, with mortality rate as high as 90%. We present one of the first reported cases of successful surgical management of an acute right coronary artery thrombosis after an early diagnosis. The cause of thrombosis remains unclear in our patient. They were born in poor condition with initial pH 6.9 and lactate of 10, but with a structurally normal heart and negative thrombophilia screen. Perinatal asphyxia is a potential cause; however there is doubt that this may be a symptom rather than cause of the right coronary artery occlusion. Early diagnosis was key in management after a high level of clinical suspicion. He made significant recovery with near normal RV function, and is currently on captopril and carvedilol post-surgery. This is one of the first cases to document near full return of cardiac function following ischaemia to the right ventricle
Abstract 478 Figure. 5
479 When 2 rights make a wrong
Authors: Tong J , Joseph Francis P , Lee E 
Published: January 2020

Abstract

Background
The presence of an intra-cardiac mass is always a cause for concern, with regards to not only aetiology, but also treatment of complications. We describe a case series of 2 right sided cardiac myxomas, where the first case described an unusual location for tumour occurrence, while the second case provided insights into complications of a cardiac myxoma.

Methods
The first case involved a 70 year old asymptomatic lady who was referred for an additional heart sound. A transthoracic echocardiogram (TTE) showed a large, mobile 1.5 X 1.2 cm mass, attached to the atrial surface of septal tricuspid valve leaflet, prolapsing in and out of the right sided chambers. This was confirmed on transoesophageal echocardiogram (TEE). Cardiac MRI (magnetic resonance imaging) showed a similar mass attached to the septal tricuspid leaflet with features consistent with a myxoma. She was referred to cardiothoracic surgery, and 2 lobulated tumours arising the septal tricuspid valve and adjacent posterior leaflet were seen. The tumours were resected and a bio-prosthetic tricuspid valve replacement implanted. Histology of the tumours showed myxomatous degeneration of tricuspid valve, consistent with cardiac myxoma.
The second case was a 56 year old lady who had dyspnoea, pedal oedema and an elevated jugular venous pulse on examination. A TTE done showed a large 7 X 4 cm mass extending from the right atrium (RA) into the right ventricle (RV). The left ventricular ejection fraction was 35%. Cardiac MRI confirmed the presence of a large mass in the right ventricle that exerted pressure effects on the ventricular septum and RV anterior free wall. Intra-operatively, a large RA mass attached by a stalk to the fossa ovalis was seen. The mass was excised and histology was consistent with cardiac myxoma. A repeat transthoracic echocardiogram done 2 weeks later showed normalisation of the LVEF.
See images below for more information.

Conclusion
While myxomas are the most common benign cardiac tumours, they occur less commonly in the right atrium, and much less so on the tricuspid valve. Clinical manifestations range from being completely asymptomatic, as in the 1st case, to non-specific constitutional symptoms such as fever or general malaise, and to life-threatening complications. These include embolism to the pulmonary circulation, causing sudden death, or to the systemic circulation through an intra-cardiac shunt, causing strokes. This risk is increased if the tumour is large, polypoidal and friable. Large tumours can also cause obstructive symptoms and heart failure. Thus timely diagnosis with multi-modality imaging tools, and definitive treatment with complete resection of the tumour are essential. Continued monitoring for recurrences of the tumour, which can occur in 1-5% of all cases, should be performed as well.
Abstract 479 Figure. Right sided cardiac masses
503 Unlocking the mystery of haemolytic anaemia after mitral valve repair
Authors: Sotananusak T , Yingchoncharoen T , Chaiyaroj S , Limpijankit T 
Published: January 2020

Abstract
Hemolytic anemia is an uncommon complication after mitral valve repair. All possible causes should be excluded before making a diagnosis. Echocardiography is an important tool. Transthoracic echocardiography may underestimate the severity and direction of regurgitation jets. Transesophageal echocardiography is the helpful imaging modality helping identify an accurate mechanism.
A 55-year-old female with a history of mitral valve repair 5 years earlier presented with shortness of breath for 2 months. She noticed that she had intermittent jaundice and dark urine for 5 months but these symptoms were worsening and persistent for 2 months. She had no fever and abdominal pain. She did not take any medication. The physical examination revealed mark pale conjunctiva and icteric sclera. The apex of heart was palpated at 6th intercostal space lateral to the midclavicular line. The pan-systolic murmur was audible along the mitral valve area. The lung was clear and no pedal edema. Her complete blood count showed hematocrit of 13% with fragmented red blood cell and polychromasia in a blood smear. The level of aspartate transaminase, direct bilirubin, and lactate dehydrogenase was elevated with low haptoglobin level. A chest X-ray showed cardiomegaly without pulmonary edema. The diagnosis of autoimmune hemolytic anemia was made but her symptom was not improved after corticosteroid treatment. Transthoracic echocardiography cannot explain the cause of hemolytic anemia, so the transesophageal echocardiography was performed. The echocardiography revealed severe mitral regurgitation and paravalvular leak. The turbulent flow was seen across the mitral annuloplasty ring. She underwent mitral valve replacement to treat her symptoms. After an operation, her symptoms were significantly improved without any jaundice. The hemolytic anemia was resolved.
This case demonstrated an important role of transesophageal echocardiography, especially in post heart valve surgery patient. Although hemolytic anemia after mitral valve surgery is rare, it should be considered in every hemolytic anemia patient without other explainable causes. An accurate diagnosis is a crucial role in treatment.
Abstract 503 Figure.
542 Non-invasive risk assessment of the left atrial appendage thrombosis using deep learning methods
Authors: Suvorov A , Melik - Ogandzhanyan G , Dmitrieva E , Voskresenskaya N , Kruglov A 
Published: January 2020

Abstract

INTRODUCTION
patients undergoing planned cardioversion have high risk of left atrial appendage (LAA) trombosis. Transesophageal echocardiography (TEE) is usually performed to rule out LAA thrombosis.

PURPOSE
building a model for predicting the risk of thrombosis of LAA prior to TEE in patients with atrial fibrillation (AF) planned to cardioversion based anamnesis, clinic and transthoracic echocardiography (echo) using deep learning algorithms.

METHODS
From 12.2018, 100 patients with AF included in the hospital registry or planned cardioversion. All patients underwent echo and TEE . Other clinical data was collected from medical records, echo and TEE results. Deep learning neural network was constructed in R v. 3.5.3 for risk assessment of the LAA trombosis prior to TEE. The model was trained / verified for 70% / 30% included patients.

RESULTS
Among included, 47.0% were women, mean age was 67.8 ± 11.9 years. LAA thrombosis rate was 37.0%. The paroxysmal form of AF diagnosed in 22.0%, the rest had persistent form. Arterial hypertension was observed in 77.0%, diabetes mellitus - in 14.0%. Previous stroke was diagnosed in 5.0% of patients, previous myocardial infarction — in 3.0%, heart failure - in 51.0% of patients. Median of CHA2DS2VASc score was 3 (2; 4) points. The mean indexed volume of left atrium was 50.1 ± 13.7 ml/m2, for LAA - 4.0 ± 1.8 ml/m2. Mean ejection velocity in the LAA is 3.5 ± 1.3 cm/s. Before admission 24.0% of patients did not receive any anticoagulant therapy. The group was divided into «training» and «test» parts in the proportion of 70%/30%. Both groups were statistically comparable by cardiovascular deseases, risk factors, demography, age and treatment before admission. Neural network was trained on the following factors of the «training» group: gender, previous infarction, heart failure, score for CHA2DS2VASc, creatinine level, left atrial indexed volume and linear dimensions, transmitral E and mitral annulus e`, peak and mean pressures and square of mitral regurgitation, pulmonary veins systolic and diastolic flows, anamnestic anticoagulation and duration of its intake. 10-fold cross-validation was performed. Verification (comparison of the real results with the predicted by model) was made for the «test» group: the Cohen’s kappa was 0.68, 95%CI for positive predictive value was 65.3 - 98.6%, for negative predictive value - 35.9 - 99.6%, for model accuracy 67.6 - 97.3% , ROC analysis showed 91.7% for area under curve (95%CI 79.3 - 99.9%).

CONCLUSION
deep learning neural net for assessing the risk of thrombosis of LAA using only anamnestic and echo data can be used for experimentally prediction for pretest probability of thrombosis prior to TEE. Further verification of the model with more data is required.
544 Deep learning in segmentation and function evaluation of right ventricle in 2D echocardiography
Authors: Karuzas A , Sablauskas K , Verikas D , Teleisyte E , Skrodenis L , Matuliauskas D , Balciunas J , Mileris J , Rumbinaite E , Zaliaduonyte-Peksiene D , Vaskelyte J J , Jurkevicius R , Plisiene J 
Published: January 2020

Abstract

INTRODUCTION
Deep learning (DL) has been of increasing use in the field of echocardiographic cardiology. The importance of segmentation and recognition of different heart chambers was already presented in different studies. However, there are no studies made regarding the functional heart measurements. Even though, functional measurements of right ventricle (RV) remains "dark side of the moon", no doubtfully severity of RV dysfunction influences the worse outcomes.

PURPOSE
To evaluate DL for recognition of geometrical features of RV and measurement of RV fractional area change (FAC).

METHODS
A total of 896 end-systolic and end-diastolic frames from 129 patients (with various indications for the study) were used to train and validate the neural networks. Raw pixel data was extracted from EPIQ 7G (Philips) imaging platform. All of the images were from 2D echocardiography apical four chamber views. RV was annotated in each image, with 1716 images used for training and 180 for validation.
We used the state of art mask regional convolutional neural network (MR-CNN) and attention U-net convolutional neural network models for the RV segmentation task. Intersection over Union (IoU) was used as the primary metric for model evaluation. IoU measures the number of pixels common between the target and the prediction masks divided by the total number of pixels present across both masks. Additionally FAC was calculated using frames with minimal and maximal segmented area by the network.

RESULTS
U-Net architecture demonstrated considerably faster training compared to MR-CNN with time per training step of 85 ms and 750 ms for U-Net and MR-CNN, respectively (p &lt; 0.001). MR-CNN and U-Net had an IoU of 0.91 and 0.89 respectively on validation dataset which corresponds to good performance of the model and there was no significant difference between the different neural networks (p = 0.876). Comparing the evaluation of FAC by physician and U-Net the mean squared difference was 12% when using minimum and maximum right ventricle area detected by the network.

CONCLUSION
With small dataset deep learning give us ability to recognize RV and measure RV FAC in apical four chamber view with high accuracy. This method offers assessment of RV to become daily used in the cardiologist practice, moreover, in the near future automated measurements will allow to reduce the need of observer manual evaluation. Improvements can be made in FAC calculation by also improving techniques for end-systolic and end-diastolic frame detection.
558 Prevalence of diastolic dysfunction according to EACVI/ASE guidelines from 2009 and 2016 in a 63-65 years old general population cohort-Data from the ACE 1950 study
Authors: Sveen K A , Aagaard E , Berge T , Enger S , Orstad Bjoerkan E , Roesjoe H , Omland T , Tveit A , Steine K 
Published: January 2020

Abstract

Funding Acknowledgements
Akershus University Hospital and Vestre Viken Hospital Trust

OnBehalf
ACE 1950

Background
Large surveys have previously reported a prevalence of left ventricular diastolic dysfunction (DD) between 20- and 30 % in individuals above 60 years of age. The new DD guidelines from 2016, however, have emphasized the presence of increased left ventricular filling pressure, and may result in a stricter definition of DD.

Purpose
The aim of the present study was to compare the prevalence of DD using 2009 and 2016 EACVI/ASE criteria and to identify clinical correlates of DD.

Methods
The present cross-sectional substudy consisted of 3706 indivuduals born in 1950 included in the Akershus Cardiac Examination (ACE1950) 1950 study. Comprehensive baseline cardiovascular examination was performed, including ultrasound imaging utilizing echocardiographic indices for diagnosing DD according to both the 2009 and 2016 criteria.

Results
Complete echocardiographic data were available in 3464 (93.5%) individuals. Mean age was 63.9 ± 0.7 years, and 49% were women. 11% had diabetes mellitus and 23% were obese (BMI &gt;30). In the total cohort, 19.8% (685/3464) fulfilled the 2009 criteria for diastolic dysfunction. Of these, 7.9% (n = 273) had grade 1; 8.7% (n = 303) grade 2 and 3.1% (n = 109) grade 3 diastolic dysfunction. Only 2.0% (71/3464) of the total cohort were classified with DD according to the 2016 criteria. In individuals with known diabetes the prevalence of DD was 22% and in obese this number was 28.9% using the 2009 criteria.

Conclusions
Diastolic dysfunction is present in 1 in 5 of 63-65 years old norwegians, and higher in the obese and those with diabetes, according to the 2009 criteria. However, the prevalence was dramatically lower by applying the 2016 criteria. LV filling pressure can be looked upon as dynamic and be normalized by unloading, and therefore possibly mask DD in some individuals.
561 Targeting septal work and viability identifies responders to cardiac resynchronization therapy
Authors: Aalen J , Donal E , Larsen C K , Duchenne J , Cvijic M , Leclercq C , Bogaert J , Hopp E , Fjeld J G , Penicka M , Linde C , Kongsgaard E , Galli E , Voigt J U , Smiseth O A 
Published: January 2020

Abstract

Funding Acknowledgements
The study was supported by Center for Cardiological Innovation.

Introduction
Septal dysfunction is the dominant mechanism of left ventricular (LV) failure in left bundle branch block (LBBB). We hypothesize that, provided septum is viable, septal function can recover and hence LV function improve after cardiac resynchronization therapy (CRT).

Purpose
To determine if combined assessment of septal function and viability identifies responders to CRT.

Methods
In a prospective multicenter study of 200 unselected patients referred for CRT, we measured myocardial strain by speckle-tracking echocardiography and regional work by pressure-strain analysis before and 7 ± 1 months after CRT. Viability was assessed by late gadolinium enhancement cardiac magnetic resonance imaging (n = 123). CRT response was defined as ≥15% reduction in LV end-systolic volume.

Results
Before CRT, septal work was 258 ± 463 and LV lateral wall work 1469 ± 674 mmHg·% (p &lt; 0.0001). In CRT responders, septal work was restored to 1243 ± 495 mmHg·%, whereas non-responders showed less marked improvement (p &lt; 0.0001). The figure illustrates a typical CRT responder with negative septal work and a large difference between work in the LV lateral wall and septum (panel A). There was no septal scar (panel B) and, after 6 months with CRT, septal work was recovered (panel C). Pressure-strain loops illustrate that CRT converted inefficient septal contractions with substantial negative (wasted) work to positive work throughout systole. For the entire study population, the difference between work in the LV lateral wall and septum predicted CRT response with area under the curve (AUC) 0.75 (95% CI: 0.68-0.83) and was feasible in 98% of patients. Furthermore, septal scar predicted non-response to CRT with AUC 0.76 (95% CI: 0.65-0.86). Combining work difference and septal viability improved AUC for CRT response to 0.85 (95% CI: 0.76-0.94) (figure panel D). The AUC was similar for QRS 120-150 and &gt;150 ms.

Conclusions
The proposed combined approach with assessment of septal work and viability identified CRT responders with high precision.
Abstract 561 Figure.
570 Myocardial deformation imaging after STEMI: can we better predict one-year mortality and heart failure development?
Authors: Trifunovic D , Krljanac G , Asanin M , Savic-Spasic L , Aleksandric S , Dudic J , Cucic L , Sulovic V , Mrdovic I 
Published: January 2020

Abstract

Prognosis after STEMI is still challenging. One-year mortality ranges between 10-12% and the incidence of heart failure (HF) is between 4% and 28%. Early and accurate identification of high-risk patients necessitates therapy intensification.

Aim
this study is a part of PREDICT-VT study (NCT03263949). The aim was to test whether deformation imaging based on spackle tracking echocardiography predict MACE (total mortality, HF hospitalization and NYHA class ≥3 development) better than conventional echocardiography and clinical parameters.

Methods
in 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec). LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strain were calculated as average of PSS over 18 LV segments.

Results
198 patients completed 1-year follow-up and 22 patients (11.1%) experienced MACE. Significant echo, clinical and laboratory predictors with the ROC analysis are listed in the table according to AUC .

Conclusion
peak systolic longitudinal and to a lesser degree peak systolic circumferential deformation predict mortality and HF development after pPCI better than conventional echo and even clinical parameters. From diastolic parameters only radial SR during atrial contraction was better MACE predictor compared to conventional echocardiography.
AUC p Cut-off Senz Spec Peak systolic LS epicardial layer 0.757 &lt;0.001 -11 75 63 Radial SR during atrial contraction 0.754 &lt;0.001 -0.63 65 80 Peak systolic LS mid-wall layer 0.750 &lt;0.001 -12.58 80 60 PSS LS endocardial layer 0.744 &lt;0.001 0.1409 70 61 Peak systolic CS endocardial layer 0.744 &lt;0.001 -18.08 70 67 Wall Motion Score Index 0.740 0.001 1.53 70 70 Peak systolic CS mid-wall layer 0.730 0.001 -13.66 80 60 Peak radial LV strain 0.722 0.001 14.08 80 60 Creatine kinase peak level 0.698 0.003 2155 64 73 LV EF 0.692 0.004 47.5 67 60 TAPSE 0.685 0.015 1.95 75 60 LA strain 0.676 0.012 18.33 63 64 Killip class 0.644 0.028
619 Left ventricle remodelling in severe aortic stenosis: analysis of a large cohort of patients
Authors: Ramos Jimenez J , Hernandez S , Plaza Martin M , Zamorano Gomez J L 
Published: January 2020

Abstract
Introduction
Aortic stenosis (AS) is the most prevalent valve disease. It involves increased left ventricle (LV) postcharge leading to LV hypertrophy. The aim of the study was to assess the burden of LV hypertrophy and its different patterns among a large cohort of patients with severe AS.
Methods
Observational, multicentre and prospective study of consecutive cases. Patients with severe AS defined as aortic valve area (AVA) &lt;1.0 cm2, and preserved LV ejection fraction (LVEF≥50%) were included. LV hypertrophy was diagnosed in case of LV indexed mass &gt;95 g/m2 in females or &gt;115 g/m2 in males. LV geometry was assessed by relative wall thickness ratio, considering a cut-off value of 0.42. A p value &lt;0.05 was considered statistically significant.
Results
A total of 805 patients with severe AS were included, 49.7% (n = 400) of them females and 50.3% (n = 405) males. LV indexed mass was available in 665 subjects, most of them (74.9%, n = 498) presenting LV hypertrophy. Females showed higher prevalence of LV hypertrophy than males (82.7% vs. 60.5%; p &lt; 0.01). Concentric hypertrophy was the most frequently encountered phenotype (63.9%; n = 420), being significantly more prevalent among women (74.3% vs 53.4%; p &lt; 0.01). Despite that increased hypertrophy, females showed less severe AS when comparing mean transaortic gradient (39 mmHg vs 42 mmHg; p = 0.04) and indexed AVA (0.42 cm/m2 vs 0.40 cm/m2; p = 0.02). LV hypertrophy was associated with enlarged atria and higher pulmonary systolic pressure.
Conclusions
LV hypertrophy affects most of patients with severe AS. LV remodelling is different between gender, with women developing higher grade of hypertrophy despite lesser AS severity. LV hypertrophy is associated with poor prognosis echocardiographic signs (increased PSAP and indexed LAV).
Differences related to LV mass Normal LV mass LV hypertrophy P value Indexed AVA (cm/m2) 0.42 ± 0.01 0.41 ± 0.01 0.52 Mean gradient (mmHg) 42 ± 0.7 36 ± 1.1 &lt;0.01 Indexed stroke volumen (mL/m2) 41 ± 1 37 ± 1 &lt;0.01 Indexed LAV (mL/m2) 46 ± 1 38 ± 1 &lt;0.01 PSAP (mmHg) 30 ± 2 41 ± 1 0.01 LAV left atrial volume PSAP: pulmonary systolic arterial pressure
Abstract 619 Figure. Sex related LV geometry patterns