bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1276 Excess mortality associated with atrial fibrillation complicating tricuspid regurgitation
Authors: Peri Y , Topilsky Y A N , Sadeh B E N , Merdler ILAN , Steinvil ARIE 
Published: January 2020

Abstract

Introduction
There is limited data regarding the prevalence of Atrial Fibrillation (AFib) in tricuspid regurgitation (TR) patients. In addition the influence on mortality of AFib on TR patients is not well studied. In the current study we aimed to examine whether the prevalence of AFib is related to the severity of TR and to assess effect of AFib on the mortality of TR patients.

Methods
The cohort included 397 patients (mean age 77.1 ± 15.2 Years; 36.3 % males) with TR of any cause that underwent quantitative prospective evaluation by the PISA method for regurgitant volume and effective regurgitant orifice (ERO). The primary outcome was all-cause mortality.

Results
251 (65.9%) of the patients were classified as mild to moderate TR (ERO &lt; 0.4) and 130 (33.6%) patients classified as severe TR ( ERO≥ 0.4)
The prevalence of AFib in the total cohort was 56.4%. The prevalence of AFib in the mild to moderate TR patients was lower than in the severe TR group (52.5% vs. 63.9%; p = 0.03). In univariate Hazard analysis atrial fibrillation was associated with increased mortality (HR = 1.18, P &lt; 0.04). In sub-group analysis atrial fibrillation was associated with excess mortality in the mild and moderate TR group (Log Rank Chi square = 3.11, p= 0.07) but not in the severe TR group.

Conclusions
The prevalence of AFIB among TR patients is high, and severe TR is associated with higher prevalence of AFIB compared to milder disease.
AFib is independently associated with mortality in patients with less than severe TR but not in the severe TR group.
Abstract P1276 Figure.
P1278 Budget impact of global longitudinal strain for the early detection of cardiotoxicity incorporation in the brazilian private healthcare system
Authors: Miglioranza M , Lucchetta R C , Barros Pena J L , Castillo J M , Oliveira Jr W P , Almeida A L C , De Resende M V C , Riveros B S , Rosim M P , Medeiros M , Dos Santos W M , Okumura L , Nita M E , Vieira M 
Published: January 2020

Abstract

Funding Acknowledgements
Department of Cardiovascular Imaging / Brazilian Society of Cardiology

Objective
To estimate the budget impact of incorporating global longitudinal strain (GLS) for the early detection of cardiotoxicity in patients under cancer treatment, compared to conventional echocardiographic measurements (ECO) in the Brazilian Private Healthcare System (PHS). Methods: The BI was calculated based on a Markov constructed with the following health states: no changes, cardiotoxicity, heart failure, reversibility and death, with annual cycles. Eligible population was estimated through an epidemiological approach, based on the prevalence of cancer, proportion of cancer patients treated with anthracyclines and proportion of patients covered by health plans. The time horizon was 5 years, with perspective of the PHS. One scenario was built considering only the cost of GLS and ECO, whereas the other scenario included direct medical costs related to the management of cardiotoxicity and heart failure. Probabilistic sensitivity analyses were performed to explore uncertainties. Results: The initial eligible population was estimated in 209,657 patients. The scenario considering only GLS and ECO procedures costs resulted in a positive BI, from BRL3.6 million in the first year to R$ 59 million in the fifth year. Considering total costs, the incorporation of GLS has the potential to result in savings to PHS from the fourth year of incorporation. In the fifth year the economy reaches about R$ 9 million. Deterministic results are corroborated by the probabilistic analyses. Conclusion: Cardiotoxicity has a major impact in cancer patients treated with anthracyclines, being associated with increased risk of heart failure and mortality. Since GLS has the potential of early detection of cardiotoxicity, allowing the rapid onset of treatment, the use of GLS has the potential to promote savings for the private healthcare system.
Abstract P1278 Figure. budget impact of GLS
P1282 Follow-up evaluation of right chambers mechanics is associated with prognosis in group 1 pulmonary arterial hypertension
Authors: Biondi F , Albani S , Lo Giudice F , Howard L , De Luca A , Tsampasian V , Pasanisi E G M , Sinagra G , Stolfo D 
Published: January 2020

Abstract

Background
Pulmonary arterial hypertension (PAH) is a severe disease that progressively leads to right ventricular (RV) failure and cardiovascular death. Evaluation of right heart mechanics by means of 2-dimensional speckle tracking echocardiography (2D-STE) has displayed to be a promising tool to estimate prognosis in PAH patients.

Purpose
To evaluate the association between right ventricular free wall longitudinal strain (RVFWLS) and right peak atrial longitudinal strain (RPALS) at follow-up after initiation of specific vasodilator therapy in PAH patients, with outcomes.

Methods
83 subjects diagnosed with PAH Group 1 at three University Hospitals (Hammersmith Hospital, London, United Kingdom; Trieste University Hospital, Trieste, Italy; FTGM, Pisa, Italy), who were naive from specific treatment for PAH at the time of diagnosis, were retrospectively enrolled in this study. Standard echocardiographic parameters were collected. Outcomes were defined as the combination of all-cause mortality, hospitalization for PAH and first prostanoid administration. We investigated the correlation between RVFWLS and RPALS with outcomes adjusting for validated echocardiographic parameters strongly associated with prognosis in PAH (right atrial area – RAA and pericardial effusion – PE) and patients’ haemodynamics.

Results
30 patients experienced outcomes during a median follow-up time of 33 months. Median RVFWLS at follow-up was -15.8% (IQR: -12.1%/- 21.1%). Median RPALS at follow-up was 25% (IQR: 17.9%/36.6%). In the multivariate analysis, RVFLWS at follow-up was independently associated with outcomes (95% confidence interval [CI]: 1.01 – 1.24, p = 0.04), irrespectively from RAA (95% CI: 0.98 – 1.20, p = 0.12) and pulmonary arterial systolic pressure (PASP, 95% CI: 0.99 – 1.06, p = 0.12). We also observed a trend towards superiority of RPALS at follow-up (95% CI 0.90 – 1.00, p = 0.07) over RAA (95% CI: 0.98 – 1.20, p = 0.14) and PASP (95% CI: 0.99 - 1.05, p= 0.31). Finally, RPALS (95% CI: 0.88 – 1.00, p = 0.05) was independently associated with outcomes over PE (95% CI: 0.14 – 1.89, p = 0.32) and RVFWLS (95% CI: 0.97 – 1.20, p = 0.16).

Conclusions
In PAH group 1, assessment of both RVFWLS and RPALS at follow-up is associated with outcomes, independently from standard echocardiographic parameters.
P1323 From a suspicion of pulmonary arterial hypertension to a rare form of Takayasu disease
Authors: Wrona K , Polak M , Mizia-Stec K 
Published: January 2020

Abstract
A 27-year-old female with a history of glomerulonephritis,with diagnosed systemic lupus
and retroperitoneal fibrosis was admitted due to fast worsening dyspnoea(NYHA class IV)
over the prior four weeks with suspicion for PA hypertension. In 2015, retroperitoneal fibrosis was diagnosed based on MR examination. With the methylprednisolone treatment a regression of changes was obtained. The patient was chronically treated with prednisone 7.5mg/day and mycophenolate
mofetil 2g/d.
When admitted to the ward, the patient was in a severe condition, with
symptoms of resting dyspnea and blood oxygen saturation up to 80%. A loud systolic
murmur was audible over the entire chest. In laboratory tests, the NT-proBNP values
(11,000 pg/ml) were significantly elevated, arterial blood gases showed tendency to alkalosis, hypoxemia (PO2 45mmHg)with hypocapnia. Parameters of inflammation were moderately elevated
(CRP 25mg/l, WBC 12,000/ul), with normal serum IgG4 concentrations. In TTE, significant dilatation of the right ventricle with left chamber compression were observed. Tricuspid ring dilation with no leaflets coaptation and a severe tricuspid regurgitation
(Vmax 5m/s, RVSP 100mmHg) were found. In addition, the critical proximal pulmonary artery
(PA) stenosis was revealed (left PA Vmax 3.3m/s, Pmax 42mmHg, right PA Vmax 5.2 m/s,
Pmax 110mmHg). Angio-CT confirmed critical proximal constriction of both PAs with a flow
channelup to 4 mm. Based on angio-CT and cardiac MR study the inflammatory
etiology of stenoses was suspected and an empiric diagnosis of the Takayahu disease of
pulmonary arteries was made. The patient was qualified for conservative treatment using prednisone and cyclophosphamide.
Over the course of two months,2.8 g of cyclophosphamide were administered intravenously in
three cycles with good response to the treatment. It resulted in regression of dyspnea and a
improvement in exercise tolerance - to the NYHA class II, normalization of
saturation. Laboratory tests showed reduction of NT-proBNP (1300 pg/ml). Control
TTE revealed reduction in the size of the right ventricle and regression of PAs stenoses
(left PA 11mm, right PA 7mm), also reduction of systolic flow gradients
(left PA Vmax 3.1 m / s, Pmax 39 mmHg, right PA 4.1 m/s, Pmax 68 mmHg).
Because of the significant improvement in patient’s condition,it was decided to continue the treatment.
Legend for the Fig.1 A angio-CT, critical proximal constriction of both PA B TTE, parasternal short axis view, imflammatory infiltration C TTE, continuous wave doppler, flow velocity pattern in the PA stenosis D TTE PLAX, dilatation of the right ventricle with left chamber compression fig. 1
Abstract P1323 Figure. Fig.1 artety pulmonary stenosis
P1409 Sizing of mitral annuloplasty rings using three-dimensional transoesophageal echocardiography
Authors: Yoshitani K , Fujii T , Ito S , Shimokawa A , Ohnishi Y 
Published: January 2020

Abstract

Funding Acknowledgements
Department funding

Background
Mitral valve repair is preferred to valve replacement in cases of degenerative mitral regurgitation (MR) due to the lower risk of valve-related complications and operative mortality. In mitral valve repair, annuloplasty is associated with better clinical outcomes. Sizing of the annuloplasty ring with a ring sizer, which should be performed in the end-systolic phase, is performed in diastole during hyperkalaemia cardioplegic arrest. Three-dimensional transoesophageal echocardiography (3D-TEE) allows measurement of the mitral valve while the heart is beating, which is beneficial since the mitral valve size changes throughout the cardiac cycle.

Purpose
To investigate whether 3D-TEE measurements of the mitral valve are effective for preventing recurrent mitral regurgitation (MR) in patients who undergo mitral valve repair for degenerative MR.

Methods
This study retrospectively reviewed 139 patients who underwent mitral annuloplasty for degenerative MR. After 47 patients were excluded, 92 patients were analysed. The inter-commissural (IC) distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systolic phase. The annuloplasty ring size and type were selected by surgeons using specific ring sizers. We investigated the association of the IC distance with the size of implanted annulus ring and differences between the size of implanted annulus ring and the IC distance. We also compared the IC distance, the A2 height, and the ratio of A2 height to IC distance between patients with and without recurrent mild-to-moderate MR for 36 months.

Results
There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance (R²=0.7023, p &lt; 0.001). The variety between implanted annulus ring size and IC distance measured by 3D-TEE was shown in Figure1. Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). The A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059).

Conclusions
There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance. Our results demonstrated a higher ratio of A2 height to IC distance in patients with recurrent MR.
Abstract P1409 Figure1
P1485 multiple hindrances in and outside the heart : right ventricular outflow tract obstruction in a child with severe post-subclavian coarctation of aorta and ventricular septal defect
Authors: Naganur S 
Published: January 2020

Abstract

Funding Acknowledgements
Not applicable

OnBehalf
Not applicable
11 years boy with shortness of breath/easy fatigability. On examination obese, comfortable at rest, pulse : 80bpm, regular, normal JVP. Blood pressure : 170/100 in upper limb, 120/80 in lower limb. Mild cardiomegaly, normal S2, no S3/S4/click, harsh 4/6 ESM in left 3rd intercostal space, faint continuous murmur at the back. CXR : mild cardiomegaly, adequate pulmonary blood flow. ECG : sinus rhythm, normal QRS axis/intervals, biventricular hypertrophy. Echo : severe pulmonary stenosis (predominantly subvalvular, gradient 100mmHg) coarctation (gradient 50mmHg) preserved biventricular function. Cardiac CT : confirmed echo" findings, additional ? DCRV, anomalous RCA from left sinus. Cardiac MRI couldn"t yield more information. Hence, catheterization was performed. Pressure data : severe infundibular and mild valvular RVOT obstruction, normal PA pressure, severe coarctation. Oximetry : small L–&gt;R shunt. RV angiogram : obstruction at sub-valvular/valvular levels, doming/reverse doming of pulmonary valve. LV angiogram : small subaortic VSD, L–&gt;R. Aortic root angiogram : bicuspid aortic valve, no AR, anomalous RCA from left sinus, severe coarctation, no PDA. Plan : Single antihypertensive, surgical resection of infundibular RVOTO, pulmonary valvotomy, VSD closure, coarctation repair.
Cath data Pressure in mm of Hg Right atrium (mean) 8 Right ventricle (apex) systolic 100 end diastolic 12 Right ventricle (outflow) systolic 60 end diastolic 12 Main pulmonary artery 25/10 (15) Left ventricle systolic 158 end diastolic 14 Ascending aorta 165/75 (140) Descending aorta 116/80 (100) Right Femoral artery 117/76 (98) Oximetry Superior vena cava 68% Inferior vena cava 74% Pulmonary artery 82% Aorta 99% Pulmonary vein 100% Qp/ Qs 1.6:1
Abstract P1485 Figure. CT/MRI/Cath
P1510 Assessment of left ventricular relaxation time constant by noninvasive left ventricular pressure-strain loop: invasive validation
Authors: Meledin V , Haberman D , Gandelman G , Poles L , Goland G , George J , Gerafi A , Edri O , Shimoni S 
Published: January 2020

Abstract

Introduction
Left ventricular (LV) relaxation time constant, Tau (τ), is one of the best indexes to evaluate left ventricular diastolic function and is usually assessed invasively. Tau is the time constant of the exponential regression Pt =(P0-P∞)e-t/τ+P∞ that expresses left ventricular isovolumic pressure decay, where Pt is LV pressure (LVP) at time t, P0 is LVP at dP/dtmin and P∞ is the asymptotic pressure, to which relaxation would lead if completed without LV filling. Several noninvasive methods were developed to calculate Tau, however, they are time-consuming and complicated. Recently, a simple method regional left ventricular pressure–strain loops and myocardial work was introduced and validated. We hypothesize that left ventricular relaxation time constant can be derived and calculated from the LV pressure–strain loops.

Objective
To calculate noninvasively Tau using LV pressure–strain loops and compare it to invasive Tau assessment.

Methods
The study includes patients with preserved LV systolic function without significant valvular disease that were scheduled to elective coronary catheterization. During catheterization, a fluid-filled catheter was placed in the LV to measure pressure. Echocardiography was performed simultaneously with LV pressure recording. Three standard apical views were acquired and subsequently 2D strain analysis was performed using commercially available GE software and LV pressure–strain loops were calculated. Doppler signal was used for timing of valvular events. Tau was calculated by the equation τ =P/(-dP/dt) that is a derivative of the ventricular pressure decline P = P0e-t/τ+PB with respect to time. The pressure between peak negative dP/dt and the lowest LV pressure shortly after mitral valve opening was used for this calculation. The study was approved by the institutional ethics committee.

Results
Forty patients, (mean age 65.1 ± 10.9 years, 27 male, BSA1.93 ± 0.18 m2) were included in the study. Heart rate and the mean blood pressure at the time of catheterization were 69.9 ± 11.8 min-1 and 85.2 ± 18.8 mmHg, respectively. The mean LV end diastolic diameter was 44 ± 4 mm, the LV mass was 86.7 ± 25.2 g/m2, LVEF 58.4 ± 6.6% and GLS 21.0 ± 3.2%. Tau, calculated noninvasively using derivative method was significantly lower than invasively derived measurement (40.1 ± 13.4 vs 49.8 ± 7.7 msec, p = 0.002). However, a significant positive correlation was observed between the two methods (r =0.67, p &lt;0.001, Figure).

Conclusions
This preliminary study demonstrates that Tau estimated by a noninvasive method using LV pressure–strain loops has a good correlation with Tau measured invasively. Therefore, Tau can be estimated noninvasively using novel left ventricular pressure–strain loop method.
Abstract P1510 Figure.
P1548 Changes in left ventricular deformation with weight loss in obese adolescents with intellectual and developmental delays (IDD)
Authors: Forsha D , Ptomey L , Johnson T , Goth N , Kuzava L , France R , Kathol M , Artman M , Donnelly J 
Published: January 2020

Abstract

Funding Acknowledgements
AHA Career Development grant

Background
Adolescents with IDD have twice the prevalence of obesity as their typically developed peers, leading to frequent early obesity-related subclinical cardiac dysfunction, detected by strain echo. The effects of weight loss on cardiac deformation are unknown in this population.

Purpose
To evaluate early cardiac dysfunction in overweight IDD adolescents before and after a 6-month caloric restriction-weight loss program.

Methods
Subjects with IDD co-enrolling in a weight loss program were consented for this strain imaging study, excluding those with congenital heart disease. An echo measuring LVEF (bullet), 2D speckle longitudinal LV global strain (GLS) and strain rate (GLSr) from 3 apical views and global circumferential strain from a parasternal short axis view at the paps (GCS) was performed at baseline and 6 months. Analysis included paired T-test and regression analysis, p ≤ 0.05 significant.

Results
Overweight (5) and obese (15) adolescents (40% female) had baseline LV strain measurements that were mildly diminished with increased baseline body weight predicting diminished GLS (P = 0.034) and GCS (P = 0.046) on regression modeling. After 6 months, weight and BMI decreased significantly with improvements in GLS and GCS and non-significant trends towards improvement in GLSr and early diastolic global strain rate. BMI change at 6 months predicted change in GLS (p = 0.015) and GCS (p = 0.0087) on regression modeling. At baseline, LVEF and LV end-diastolic volume were normal with no change over 6 months (p &gt; 0.55).

Conclusions
Baseline abnormalities in LV deformation with preserved LVEF are present in this young, obese IDD population with improvements in BMI predicting those in GLS and GCS after a 6-month caloric restriction-weight loss program. These data provide compelling justification for larger studies in this population.
n Baseline (mean ± SD) 6-mo. follow up 0-6 mo. change p-value Age (years) 20 17.0 ± 2.0 17.5 ± 2.1 0.5 ± 0.1 Weight (kg) 20 86.9 ± 22.2 83.1 ± 22.7 -3.7 ± 5.9 0.014 BMI (kg/m&sup2;) 20 32.2 ± 5.3 30.4 ± 5.7 -1.8 ± 2.2 0.0031 GLS (%) 20 16.9 ± 1.6 19.2 ± 2.7 2.4 ± 2.0 0.00023 GLSr 20 1.15 ± 0.018 1.22 ± 0.18 0.06 ± 0.16 0.096 EaGLSr 20 1.83 ± 0.038 2.01 ± 0.46 0.18 ± 0.45 0.098 GCS (%) 20 19.1 ± 2.3 22.0 ± 2.6 2.82 ± 2.6 0.00019 LV deformation before and after weight loss. GLS, GLSr, and GCS are reported as positive values (absolute values). Body Mass Index (BMI); Early Diastolic Global Longitudinal Strain Rate (EaGLSr)
P1549 The quantitative value of PSI and time interval between AV closure and regional peak longitudinal strain in the assessment of CAD severity by the use of resting 2D ST_TTE
Authors: Farooq Al Kareem SAHAR , Ali Farhan Al Farhanal HASAN , Abdul Raheem YOUSIF 
Published: January 2020

Abstract

Background
Early detection of myocardial ischemia has important therapeutic and prognostic implications. Evidence of post-systolic shortening (PSS) on speckle tracking TTE is indicative of delayed myocardial contraction after aortic valve closure (AVC), and has been proposed to be a marker of myocardial ischemia. The pathologic post systolic strain index (PSI) only exists in patients with decreased systolic strain and thickening.

Purpose
To evaluate the PSI and time interval from AVC to regional PLS measured by using resting 2D speckle tracking TTE for detection of LV myocardial ischemic segments and lesion severity confirmed by coronary angiography.

Methods
A cross sectional study of patients with ischemic heart disease, underwent 2D speckle tracking TTE (Vivid E9, GE Healthcare) immediately before invasive coronary angiography. PSI, regional PLS and time interval from AVC to regional PLS in each LV segment were calculated.

Results
63 stable patients, the mean age 55.6 (± 10.95) years and male: female ratio (2: 1). Coronary angiographic lesion ≥ 50% was detected in (334) LV segments of corresponding coronary artery territory. There were significant differences between LV segments with &lt;50% CA lesion severity and LV segments with ≥50% CA lesion severity regarding both the PSI and Time interval from AVC to regional PLS. To identify the LV segments of the corresponding CA territory with ≥50% lesion severity, the receiver operator characteristic (ROC) curves for PSI and the time interval had areas under the curve (AUC) values 0.82 and 0.63 respectively which were statistically significant with best cut-off points of PSI was 15% (sensitivity 84%, specificity 68%) and for the Time interval was 85msec (sensitivity 68%, specificity 55%).

Conclusion
In ischemic patients with ≥50% coronary artery stenosis, as confirmed by invasive coronary angiography, the measurement of PSI and the time interval simultaneously on resting 2D ST_TTE, enabled the identification of LV segments of the corresponding coronary artery territory with pathologic (ischemic) PSS by using each appropriate threshold for PSI and time interval with excellent diagnostic accuracy. When both measures were significant, the sensitivity and specificity being (49 %, 69.8%) respectively which is better than using one measure alone.
Best cut-off point of PSI & Time interva variable cut-off point sensitivity specificity PSI 15% 84% 68% Time Interval 68% 55% PSI & Time Interval 15% , 85 msec 49% 69.8%