bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1356 Effects of sacubitril/valsartan on vascular resistance in patients with heart failure with reduced ejection fraction and arterial hypertension
Authors: Bayraktarova I , Katova T 
Published: January 2020

Abstract

Introduction
Vascular resistance as assessed by noninvasive measurement of the pulse-wave velocity (PWV) is a well-established separate risk factor for early cardiovascular morbidity and mortality.
High vascular resistance leads to higher pulse wave velocities and augmented values of systolic blood pressure (SBP). That leads to elevation in myocardial oxygen consumption and elevated left ventricular (LV) wall stress, indirectly worsening the systolic function of an already failing LV. PWV can be taken as an integral index of the vascular structure and function.
Sacubitril/valsartan is the first ARNI approved for the treatment of heart failure with reduced ejection fraction (HFrEF) – it simultaneously inhibits the renin-angiotensin-aldosterone system and employs the positive effects of the natriuretic peptides. The mechanisms of these remarkable effects – reduction of cardiovascular morbidity, of heart failure hospitalisations, of sudden cardiac death and of composite mortality, in patients with HFrEF are quite complex. The concomitant lowering of BP is an important element of the pathophysiologic process that improves the haemodynamic status of the patients.

Purpose
To evaluate the effect of sacubitril/valsartan on vascular level parameters.

Materials and methods
In 18 newly established patients with HFrEF and arterial hypertension we prescribed 6-month sacubitril/valsartan treatment protocol at a dose level 97/103 mg.
We measured the baseline office pressure, LV ejection fraction, 2D LV strain and Е/E1 values, and we performed analysis of the arterial rigidity by measuring the following parameters:

Arterial elastance
Еа= systolic BP / LV stroke volume

LV endsystolic elastance
ЕV = systolic BP / LV telesystolic volume
End-systolic stress of the LV wall: ЕSS = (0.33 х TSDLV х SBP) / PW х (1 + PW) / TSDLV)
Ventricular-arterial impedance: Zva = (SBP + mean transaortic gradient) / indexed LV stroke volume.
At the end of the six months" treatment protocol we measured the same parameters again.

Results
During the six months treating period the systolic arterial pressure fell significantly from 128 ± 9.8 mmHg to 113 ± 17 mmHg (р=0.002), and diastolic BP, also significantly, fell from 83.5 ± 9.5 mmHg to 70.1 ± 6.8 mmHg (р=0.001). There was a significant decrease in PWV, arterial elastance, end-systolic LV wall stress and in ventricular-arterial impedance, but not in the other measured parameters.

Conclusion
Treatment with sacubitril/valsartan at a high dose level of 97/103 mg for six months improves the indices of arterial rigidity, but does not lead to significant change in ventricular-arterial coupling, despite of significant lowering of the arterial elastance and pulse wave velocity.
P1359 Left ventricle hypertrophy and diastolic dysfunction in haemodialysis patients after surgical reduction of arteriovenous fistula blood flow
Authors: Valerianova A , Kovarova L , Hruskova Z , Bednarova V , Tuka V , Trachta P , Malik J 
Published: January 2020

Abstract

Funding Acknowledgements
Grant of the Grant Agency of Charles University and grant of the Czech Health Research council

Introduction
Over 50% of patients treated by chronic haemodialysis programme die of cardiovascular diseases. Changes of heart structure and function can be detected by echocardiography. The most frequent changes are left ventricle hypertrophy (LVH) and its diastolic dysfunction. One of the considered contributing mechanisms is the hyperkinetic circulation.

Purpose
The aim of this study was to analyse the effect of high flow arteriovenous fistula (AVF) on eft ventricular hypertrophy and diastolic function.

Materials and methods
We included 30 patients with a high-flow arteriovenous fistula into the study, indicated for AVF blood flow reduction because of heart failure or hand ischemia. All the patients underwent echocardiographic examination and ultrasonographic measurement of AVF blood flow before and 6 weeks after the surgery.

Results
The AVF banding led to significant reduction of Qa (from 2977 ± 1408 to 1295 ± 610 mL/min; p ˂ 10-6, accompanied by significant decrease of cardiac index (from 4.34 ± 1.09 to 3.56 ± 0.90 L/min.m2). These findings were accompanied by significant reduction of left ventricle mass index (from 125 ± 31 to 116 ± 32 g/m2; p = 0.04) and by improvement of diastolic dysfunction grade (from 1.66 ± 0.67 to 1.14 ± 0.95; p = 0.03). The maximum velocity of tricuspid regurgitation decreased (from 3.1 ± 0.4 to 2.7 ± 0.5), and so did the left atrium volume index (from 47 ± 14 to 42 ± 15 mL/m2; p = 0.01).

Conclusions
LVH and diastolic dysfunction are frequent in haemodialysis patients; hyperkinetic circulation caused by high-flow arteriovenous fistula is one of the significant contributing mechanisms. Surgical reduction of AVF blood flow improved diastolic function of the left ventricle and reduced the hypertrophy in our patient population. AVF flow volume should be always considered during cardiological examination of haemodialysis patients.
P1360 Tricuspid peak systolic S wave tissue doppler velocity &gt;12 cm/s avoid 50% of right heart catheterization in Pulmonary Arterial Hypertension
Authors: Fauvel C , Raitiere O , Burdeau J , Si Belkacem N , Bauer F 
Published: January 2020

Abstract

Background
Clinical risk stratification in pulmonary arterial hypertension (PAH) relies on BNP level, NYHA functional class, 6min-walk distance and cardiac output by right heart catheterization (RHC) with no place for non-invasive mean like echocardiography.

Purpose
To avoid systematic RHC in PAH patients, we aimed to determine both tricuspid peak systolic S wave tissue Doppler velocity (S-DTI, cm/s) and tricuspid annular plane systolic excursion (TAPSE, mm) cut-off values that best correlated to invasive cardiac index ≥2.5l/min/m² (CI, meaning low risk clinical worsening or death) in an initial cohort and to test them in a validation cohort.

Methods
From a single referral pulmonary hypertension centre, 125 PAH patients (initial cohort) underwent 406 hemodynamic investigations with RHC and echocardiography on the same day. S-DTI and TAPSE were performed from a standard manner following the 2015 EACVI/ASE recommendations. This initial cohort served for the receiver operating characteristic analysis from which the cut-off values were investigated in a validation cohort, to test the cardiac index stratification.

Results
The initial cohort had a mean age of 66.9 ± 14.4 y. Mean pulmonary artery pressure averaged 44 ± 12 mmHg, CI was 2.8 ± 1.0 l/min/m2, S-DTI was 11.2 ± 2.9 cm/s and TAPSE was 18.4 ± 4.7 mm. Both pulsed S-DTI and TAPSE were correlated to invasive CI (p &lt; 0.001 and p &lt; 0.0001, respectively). S-DTI ≥12 cm/s or between &lt;12 cm/s and ≥10 cm/s with TAPSE &gt; 17 mm had a specificity of 0.89 and 0.90, respectively to detect CI ≥ 2.5l/min/m² from the ROC curve analysis. Applying this cutoff-based stratification provided similar results in the validation cohort of 97 PAH patients (mean age = 65 ± 16 y, mean pulmonary artery pressure = 45 ± 16 mmHg, CI = 3.0 ± 1.0 l/min/m2, while S-DTI = 11.1 ± 3.1 cm/s, TAPSE = 17.8 ± 5.4 mm). Overall, almost 50% of patients were appropriately classified avoiding RHC

Conclusion
Considering tricuspid peak systolic S wave tissue Doppler velocity ≥12 cm/s or &lt;12 cm/s but ≥10 cm/s with tricuspid annular plane systolic excursion by M-mode &gt;17 mm, then RHC may be avoided in almost 50% of patient to predict CI≥2.5l/min/m² in PAH patients.
P1361 Loading conditions might mimic right ventricular longitudinal dysfunction in patients with chronic left heart disease and forward failure
Authors: Bech-Hanssen O , Fredholm M , Bartfay S E , Karason K , Dellgren G , Ricksten S E 
Published: January 2020

Abstract

Background and aim
Right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important prognostic implications. RV longitudinal function parameters (tricuspid annular plane systolic excursion, TAPSE; peak systolic longitudinal strain, RV-Str; tricuspid annulus systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesized that longitudinal RV dysfunction (LDF) might be due to loading conditions and not necessarily RV dysfunction.

Methods
We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC), ergospirometry (n = 47) and echocardiography (Echo) within 48 hours. Patients were divided into three groups from Echo data: normal RV function (TAPSE ≥17 mm + normal central venous pressure (CVP) from collapsibility of cava inferior, n = 18); LDF (TAPSE &lt; 17 mm + normal CVP, n = 22) and RVF (CVP≥10 mmHg, n = 26).

Results
Patients with RVF had compared with normal and LDF lower peak VO2, more advanced LHD, enlarged RV and higher RV afterload (Table). Patients with LDF had compared with normal reduced stroke volume index (SVI). The patients with normal and LDF did not differ regarding right atrial pressure (RAP) response during exercise (P = 0.84). The longitudinal parameters did not differ between patients with LDF and RVF.

Conclusions
Longitudinal parameters in patients with chronic LHD and normal CVP should be interpreted with caution. Loading conditions with reduced stroke volume might mimic LDF.
Normal (n = 18) LDF (n = 22) RVF (n = 26) Overall P-value Normal vs LDF Normal vs RVF LDF vs RVF Peak VO2 (mlO2/min/m2) 14.8 ± 3.3 13.5 ± 3 11 ± 2 0.001 0.29 &lt;0.001 0.005 RAP (mmHg) 4 ± 3 4 ± 4 12 ± 3 &lt;0.001 0.55 &lt;0.001 &lt;0.001 PASP (mmHg) 32 ± 13 37 ± 14 47 ± 11 &lt;0.001 0.28 &lt;0.001 0.002 PCWP (mmHg) 10 ± 6 14 ± 7 22 ± 5 &lt;0.001 0.03 &lt;0.001 &lt;0.001 SVI(ml/m2) 43 ± 10 34 ± 6 30 ± 9 &lt;0.001 &lt;0.001 &lt;0.001 0.15 PVR (Wood unit) 2.0 ± 1.1 2.0 ± 0.8 2.3 ± 1.1 0.29 - - - RVdA (cm2) 19 ± 3 22 ± 7 26 ± 7 0.003 0.16 &lt;0.001 0.04 RVsax (mm) 23 ± 4 25 ± 8 34 ± 8 &lt;0.001 0.42 &lt;0.001 &lt;0.001 TAPSE (mm) 21 ± 4 12 ± 3 12 ± 3 &lt;0.001 &lt;0.001 &lt;0.001 0.98 TAPSm (cm/s) 11 ± 3 8 ± 2 8 ± 2 &lt;0.001 &lt;0.001 &lt;0.001 0.55 RV-Str (%) -24 ± 5 -16 ± 5 -15 ± 5 &lt;0.001 &lt;0.001 &lt;0.001 0.87 PASP, pulmonary systolic pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; RVdA, RV diastolic area; RVsax, RV short axis diameter.
P1363 Risk factors of severe tricuspid regurgitation after left-sided valve surgery
Authors: Horita R , Mahara K , Izumi Y , Terada M , Kishiki K , Takanashi S 
Published: January 2020

Abstract

Background
Tricuspid regurgitation (TR) sometimes deteriorate late after left-sided valve surgery. The recent guidelines recommend tricuspid valve repair at the same time as the left-sided valve surgery. However, little is known about the pathophysiology that leads to severe TR after left-sided valve surgery.

Purpose
To clarify the risk factors of the patients with severe TR after left-sided valve surgery.

Methods
We retrospectively investigated consecutive 526 patients diagnosed as severe TR from January 2004 to December 2018 at our hospital. Clinical background, echocardiographic parameters were evaluated. Demographic information and clinical data (including age, electrocardiograms, type of left-sided valve surgery, underlying valve diseases and history of pacemaker or ICD implantation) were obtained by chart review.

Results
Of the 526 patients with severe TR, 107 patients were after a left-sided valve surgery. Patients developed severe TR at a mean of 14.8 ± 8 years after surgery.The surgical indications were as follows: mitral valve stenosis (74 patients, 69%), mitral valve regurgitation (43 patients, 40%), aortic valve stenosis (37 patients, 35%) and aortic regurgitation (28 patients, 26%), respectively. The mean age at diagnosis of severe TR was 74 ± 10 years and 75 were female (70%). Among those patients, 32 patients (30%) had a tricuspid annuloplasty (TAP) with the first left-sided valve surgery. Ninety-five patients (88%) had atrial fibrillation (AF), 75 patients (70%) were diagnosed as rheumatic heart disease, 64 patients (60%) had pulmonary artery hypertension (PH) and 28 patients (26%) had a permanent pacemaker or ICD implantation.
There were only 12 patients who had severe TR without AF. Eight of 12 patients without AF had PH, and permanent pacemakers were implanted in remaining 4 patients.

Conclusions
Almost all patients with severe TR after left-sided valve surgery present with AF and prevalence of rheumatic heart disease were about 70 percent. These two factors may be one of the important risk factors for severe TR after left-sided valve surgery.
P1369 Mitral regurgitation reduction after transcatheter aortic valve implantation (TAVI)
Authors: Ostrowska Kaim E , Stapor M , Trebacz J , Sobczynski R , Konstanty-Kalandyk J , Wiewiorka Ł , Nawara-Skipirzepa J , Musial R , Zmudka K , Kapelak B , Legutko J 
Published: January 2020

Abstract

BACKGROUND
Concomitant mitral regurgitation (MR) is frequently observed in patients with severe aortic stenosis. Improvement of functional MR after TAVI has previously been reported, although influence of TAVI on organic MR remains unclear.

METHODS
We analyzed 136 patients who underwent TAVI in years 2017-2018 in our center. 16 of them had none or trivial preprocedural MR, 80 had mild preprocedural MR (nonsignificant MR group) and 40 had moderate or severe regurgitation (significant MR group). Specific etiology of each significant MR was classified as functional (11 patients), organic or mixed (29 patients). In addition, left ventricular ejection fraction (EF) was assessed using Simpson"s method. Follow-up (discharge) transthoracic echocardiographywas performed 1 to 5 days after TAVI.

RESULTS
MR diminished in 33,9% of patients undergoing TAVI (nonsignificant and significant MR group, p = 0,0118). Reduction of MR was pronounced in both: functional MR (45,4%, p = 0,0152) and organic or mixed etiology (72,4%, p = 0,0000). Left ventricular EF did not change after TAVI (p = 0,976).

CONCLUSIONS
Mitral regurgitation decreases significantly after TAVI, regardless of the etiology.
P1370 Correlation of aortic stenosis by integrated transthoracic and transesophageal echocardiography with calcium score
Authors: Schwartzenberg S , Shapira Y , Vaturi M , Nassar M , Hamdan A , Yedidya I , Ofek H , Kazum S , Monakier D , Kornowski R , Sagie A 
Published: January 2020

Abstract

Funding Acknowledgements
None

BACKGROUND
Aortic stenosis (AS) classification depends on left-ventricular ejection-fraction (LVEF &lt;≥50%), aortic valve area (AVA&lt;≥1cm2), mean pressure gradient (MG&lt;≥40mmHg), peak velocity&lt;≥400 cm/sec, and stroke-volume index (SVI&lt;≥35ml/m2). Aortic Valve Agatston CT score (AVC) correlates with AS severity by trans-thoracic echo (TTE), but its association with AS severity determined by integrated TTE and TEE is unknown.

PURPOSE
We investigated correlation of AVC with dichotomous AS grouping by Integrated TTE + TEE vs TTE only.

METHODS
64 TAVI candidates underwent sequential TTE and TEE, of which 24 underwent coronary CT within 4 months. Based on recommended conservative vs invasive treatment implication (A/B respectively), AS types were aggregated separately by TTE or Integrated TTE-TEE into two groups: Group-A (Moderate AS and Normal-Flow Low-Gradient), and Group-B (High-Gradient, Low-EF Low-Flow Low-Gradient, and Paradoxical Low-Flow Low-Gradient). Continuous and dichotomous AVC correlation (cutoffs based on guidelines) with echo binary classification was then determined.

RESULTS
Patients were 81.1(77.3-84.6) years old, 18(48.6%) were women, and had LVEF of 60% (49-65). AVC-score distribution in the two AS A/B Groups by two echo modalities is presented in the boxplot Figure. Only classification by TTE held discriminative accuracy in A/B grouping, with Area-Under-Curve of 0.736 (CI 0.57-0.9), and optimal threshold value of 1946 AU having 77% sensitivity and 74% specificity. Compared with AVC dichotomous classification, integrated TTE + TEE upgraded AS class (from A to B) in 5/6 (83.3%) patients vs 12/18 (66.7%) in which it downgraded AS class from B to A.

CONCLUSIONS
Aortic valve calcification correlates well with AS class dichotomized by operative implication through conventional TTE but not through integrated TTE + TEE. Our preliminary results appear to be caused by initial selection bias of patients in whom coronary CT performance was deemed to be justified by the treating physician rather than reflect a true better correlation between CT score and AS assessment by TTE vs by integrated TTE + TEE.
Abstract P1370 Figure.
P1373 Cardiac source of embolism diagnosed by transeophageal echocardiography - what to expect in nowadays clinical practice
Authors: Branco Mano T , Aguiar Rosa S , Timoteo A T , Rio P , Moura Branco L , Galrinho A , Abreu J , Castelo A , Vaz Ferreira V , Garcia Bras P , Mendonca T , Leal A , Gameiro F , Cruz Ferreira R 
Published: January 2020

Abstract

Background
Transeophageal echocardiography (TEE) is an essential tool to diagnose cardiac source of embolism (CSE) and to define treatment approach. Purpose: To review the identified CSE in 25 years experience in TEE at a tertiary centre. Methods: Retrospective study of consecutive patients (pts) who underwent TEE to search for CSE, from 1994 to 2019. Results: 2936 pts (55% males, mean age 53 ± 13 years). Ischemic cerebral event (96%) was the main location of embolism. TEE identified potential CSE in 41.5% and 7% had more than one diagnostic. The most frequent CSE were patnt foramen ovale (PFO) (16.3%) and atrial septal aneurysm (ASA), among these 65% had concomitant PFO or atrial septal defect (ASD) (14.1%). Aortic plaques ≥ 4mm were noted in 9.6%, followed by valve disease or prosthesis (5.4%), intracavitary thrombi (3.9%), vegetations (1.6%), ASD (1.5%), dilated cardiomyopathy (1.4%) and tumors (0.7%). In the last 15 years, the diagnostic effectiveness increased (35.6% vs 45.95%) and there was a shift in etiologies with an increased in the diagnose of PFO/ASD (26.8% vs 38.5%) and valve disease or prosthesis became less frequent (29.9% vs 3.7%). Overall, in elderly pts there was a preponderance of atherosclerotic plaques in the aorta, contrasting with younger pts who presented a predominance of PFO (Table1). The prevalence of spontaneous echo contrast increased with age. Pts with ischemic cerebral event were younger, mostly male and PFO was the main source of embolism (17%), while in pts with peripheral embolism the most frequent etiologies were intracavitary trombi (16%) and aortic plaques ≥ 4mm (14%). Conclusion: The main cause to perform a TEE to search for CSE was cerebral embolism, with a diagnostic effectiveness overall of 41.5%, that increased in the last 15years.
Table 1 Characteristics &lt;50 years (n = 1191) 50-75 years (n = 1569) ≥75 years (n = 171) Male (%) 601 (50%) 931 (59%) 80 (47%) Atrial septal defect (%) 23 (2%) 20 (1%) 0 Patent foramen ovale (%) 239 (20%) 226 (14%) 12 (7%) Atrial septal aneurysm (%) 70 (6%) 130 (8%) 13 (8%) Vegetations (%) 8 (0.7%) 29 (2%) 9 (5%) Tumors (%) 10 (0.8%) 8 (0.5%) 4 (2%) Intracavitary trombi (%) 28 (2%) 74 (5%) 14 (8%) Aortic plaque ≥4mm (%) 31 (3%) 203 (13%) 48 (28%) Valve disease or prothesis (%) 54 (4.5%) 109 (6%) 11 (6%) Spontaneous echo contrast (%) 36 (3%) 155 (10%) 32 (19%) Distribution of cardiac source embolism by age
P1378 Impact of maternal diabetes on fetal left atrial function
Authors: Pathan F , Lam P , Sivapathan S , Orde S , Negishi K , Nanan R 
Published: January 2020

Abstract

Background/Introduction: Diabetes impacts 12- 14% of pregnancies. Evaluating the impact of maternal diabetes on the fetal heart is challenging due to variable image quality and limited time for structural changes to manifest. Left atrial reservoir strain (ER) is a sensitive marker of early left atrial dysfunction which may elucidate fetal atrial dysfunction resulting from maternal diabetes.

Purpose
We sought to evaluate if fetal ER can detect impairment of left atrial function in the fetal heart as a result of maternal diabetes.

Methods
We performed a prospective observational study evaluating patients who were referred to the high risk pregnancy service as a result of maternal diabetes (pre-existing or gestational) and healthy controls.
Patients were excluded if adequate imaging of the fetal myocardium was not possible. Baseline characteristics of the mother and cardio-metabolic risk factors were recorded.
The fetal echocardiogram focused on the 4 chamber view. We used the 4 chamber view with closure of the mitral valve as the zero reference point (R-R) gating. The strain curves from 6 atrial segments were averaged.
Normality of the data was assessed using the Shapiro-Wilk test. The Mann-Whitney U test was used to compare ER between fetuses, whose mothers had diabetes versus those fetuses whose mothers were healthy controls.

Results
A total of 120 fetal scans were performed. 5 were excluded due to poor image quality, which prevented strain analysis. 115 fetal scans were analysed (87 with maternal diabetes and 27 healthy controls). The diabetic subjects and controls did not defer significantly in age Mean ± SD (31± 5 vs 30± 5, p= 0.81). The mothers with diabetes had a higher body mass index than controls (Median [IQR]) (30.5 kg/m2 [25.1, 35.3] vs 24.6 kg/m2 [22.1, 28.6] p &lt; 0.001).
The presence of maternal diabetes resulted in lower fetal ER (28.5% [22.1, 36.2] vs 33.4% [26.6, 41.6] P = 0.01).
Figure 1 illustrates the Box-Whisker plot comparing Fetal ER between fetuses exposed to maternal diabetes and fetuses where mothers were healthy controls.

Conclusion
The presence of maternal diabetes results in impaired fetal left atrial function as measured by fetal left atrial strain (ER).
Abstract P1378 Figure 1