bluuebunny/crossref_metadata_2025_split huggingface dataset:
P655 Prognostic value of the new classification of ventricular remodeling in severe aortic stenosis
Authors: Gonzalez Estriegana S , Gamaza Chulian S , Diaz Retamino E , Serrano Munoz B , Giraldez Valpuesta A , Oneto Otero J 
Published: January 2020

Abstract

Introduction
remodeling is defined as the changes produced in the geometry of the left ventricle after damage or overload of the myocardium. The most common classification only considers left ventricle relative wall thickness and mass index, but a new classification includes also end-diastolic volume index.

Purpose
to determine if the new patterns of ventricular remodeling had clinical relevance according to symptoms or cardiovacular outcomes.

Methods
patients with severe aortic stenosis (valve area &lt;1cm2) between 2015 and 2018 were included, excluding other concomitant at least moderate valvular diseases.
The patients were classified according to the indexed ventricular mass, relative parietal thickness and left ventricular volume. Cardiovascular mortality was analyzed as the primary endpoint.

Results
we recruited 234 patients with severe aortic stenosis (55% women, age 77 ± 9 years) with a BMI of 29 ± 5, of which 82% were hypertensive, 47% diabetic, 47% dyslipidemic and 19% smokers. 81% were symptomatic. The average time of follow-up was 280 ± 231 days.
1% had eccentric hypertrophy, 7% mixed hypertrophy, 3% dilated hypertrophy, 73% concentric hypertrophy, 15% concentric remodeling; no patient presented normal ventricle or physiological hypertrophy.

Dyspnea was the predominant symptom
100% in eccentric, mixed and dilated hypertrophy; 72% in concentric hypertrophy and 85% in concentric remodeling (p = 0.05).
Most patients with mixed hypertrophy had NYHA functional class&gt; II: 0% vs 62% vs 37% vs 27% vs 37% (p = 0.008).
The group with the highest cardiovascular mortality was mixed hypertrophy (0% vs 43% vs 0% vs 14% vs 11%, p = 0.04), also shown in the survival analysis (Log Rank = 0.009) (Graph 1).

Conclusions
in patients with severe aortic stenosis, the pattern of mixed hypertrophy was an adverse prognostic marker in our study, although prognostic role of these new remodeling patterns needs to be investigated in future prospective studies.
Abstract P655 Figure. Graph 1.: Kaplan-Meier survival function
P675 ECHO COLOR DOPPLER EVALUATION OF SPLANCHNIC HEMODYNAMIC DURING ACUTE HEART FAILURE
Authors: Ricco" B , Sacchi A , Galassi A , Messora R , Bertolotti M , Pinelli G , Turrini F 
Published: January 2020

Abstract

BACKGROUND
Acute heart failure (AHF) seems to provoke profound derangement of abdominal hemodynamic, which causes symptoms and impacts on renal function.

METHODS
27 patients (10 F - age 78 - EF 0.39) admitted for AHF underwent cardiac and abdominal ultrasound at day 1 and 5. Arterial and venous flow within liver, spleen and kidney were recorded. Portal and Splenic Vein flow was described as continuous, pulsatile or reversed, whereas hepatic vein systolic and diastolic ratio was measured. Renal Venous Doppler Profile (VDP) was classified as: continuous, pulsatile, biphasic or monophasic. Arterial Resistive Index (RI) ≥0.7 was considered elevated.

OUTCOME
At day 1 most patients presented with some degree of deranged VDP and high RI in all examined organs. At day 5, a significant proportion of patients improved their VDP in Liver, Kidney and Spleen, while the percentage of patients with collapsing IVC did not significantly change. On the arterial side, the proportion of patients with high Hepatic RI dropped significantly.

CONCLUSIONS
Our preliminary data show that most deranged VDP in abdominal organs and Hepatic RI improve after decongestion despite a nonsignificant trend in improvement in IVC profile.
RESULTS Classification day 1 day 5 p IVC Collapsing 24% 34% ns Portal Vein Continous 22% 50% Pulsatile 72% 50% Reversed 6% 0% &lt;.05* Hepatic Vein S/D≥1 24% 59% S/D &lt;1 60% 28% Reversed S 16% 14% &lt;.05* Hepatic Artery RI ≥0.7 87% 36% &lt;.05 Splenic Vein Flat 28% 57% Pulsatile 56% 33% Reversed 16% 10% &lt;.05* Splenic Artery RI ≥ 0.7 52% 48% ns Renal Vein Continous 11% 39% Pulsatile/Biphasic 52% 52% Monophasic 37% 9% &lt;.05* Renal Artery RI ≥0.7 63% 65% ns * Refers to normal profile versus all other deranged profiles
P705 Is chest wall deformity a serious issue? A rare case of TGFBR1 mutation in the paediatric population
Authors: Abood L , Padmanabhan S 
Published: January 2020

Abstract

INTRODUCTION
Mutations in the genes encoding transforming growth factor β receptors 1 and 2 (TGFBR1 and TGFBR2) have recently been found in association with a continuum of clinical features.
Mild association – a presentation similar to that of Marfan"s syndrome.
Severe association – a complex phenotype in which aortic dissection or rupture commonly occurs in childhood and at aortic diameters, that ordinarily would not be predictive of these events. Classified as the Loeys–Dietz syndrome.
Is chest wall asymmetry a serious issue? A study of 71 patients with Loeys-Dietz – 9% died from aneurysm rupture or dissection with aortic diameters of less than 4.5cm and as early as 6 months of age.
Genetic variants of unknown clinical significance - how should they be managed?
CASE

History
3-year old girl seen in general paediatric clinic with 5 months history of worsening chest wall deformity.

Examination
Asymmetrical pectus deformity. Spinal asymmetry and soft systolic murmur at the lower left sternal edge.
INVESTIGATION
Chest x-ray: Grossly enlarged and distorted cardiac/mediastinal silhouette.

Echocardiogram
Massive ascending aortic root dilatation (5.5cm) with significant aortic regurgitation.

MRI whole body angiogram
Massively dilated aortic root and ascending aorta to the proximal arch, hugely tortuous and ectatic cerebral vessels, diffuse marked dural ectasia, asymmetrical pectus deformity and a diaphragmatic morgagni hernia in the lower right hemi thorax.

Genetic analysis
Heterozygous missense variant of unknown clinical significance in exon 3 of TGFBR1 gene. The first heterozygous missense variant of its kind in the paediatric population for which its clinical significance remains unknown.
TREATMENT
As risk of dissection, a Bentall procedure was performed.
Family screening - Father has a dilated proximal ascending aorta.
LEARNING POINTS
Chest wall deformity should prompt clinicians to expedite investigations for aortic root dilatation/aneurysm and connective tissue disorders.
The continuum of clinical features of these genetic associations emphasises the importance of early recognition of the phenotype, prophylactic intervention and meticulous surveillance of the distal aorta and vascular tree for optimal management.
A genetic variant of uncertain significance (VUS) should not be used in clinical decision making. Efforts to resolve the classification of the variant as pathogenic or benign should be undertaken with good working relationships with clinical geneticists.
A VUS is difficult for patients and parents to understand and may also cause psychological distress. The importance of careful clinical and molecular characterisation to identify patients and families at risk cannot be overemphasised. This allows the use of a structured approach to intervention, informed counselling regarding the risk of recurrence, concerns related to pregnancy, and guidelines for clinical management.
Abstract P705 Figure. Case Photography and Imaging
P717 Isolated left ventricular tamponade in a patient with severe pulmonary hypertension due to chronic thromboembolisms: a case report
Authors: Vinter O , Trbusic M , Menegoni M 
Published: January 2020

Abstract
A case presents a 37 years old patient who presented to emergency department with progression of dyspnea. Patient had a history of pulmonary hypertension due to chronic thromboembolism and known, repetitive thrombosis of both legs with both of them postthrombotically altered, especially left leg. During his emergency department workup he had a pulmonary angiography performed which showed evidence of old thromboembolism in right pulmonary main branch and circumferential pericardial effusion which was dominantly locularized behind left ventricular posterior wall. Emergency echocardiography was performed which showed marked respiratory variations in mitral and aortic flow with mid to late diastolic left ventricular collapse. Also left ventricular cavity was severely reduced ( EDD 29 mm) due to prominent interventricular septum (right ventricular pressure overload) and hyperkinetic posterior wall (pericardial effusion). There were no apparent signs of compression of right ventricular chambers. Clinically patient had no pulsus paradoxus and had an RR of 115/70 mmHg. Emergency pericardiocentesis was performed using subxiphoid approach. However, pericardiocentesis setting was challenging because patient also had ample of ascites which made orientation by aspiration impossible. Instead puncture was performed under fluoroscopy while slowly instilling the contrast until contrast was delievered intradiaphragmally. From there needle was advanced 3-4 mm into pericardial cavity and pigtail catheter was placed. A total of 2200 ml of milky pericardial fluid was removed during the following 48 hours (cytology – mixed type; triglycerides 1.9 mmol/L). Patient was initially treated with corticosteroids and colhicin, but had a relapse of pericardial effusion once drainage was stopped so re-pericardiocentesis was performed. This time a total of 7200 ml of pericardial fluid was drained so we opted for pericardial fenestration (into left pleural space). Unfortunately, patient died on the 8th postoperative day due to complications (developed subcutaneous emphysema at the place of insertion of thoracal drainage and developed respiratory, then refractory cardiac arrest).
P729 A shocking tumor
Authors: Lorente Ros A , Pascual Izco M , Hinojar-Baydes R , Carvelli A , Vieitez Florez J M , Abellas Sequeiros M , Pinacho J , Navarro M , Fernandez Santos S , Alonso Salinas G , Hernandez S , Gonzalez Ferrer E , Jimenez Nacher J J , Zamorano Gomez J L , Fernandez Golfin C 
Published: January 2020

Abstract

Introduction
Primary cardiac tumors are a relatively uncommon condition, which may appear both in asymptomatic patients or in a myriad of clinical presentations. Imaging techniques are crucial for its diagnosis, and a multi-modality approach may be useful in the evaluation of this masses.
Case description
A 57 year-old man with history of hypertension presented in the emergency department with acute pulmonary edema and cardiogenic shock. He was admitted to the coronary care unit, and on bedside echocardiography a mass on the tricuspid valve was observed.
Upon clinical improvement, a cardiac CT and cardiac MRI was performed (figure 1). A solid mass with no calcium content and dependent exclusively on the anterior leaflet of the tricuspid valve was seen on CT-scan (fig 1, A and B). Thrombus on the right atrial appendage could also be appreciated.
MRI confirmed the presence of a 18x19 mm mass with isointense signal on T1-turbo spin echo black-blood (fig 1, C) and cine steady-state free precession sequences, whereas an hyperintense signal was evident on T2 weighted images (T2-STIR; fig 1 D). In first pass sequences the central core was hypointense and late gadolinium enhancement showed peripheral enhancement with a non captating central core (fig 1, E).
The patient underwent surgery and the anatomopathological results showed a tumor constituted by dense connective tissue, scarce cellular content and an avascular matrix of mucopolysaccharides, elastic fibers and fusiform cells consistent with the diagnosis of papillary fibroelastoma.

Discussion
The imaging characteristics of papillary fibroelastoma are not commonly reported on MRI. We present an unusually large right-sided fibroelastoma with a characteristic distribution of late gadolinium enhancement, which has not been consistently described on a fibroelastoma.
Cardiac tumors are rare, and a non-invasive differential diagnosis is always a challenge. A multi-modality approach (echocardiography, cardiac-CT and cardiac MRI) as well as integration of relevant morphological information, including the location of the lesion and tissue characteristics was essential to the orientate the most plausible diagnosis. The distinctive images are presented.
Abstract P729 Figure 1.
P742 The role of oxidative stress and inflammation for stress induced right ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease patients
Authors: Cherneva Z , Lozanov V L , Sugareva P S , Cherneva R C H 
Published: January 2020

Abstract

Background
Oxidative stress and inflammation have been implicated in the pathogenesis of diastolic dysfunction (DD) and are both present in chronic obstructive pulmonary disease (COPD).

Aim
To evaluate the role of oxidative stress markers (8-isoprostane) and inflammation (prostaglandin E2, resistin) in the pathogenesis of stress induced right ventricular diastolic dysfunction (RVDD) in non-severe COPD.

Materials and methods
104 patients with non-severe COPD (FEV1 &gt; 50%) and preserved left ventricular ejection fraction &gt;50% underwent incremental cardio-pulmonary exercise testing (CPET). Echocardiography was performed before CPET and 1-2 minutes after peak exercise. Peak E/e’ ratio &gt; 6 was a marker for stress induced RVDD. Urine concentration of 8-isoprostanes was assumed as surrogate marker for oxidative stress; urine concentration of prostaglandine-E2 and plasma resistin levels as inflammatory markers. Mass spectrometry was applied for 8-isoprostane and prostglandine E2 (Cayman. Chemical) measurement. Values were normalised to urine creatinine (µmol/l/cre). ELISA was applied for resistin measurement (Raybio_Human) (ng/ml).

Results
Patients were divided into two groups: subjects with stress RVDD (82) and those without stress RVDD (22). In patients with and without RVDD the levels of 8-isoprostane were similar (30.78 vs 30.41µmol/l/cre). The urine concentration of prostaglandin E2 in patients with and without RVDD significantly differed (49.73 vs 62. 19µmol/l/cre; p &lt; 0.05). The same is observed regarding resistin plasma levels - in patients with and without RVDD (18.91 vs 5.47ng/ml).

Conclusions
In non-severe COPD patients oxidative stress levels are similar in the studied groups. Inflammation (resistin) seems to be the predominant pathogenetic factor, associated with stress induced RVDD. The exact role of prostaglandine E2 for RVDD remains elusive.
P764 Right ventricular basal diameter, but not volume, can predict severe tricuspid regurgitation
Authors: Previtero M , Guta A C , Ochoa-Jimenez R C , Palermo C , Bottigliengo D , Figliozzi S , Baritussio A , Cecchetto A , Aruta P , Iliceto S , Badano L P , Muraru D 
Published: January 2020

Abstract

Background
According to current EACVI guidelines, right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation are supportive signs to identify severe functional tricuspid regurgitation (TR) by echocardiography. However, the ranking by which those parameters should be considered to identify severe TR remains to be clarified.

Purpose
Accordingly, the aim of this study is to compare RV, RA and TA association with severe TR and to rank them in order of importance to predict severe TR.

Methods
302 patients (59 ± 13 years, 54 % women) with functional TR underwent two- and three-dimensional echocardiography. Using the nonparameteric Variable Importance (VIMP) software package, we assessed the relative importance of 6 differerent parameters (indexed by body surface area) to identify severe TR: 3D RV end diastolic volume (RVEDVi), 3D RV end systolic volume (RVESVi), 3D RA max volume (3DRAi), 2D RA systolic volume (3DRAi), 2D RV basal diameter (2DRVdi) and 2D TAi measured in the apical 4-chamber view.

Results
According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. 3DRAi (VIMP = 0.075) was the most important predictor of severe TR. 2DRVdi (VIMP= 0.005) was the second most important parameter and was the only parameter of RV dilation (RVEDVi= -0.0011 and RVESVi= -0.0012) associated to severe TR. Also, 2DRAi (VIMP= 0.023), and 2D TAi (VIMP= 0.004) showed good predictive ability.

Conclusions
Among the various right heart structures undergoing remodeling in patients with functional TR, RA dilation was the most important predictor of severe TR. Also the RV basal diameter, but not the volumes, was a predictor of severe TR. This underlines the importance of the shape, more than the volume of the RV as a predictor of severe TR.
P771 3D versus 2D transesophageal echocardiography in the detection of thoracic aorta atherosclerosis stage and prediction of coronary atherosclerosis
Authors: Vrublevsky A , Boshchenko A , Bogdanov Y U 
Published: January 2020

Abstract

Background
2D transesophageal echocardiography (TEE) was approved as a suitable method for the assessment of thoracic aorta (TA) atherosclerosis.

Purpose
A comparison between 2D and 3D multiplane TEE for qualitative and quantitative assessment of aortic atheromas and for coronary atherosclerosis prediction.

Methods
180 consecutive CAD patients (104 men, 76 women, mean age 62 ± 7 years) were examined. 2D and 3D TEE was performed using Philips IE33 xMatrix system and a X7-2t multiplane probe. 2D study of TA was performed using Live xPlane mode. 3D study of TA was performed using Live 3D and Full Volume modes. Qualitative and quantitative assessment of every atheroma was performed using 2D and 3D modes. The degree of severity and distribution of the TA atheromatosis was evaluated according to the classification of ASE and EACVI (2015): grade 0 – intimal-medial thickness ≤1 mm, 1 – intimal thickness ≤2 mm, 2 – focal or diffuse intimal thickening of 2-3 mm (small atheromas), 3 – atheromas &gt;3–5 mm (no mobile/ulcerated components), 4 - atheromas &gt; 5 mm (no mobile/ulcerated components), 5 - grade 2, 3, or 4 atheromas plus mobile or ulcerated components. After TEE all patients underwent digital coronary angiography and SYNTAX Score was calculated. Findings were presented as M ± SD or n (%).

Results
620 atheromas were analysed: 109 in the ascending part, 8 in the arch and 503 in the descending part. On average 3,43 ± 2,15 atheromas per patient were revealed. Atheromas height in 3D was significantly higher (p &lt; 0,001), than in 2D, being 0,38 ± 0,09 mm and 0,26 ± 0,07 mm, respectively. Atheromas height increase in 3D was 0,12 ± 0,06 mm. In 3D 88% of atheromas have shown irregular contours while in 2D only 35% of atheromas had rough countors. The mobile component in 6 out of 9 atheromas was revealed only in 3D. In 2D 1-5 stages of TA atheromatosis were revealed in 22 (12%), 103 (57%), 43 (24%), 7 (4%) and 4 (2%) cases, respectively. In 3D 1-5 stages of TA atheromatosis were revealed in 16 (9%), 25 (14%), 90 (50%), 38 (21%) and 10 (5%) cases, respectively. With 3D TEE 72% of patients were found to have higher gradation of TA atheromatosis stage. The direct Spearman’s correlation between a stage of TA atheromatosis and SYNTAX Score which has been established for 2D r = 0,32 p &lt; 0,001 and 3D r = 0,30, p &lt; 0,01, respectively.

Conclusions
A comparison between 2D and 3D TEE has shown, that 3D is more precise method of qualitative and quantitative assessment of aortic atheromas and diagnosis of TA atheromatosis stage. 3D ultrasound stage of TA atheromatosis is a surrogate marker of severity and prevalence of coronary atherosclerosis.
P795 Intraventricular fluid patterns during dobutamine stress echo in patients with significant coronary stenosis
Authors: Filomena D , Cimino S , Maestrini V , Petronilli V , Cantisani D , Neccia M , Monosilio S , Luongo F , Tonti G , Pedrizzetti G , Fedele F , Agati L 
Published: January 2020

Abstract

Background
Dobutamine stress echo (DSE) is a useful tool for the evaluation of patients with suspected stable coronary artery disease (CAD). There has been no detailed investigation about the effects of exercise or pharmacological stress on intraventricular fluid dynamics. The possible association between significant CAD and abnormal fluid patterns has not been studied yet.

Purpose
Aim of the study was to evaluate the intraventricular vortices during dobutamine stress and to find fluid-dynamic patterns associated with the presence of significant CAD.

Methods
36 patients scheduled for coronary angiography (CA) and with clinical indication for DSE for suspected CAD were enrolled. Each patient underwent 2D, 3D and contrast echocardiography for Echo-PIV analysis and vortex quantification, both at rest and at peak stress. Vortex geometric and energetic parameters were evaluated using a post- processional software. Intraventricular pressure gradients were evaluated as well. Positive CA for significant CAD was defined as the presence of at least one epicardial coronary stenosis with ≥70% luminal narrowing.

Result
CA was positive in 58% of patients while DSE in 33%. In the whole population, at peak stress a reduction in vortex area (from 0.36 ± 0.01 to 0.21 ± 0.02; p= 0.001) and in absolute value of vortex intensity (from 0.36 ± 0.1 to 0.26 ± 0.12; p= 0.001) were detected. Vorticity fluctuation and kinetic energy (KE) fluctuation showed a significant increment at peak stress (respectively 0.84 ± 0.17 to 0.93 ± 0.07; p= 0.005; from 1.76 ± 0.37 to 2.47 ± 0.82; p= 0.001), as well as a deviation of flow force momentum angle (φ: from 36 ± 8 to 44 ±9; p= 0.001). Patients with positive CA showed during DSE an higher decrease of the absolute value of vortex intensity (Δ% |vortex intensity| -1.7 ± 0.39 vs -1.3 ± 0.56 vs; p= 0.021), and higher increase of flow force angle (Δ% φ 0.48 ± 0.6 vs 0.1 ± 0.27; p= 0.042). A reversal in the main direction of the vortical flow occurred in 9 patients (25%) at peak stress and 7 of them (64%) were found to have significant right coronary stenosis. This unexpected change in the vortical flow and the presence of right coronary artery stenosis were found significantly associated (X2 p= 0,02). Moreover, patients with circumflex artery stenosis were less likely to have a decrease of vortex length at peak stress (Δ% Vortex length - 0,06 ± 0, 36 vs - 0,34 ± 0,28, p= 0,034).

Conclusion
Significant changes in intraventricular vortices occur during DSE. The presence of significant CAD evaluated with CA was associated with different behavior of fluid dynamics during DSE. Further studies are needed to assess normal and pathological intraventricular flow patterns evaluated during DSE.
Abstract P795 Figure. Vortex reversal at peak stress