bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1484 Unusual manifestation of constrictive pericarditis
Authors: Golinska Grzybala K , Gackowski A 
Published: January 2020

Abstract

Introduction
The objective of this case report is to highlight the difficulties in establishing the proper management in some patients with chronic constrictive pericarditis (CCP).

Case Description
A 67 year-old-man with a long history of COPD (stage D), coronary heart disease, diabetes mellitus type 2, prostate cancer treated with local radiotherapy and hormonotherapy, was admitted due to progressive fatigue and dyspnoea on exertion,. Three months before he was hospitalised in pulmonary ward because of sudden onset of severe dyspnoea with mild leg oedema, and unusually weak response for typical COPD treatment was observed. At this time local lab test revealed moderately elevated CRP (43.6 mg/l), ESR (36 mm) and NT-proBNP (483 pg/ml). CT scan was performed to exclude pulmonary embolism. No pericardial calcifications were noted.
Physical examination showed obesity (33 kg/m2), heato-jugular reflux and mild ankle oedema. Chest auscultation revealed normal lungs sounds and muffled heart sounds. Pleural effusion was excluded and no ascites nor hepatomegaly was found.

Echocardiography revealed typical changes for CCP
prominent septal bounce during inspiration, annulus reversus (TDI e` lat 16 cm/sek; e` med 18 cm/sek), annulus paradoxus (E/e` 8), normal LV function, dilated vena cava inferior (VCI).
MRI showed thickened pericardium (5mm) particularly near the right ventricle (RV) and thick layer of fatty tissue (15 mm) localised in pericardium, next to the RV free wall. RV was compressed (fig.1). LVEF was 63%, EDV 117 ml, SV 74 ml, SVi 33 ml/m2, LV mass 78 g; RV EF 71%, EDV 72 ml/m2, right atrium enlargement was found (38 cm2), while left atrium was of normal size (22 cm2). VCI and hepatic veins were dilated (29 mm and 13mm respectively.
Fig 1. MRI – thickened pericardium containing thick fatty tissue causin with RV compression
After diuretic uptitration, the dyspnoea improved to NYHA I/II. Due to clinical improvement heart team decided to continue medical treatment. Due to comorbidities (DM, COPD, obesity), the risk of pericardiectomy was considered high. Three month later the patient was hospitalized due to sudden dyspnoea and subsequent cardiac arrest. Despite cardiopulmonary resuscitation the patient died in ICU. CCP was confirmed in autopsy.

Discussion
The diagnosis of CCP remains challenging. In this case the presentation was not fully typical. There was no clear precipitating factor, the history was relatively short and the symptoms and signs mild. CT scan did not show pericardial calcifications. Although TTE revealed typical features of CCP and MRI confirmed compression of the right ventricle, the heart team did not confirm the need for pericardiectomy, which is treatment of choice in progressive CCP.
Abstract P1484 Figure. Fig.1
P1509 Obesity and diastolic function of the left ventricle by echocardiography in a Mediterranean child population
Authors: Aristizabal Duque C , Fernandez Cabeza J , Blancas Sanchez I M , Ruiz Ortiz M , Delgado Ortega M , Rodriguez Almodovar A , Romo Pena E , Fonseca Del Pozo F J , Romero Sardana M , Pan Alvarez Osorio M , Mesa Rubio D 
Published: January 2020

Abstract

Background
The prevalence of overweight in childhood is 26% and obesity is 12.6% in Spain. Diastolic function assessed with echocardiography shows significant worsening in obese adults compared to non-obese adults. However, few studies describe the association between obesity and diastolic function in the pediatric population.

Aim
To investigate the relationship between obesity and diastolic function in a Mediterranean pediatric population.

Methods
A random sample of children and adolescents of primary and secondary education was selected, stratifying by age, gender and educational centers in a rural town of 2864 inhabitants of southern Spain. Children between 6 and 17 years old were included. A transthoracic echocardiogram was performed to evaluate diastolic function.

Results
A total of 212 children were studied (10.9 ± 3.0 years old and 51.9% males): 163 (76.9%) were not obese and 49 (23.1%) were obese. Age and sex were similar in both groups. Results are shown in the table. Obesity was related to a larger left atrial volume, a higher A-wave velocity, a lower lateral e "wave velocity, a higher average E/e ratio, and a higher pressure gradient between the atrium and the right ventricle.

Conclusions
Obesity in childhood is associated to worsening of diastolic function parameters commonly measured in echocardiography.
Obese Vs non-Obese non-obese obese p Age 10,8 ± 3,0 11,0 ± 2,8 0,63 Male (%) 50,1% 57,1% 0,4 A-wave velocity (cm/s) 58,7 ± 13,1 64,8 ± 13,8 0,005 E/A 1,89 ± 0,45 1,75 ± 0,41 0,05 lateral e" velocity (cm/s) 21,26 ± 4,61 19,58 ± 3,97 0,02 average E/e" 6,4 ± 1,1 7,0 ± 1,2 0,001 left atrial volume (mL) 20,8 ± 6,8 27,9 ± 7,4 &lt;0,0005 pressure gradient (mmHg) 15,5 ± 4,5 18,0 ± 4,9 0,02
P1514 Increased myocardial oxygen demand is associated with impaired left ventricular strain in patients with morbid obesity referred for bariatric surgery
Authors: Grymyr L M , Nadirpour S , Gerdts E , Nedreboe B G , Hjertaas J J , Matre K , Cramariuc D 
Published: January 2020

Abstract

Background
Obesity predisposes for left ventricular (LV) hypertrophy and systolic dysfunction. Higher myocardial oxygen demand in LV hypertrophy is associated with higher risk for cardiovascular events, while the association with LV systolic function has been less explored.

Purpose
To assess the association of myocardial oxygen demand with LV systolic function in morbidly obese subjects without known heart disease.

Methods
Clinical and echocardiographic data from 110 obese subjects referred for gastric bypass surgery (mean age 42 ± 11 years, 74% women, mean body mass index [BMI] 41.9 ± 4.8 kg/m², 33% with hypertension, 15% with diabetes) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV function was assessed by ejection fraction (EF) by Simpson"s biplane method and endocardial global longitudinal strain (GLS) by 2D vector velocity imaging using a 16-segment model (Image Arena 4.6, Tomtec, Unterschleissheim, Germany). Myocardial oxygen demand was estimated from LV mass - wall stress - heart rate product according to a previously validated formula.

Results
Myocardial oxygen demand was higher in men (1884 vs. 1579 x 10³ g x kdyne/cm² x bpm, p &lt; 0.05), and associated with higher BMI (r = 0.24) and pulse pressure (r = 0.28), and with lower EF (r = -0.22) and lower GLS (r = 0.26, all p &lt; 0.05). In multiple regression analysis, higher myocardial oxygen demand was associated with lower LV GLS (Beta = 0.21, p &lt; 0.05) independent of age, gender, BMI, pulse pressure, diabetes, and EF (Table).

Conclusion
In obese patients without known heart disease referred for bariatric surgery, higher myocardial oxygen demand was associated with lower LV systolic function measured by GLS independent of confounders.
Covariates of lower GLS in multivariable Variable β correlation coefficient p LV mass - wall stress - heart rate product (g x kdyne/cm&sup2; x bpm x 10&sup3;) 0.21 0.04 Age (years) -0.12 0.22 Gender 0.34 &lt;0.01 BMI (kg/m&sup2;) 0.25 &lt;0.01 Pulse pressure (mmHg) -0.04 0.71 Diabetes -0.17 0.09 LV EF (%) -0.01 0.90
P1516 Detecting right ventricular systolic dysfunction in patients with acute ST-elevation myocardial infarction: echocardiography is good enough
Authors: Pickure Z , Kalinin A , Pickurs K , Zakharova E , Alekhin M , Lejnieks A 
Published: January 2020

Abstract

Background
Many recent years" studies confirm the impact of the right ventricle (RV) dysfunction on morbidity and mortality in patients with an acute ST segment elevation myocardial infarction (STEMI). Earlier echocardiography (Echo) was not accurate enough in detecting RV dysfunction. The newest Echo methods allow to directly and accurately assess the RV systolic function.

Purpose
The aim of this study was to estimate the frequency of both RV segmental and global dysfunction in patients with STEMI using three-dimensional (3D) Echo and myocardial longitudinal strain (LS).

Methods
A group of 73 patients with first-time acute STEMI of different localization was selected. A control group of 32 people was formed of healthy individuals. As a standard for determining RV systolic dysfunction, changes in the traditional Echo parameters of the RV were accepted. In our study RV 3D ejection fraction (EF) less than 49% (AUC = 0.88, p &lt; 0.001, sens 73%, spec 78%, PPV 50%, NPV 91%) and RV free wall LS less than 24.5% (AUC = 0.95, p &lt; 0.001, sens 88%, spec 89%, PPV 74%, NPV 96%) best predicted RV involvement in STEMI. RV involvement frequency in STEMI was analyzed in 4 levels: 1 - visual estimation only (RV segmental or global dysfunction); 2 – visually + pathologically changed conventional Echo parameters; 3 – visually + pathological conventional Echo parameters + pathological RV EF and RV LS defined by current guidelines; 4 - visually + pathological conventional Echo parameters + new pathological 3D RV EF and RV LS cut-off levels, defined in our study.

Results
RV involvement in patients with STEMI was found in 26%, if estimation was only visual (presence of segmental and/or global dysfunction). By adding in algorithm pathologically changed conventional Echo parameters, RV dysfunction was detected already in 36% of cases. New Echo parameters (3D RV EF and RV LS) added 6% more to RV involvement cases, resulting in 42% in total, if current guideline-recommended pathological cut-off levels were used. But the highest number of RV involvement cases - 62%, was reached, if visual evaluation and conventional Echo parameters were combined with 3D RV EF and RV LS, using higher pathology cut-off levels, defined in our study. This number is much closer to the data, provided by cardiac magnetic resonance and autopsy.

Conclusion
Modern echocardiography can provide greatly improved RV dysfunction diagnostics. In the case of STEMI current echocardiography methods show much closer results to the gold standard – cardiac magnetic resonance imaging and autopsy data, detecting RV involvement in more than 60% cases of acute STEMI.
P1525 Residual functional mitral regurgitation post-MitraClip is associated with worse hemodynamics and predicts poor outcome at 2-year follow-up
Authors: Van De Heyning C M , Debonnaire P , Bertrand P B , Mortelmans P , Deferm S , Paelinck B P , De Bock D , Coussement P , Vandervoort P M , Claeys M J 
Published: January 2020

Abstract

Background
Percutaneous mitral valve repair using MitraClip offers symptomatic benefit and improves rest and exercise hemodynamics in patients with severe functional mitral regurgitation (MR). Recent randomized trials have shown contradictory results regarding the impact of MitraClip on mid-term survival in functional MR. It is unknown whether improved hemodynamics are related to patients" outcome.

Purpose
To assess whether residual MR and altered resting and exercise hemodynamics are predictors of outcome in patients with functional MR treated with MitraClip.

Methods
Consecutive patients (n = 45, 72 ± 10years, left ventricular ejection fraction (LVEF) 34 ± 9%) with symptomatic severe functional MR were prospectively evaluated by Doppler echocardiography at rest and during symptom-limited exercise on a semi-supine bicycle pre- and 6 months post-MitraClip procedure. LVEF, MR severity, cardiac output (CO), systolic pulmonary artery pressure (SPAP) and a flow-corrected SPAP/CO ratio were assessed at rest and peak exercise. 2-year follow-up clinical data were collected from patient records.

Results
During 2-year follow-up post-MitraClip, 15 patients (33%) experienced major cardiac events (hospitalization for heart failure (n = 14) and/or cardiac death (n = 5)). Age, gender, a history of coronary artery disease, diabetes, baseline MR severity and baseline SPAP/CO ratio at rest and during exercise were not related to a worse event-free survival. In contrast, patients with events at 2-year follow up had more often a history of hospitalization for heart failure (73 vs. 37%, p = 0.029), lower baseline LVEF (30 ± 8 vs. 36 ± 10%, p = 0.041), more residual MR at 6 months post-MitraClip (MR jet area/left atrial area 27 ± 14 vs. 15 ± 10%, p = 0.004) and higher SPAP/CO ratios at rest and during exercise 6 months post-MitraClip (13.9 ± 5.3 vs. 9.9 ± 3.4mmHg/L/min, p = 0.007 and 13.6 ± 4.9 vs. 9.4 ± 4.6mmHg/L/min, p = 0.009, respectively). When corrected for baseline LVEF, residual MR 6 months post-MitraClip remained an independent predictor for worse 2-year outcome. Residual MR was moderately correlated to a worse SPAP/CO ratio 6 months post-MitraClip (Pearson Rho 0.518, p &lt; 0.001).

Conclusions
In patients with functional MR treated with MitraClip, residual MR at 6-month follow-up is associated with impaired hemodynamics, and is an independent predictor of cardiac events at 2-year follow-up.
P1543 The assessment of regional myocardial strain in classifying amyloid cardiomyopathy
Authors: Geenty P , Shivapathan S , Deshmukh T , Brown P , Boyd A , Taylor M , Kwok F , Altman M , Richards D , Stewart G , Thomas L 
Published: January 2020

Abstract

Background
An infiltrative cardiomyopathy is a common manifestation of AL-amyloidosis, with cardiac involvement associated with a poor prognosis. Wild-type transthyretin amyloidosis (wt-TTR), is a distinct clinical entity occurring predominantly in men &gt; 65 yrs, that has gained interest recently due to novel treatment options. Regional strain analysis has been shown to discriminate both forms of cardiac amyloidosis from other causes of concentric left ventricular hypertrophy, with a characteristic pattern of ‘apical sparing’. Due to the significant difference in both the course of the disease and treatment options between groups, a non-invasive echocardiographic method of determining subtype would be valuable.
Aim/Method: We sought to compare traditional and novel echocardiographic parameters in a cohort of AL ( n = 80) and wild type (wt-TTR) amyloid ( n = 32) patients. All amyloid patients underwent comprehensive transthoracic echocardiography, including both conventional parameters and LV longitudinal strain. Further novel parameters were computed including the ratio of global longitudinal strain (GLS) to LV ejection fraction (LVEF), as well as GLS to indexed LV mass.

Results
wt-TTR patients had significantly greater LV mass (176 ± 59g/m2vs118 ± 37g/m2, p &lt; 0.001), and worse diastolic dysfunction as expressed as E/E’ (21.5 ± 11vs17 ± 8, p = 0.04). LVEF was significantly lower in wt-TTR patients however remained in the normal range in both groups (53 ± 6%vs57 ± 6%, p = 0.001), whilst GLS was significantly reduced compared to AL-amyloid patients (11.5 ± 3.4%vs16.2 ± 4.6%, p &lt; 0.001). LVEF:GLS was significantly higher in wt-TTR patients (4.93 ± 1.4vs3.87 ± 1.3, p = 0.001) reflecting a more profound reduction in strain with a relatively preserved ejection fraction. Similarly, the ratio of GLS to LV mass was significantly lower in wt-TTR amyloidosis (0.078 ± 0.05vs0.155 ± 0.07, p &lt; 0.001), reflecting a more significant reduction in strain for a given wall thickness in wt-TTR patients. GLS:LV mass was the strongest discriminator between subtypes (AUC 0.82), with a cutoff of 0.09 giving a sensitivity and specificity of 71% and 80% respectively, for detecting wt-TTR.

Conclusion
In this cohort, patients with wt-TTR had significantly greater increase in LV wall thickness and diastolic dysfunction, which may in part reflect their increased age (77vs62). However, GLS was also significantly reduced compared to AL-amyloid, even when accounting for LV ejection fraction and LV mass, suggesting these composite parameters may have value in determining the subtype of cardiac amyloidosis.
P1544 Independent prognostic significance of non invasive left atrial stiffness in outpatients with heart failure and reduced ejection fraction
Authors: Bytyci I , Riccardo N , Bajraktari A , Mazzola M , Bajraktari G , Henein M , Dini F L 
Published: January 2020

Abstract

Background and Aim
Left atrial (LA) stiffness is an important marker of cardiac pump function, especially in patients with heart failure (HF) and preserved ejection fraction (HFpEF). The aim of this study was to evaluate the relationship between LA stiffness and cardiac events (CE) in HF patients with reduced ejection fraction (HFrEF).

Methods
This study included 136 consecutive HFrEF outpatients (mean age: 65 ± 11 years). A complete conventional and tissue Doppler imaging study was performed. The LA dimension and function were measured. Non invasive LA stiffness was calculated with the following formula: LA stiffness = E/e’ratio/LA strain. The cardiac events were HF hospitalization and cardiac death.

Results
During a median follow up of 55 ± 37 months, 51 patients had CE, they had higher NYHA functional class (p = 0.001), higher LV end-diastolic dimension (p = 0.001), higher LV end-systolic dimension (p = 0.04), lower EF (p &lt; 0.001), higher E/A ratio (p = 0.01) and reduced TAPSE (p = 0.001) compared with patients without CE. LA volume index was higher (p = 0.001), LA strain was reduced and LA stiffness was increased in patients with CE compared to those without CE (p = 0.0001, p &lt; 0.0001, respectively). LA stiffness exhibited the closest relationship with E/e’ ratio (r = 0.67, p &lt; 0.001). Survival analyses showed that LA stiffness [HR: 4.026 (1.300–12.468), p = 0.001] was the most powerful independent predictor of cardiac events[C1] . On ROC curve analysis, a LA stiffness &lt; 0.82% was 81% sensitive and 73% specific (AUC 0.81, p &lt; 0.001) in predicting clinical events (Figure 1).

Conclusion
In this cohort of outpatients with HFrEF, LA stiffness proved the most important predictor of clinical outcome.
[C1]
Abstract P1544 Figure.
P1554 Assessment of functional mitral regurgitation with leg lift and exercise echocardiography using the average pixel intensity method
Authors: Kamoen V , El Haddad M , De Backer T , Timmermans F 
Published: January 2020

Abstract

Background
Dynamic changes in functional mitral regurgitation (FMR) during exercise echocardiography were shown to be of prognostic value. However grading of FMR is challenging, especially during exercise echocardiography and therefore questioning its applicability in clinical practice. We recently introduced and validated the Average Pixel Intensity (API) for grading MR based on the pixel intensity of the continuous wave Doppler signal. In the current study we investigate the use of the API method using leg lift and exercise echocardiography in FMR.

Methods
We prospectively included 50 heart failure patients (mean ejection fraction 36%) in sinus rhythm with different grades of pure, FMR. After assessment of FMR severity at rest, the same acquisitions were repeated during leg lift and exercise echocardiography. FMR was assessed using the API method, color Doppler and quantitative grading methods (proximal isovelocity surface area (PISA) and vena contracta width (VCW)).

Results
The API method could be performed in all patients (100%) with leg lift (n = 50) and in 94% of the patients undergoing exercise echocardiography (n = 44), which was more than PISA and VCW (p &lt; 0.001).
During leg lift, there was a small but significant increase on visual color Doppler grading (grade 1.93 to 2.11 (p = 0.004); increase of FMR in 35% of patients, and no difference in 65%). For API, we found the same significant increase (93 to 101 au), however, API values showed increase of MR in 62% and decrease of FMR in 20%.
During exercise echocardiography, we found no differences in color Doppler grade and API in the overall cohort (p 0.252 and p 0.832, respectively), despite 62% of patients showing some degree of increase in API during leg lift. On multivariate analysis, no specific echo parameter could be identified as independent predictor of API increase.

Conclusions
The novel API method is highly feasible for assessing dynamic FMR and may be of added value for in this setting, allowing the detection of even small increments of FMR severity.
In the current study, we found only mild increases of FMR during exercise echocardiography. Leg lift testing however proved to be a simple and quick loading approach that induced a significant rise in FMR compared to exercise echocardiography. The prognostic relevance of the findings during leg lift remains to be determined.
P1557 Predictive significance of right ventricle dysfunction on clinical outcome in patients with HFpEF
Authors: Skidan V I , Rosseykin E V , Pavlyukova E N , Nartsissova G P 
Published: January 2020

Abstract

Background
the volume and function of the right ventricle (RV) are the parameters that determine the echo predictive factors of mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). In the concept of the mechanism of the contraction of the heart the global RV ejection fraction consist of combined longitudinal, radial and anteroposterior displacement of the RV walls. RV pump function realized by shortening of the longitudinal axis with the traction of the tricuspid annulus towards the apex; inward movement of the RV free wall; bulging of the interventricular septum into the RV and stretching the free wall over the septum. In case of HFpEF the longitudinal mechanism of RV reduction is more sensitive than others. Longitudinal strain of RV free wall (RVFWS) and 3DRVEF has been proposed as a more accurate and sensitive tool to evaluate RV function in longitudinal displacement of patients with HFpEF. Methods and Results—A total of 73 patients with HFpEF (age, from 26 to 77 years; the clinical manifestations of HFpEF corresponded to NYHA III in 52 patients (71%), NYHA IV in 21 patients (29%); LV EF ≤ 35%) with preserved TAPSE (≤15 mm) underwent RV function assessment using 4DETomTec, speckle-tracking TTE to measure peak RVFWS, GLS, 4DEEF. After a median follow-up period of 36 months, 61 (83%) patients reached the primary composite end point of all-cause death/Heart transplantation. Median RVFWS was −12.3% (interquartile range, −20.3% to −9.4%). Median RVGLS was −15.3% (interquartile range, −21.3% to −10.54%). Median RV4DEF was 31.6% (interquartile range, 21,1% to 36,2%). By Kaplan–Meier plot, RVFWS &gt; -15%, (p &lt; 0,02), GLS &gt;-20%, (p &lt; 0,04), 4DETomtecEF &lt;30% (p &lt; 0,0001) were an independent predictor of outcome in patients with HFpHF. Conclusions: In patients with HFpEF the fast and accurate quantification of RV free-wall strain and 4DTomtecEF provides incremental prognostic information and improved risk stratification.
Online media use and HPV vaccination intentions in mainland China: integrating marketing and communication perspectives to improve public health
Authors: Yang Guolan , Myrick Jessica Gall 
Published: January 2020

AbstractThis study investigates the role of media in shaping human papilloma virus vaccination intentions in mainland China by applying both communication and marketing-focused theoretical frameworks in order to better understand ways to increase vaccine uptake across young men and women in China. An online survey (N = 359) revealed direct effects of online information consumption on perceived scarcity of the vaccine, as well as an indirect effect via perceived influence of media on others. Scarcity perceptions, in turn, predicted vaccine attitudes and behavioral intentions. Additionally, gender differences emerged in the data. Compared with women, men’s intent to be vaccinated were not high, even if they realized the vaccine shortage. Implications for theory and practice are discussed.