bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1517 Prognostic value of echocardiographic parameters for RV function in long term follow up of patients presenting with ST elevation myocardial infarction
Authors: Guzu C , Zamfir D , Onciul S , Pascal A , Scarlatescu A , Diaconeasa A , Stoian M , Cojocaru I , Petre I I , Iancovici S , Bataila V , Dorobantu M 
Published: January 2020

Abstract

Funding Acknowledgements
Funding Acknowledgements : This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by theERDF

Background
The prognostic value of right ventricular (RV) function assessed by echocardiography in patients with acute ST elevation myocardial infarction ( STEMI ) treated by primary percutaneous coronary intervention (PCI) remains controversial, especially in terms of long term follow up .

AIMS
To evaluate the relation between RV function assessed by various echocardiographic parameters in patients presenting with STEMI and the occurrence of major cardiovascular adverse events (MACE) whithin a long period of follow-up.

Methods
We have prospectively analyzed a cohort of 37 patients (mean age: 62.49+/- 1.67 years, 28 males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary diseases were excluded. All patients underwent serial conventional 2D echocardiography, tissue Doppler imaging ( TDI ), speckle tracking echocardiography (STE) and 3D echocardiography at 24 hours after the acute event, at discharge, at 6 month, 1 year and 4 years of follow up. We measured in each patient the following RV functional parameters : tricuspid annular plane systolic excursion (TAPSE) , RV free wall systolic velocity (St ) assessed by TDI , RV free wall strain (RVFWS) and RV global longitudinal strain (RVGLS), RV myocardial performance index assessed by pulsed wave Doppler (RV MPI -PW) and right ventricular ejection fraction (RVEF). The mean follow up duration was 36 +/-4 months . The combined end-point of MACE was defined as all cause mortality, recurrent myocardial infarction, need for repeat revascularization or stroke.

Results
During the follow-up period 8 patients ( 18.9 % ) reached the combined end-point . In the analyzed group we observed that of all the studied parameters that reflect RV function, only RV MPI –PW and St at discharge were predictors of worse outcomes independent of LVEF or the culprit coronary artery. RV MPI was predictive at a cut-off value greater than 0,56 with a sensitivity of 66,6% and a specificity of 85,7 % ( 95% CI 0.51 to 0.67, p = 0.017, AUC= 0.71), respectively St at a cut -off value lower than 0,13 m/s with a sensitivity of 92 % and a specificity of 41 % ( 95% CI 0.12 to 0.16 p = 0.012, AUC = 0.64 ).

Conclusions
In STEMI patients treated by primary PCI, RV global function and RV regional systolic function evaluated at discharge provide prognostic information for long term MACE, independendent of infarct size or location. Our results need to be confirmed in larger cohorts of patients.
P1518 Relationship between post-operative asymptomatic status and reverse remodeling of large left atrium in patients with aortic stenosis who underwent aortic valve replacement
Authors: Hozumi T , Morimoto J , Nishi T , Takemoto K , Fujita S , Wada T , Shimamura K , Kashiawagi M , Shiono Y , Kuroi A , Matsuo Y , Ino Y , Kubo T , Tanaka A , Akasaka T 
Published: January 2020

Abstract

Introduction
Recently, we have reported that large left atrial volume (minimum left atrial volume index : LAVImin ≥30ml/m²) at end-diastole determined by direct exposure of left ventricular (LV) end-diastolic pressure can predict post-operative symptomatic status after aortic valve replacement (AVR) in aortic stenosis (AS) patients with high sensitivity and modest specificity. Reverse remodeling of large LAVImin after AVR may contribute to false positive for the prediction of post-operative symptomatic status in patients with AS.

Purpose
The purpose of this study was to evaluate relationship between post-operative symptomatic status and reverse remodeling of large LAVImin in patients with AS who underwent AVR.

Methods
The study population consisted of 75 patients with AS who underwent AVR and were followed up for 600 days after AVR, after the exclusion of the followings; atrial fibrillation, significant coronary artery disease, significant mitral valve disease, pacemaker rhythm, and inadequate echocardiographic images. We measured LAVImin by biplane Simpson"s method before and after AVR. Preoperative large LAVImin (≥30ml/m²) according to the previous study was observed in 32 (43%) of 75 patients. We divided these 32 patients into two groups according to the post-operative symptomatic status during the follow-up period.

Results
There was no significant difference in pre-operative LAVImin between patients with and without post-operative symptom (46.5 ± 13.4 vs 40.4 ± 8.6 ml/m²). On the other hand, post-operative LAVImin in patients without post-operative symptom was significantly smaller than that in patients with post-operative symptom (31.5 ± 8.6 vs 54.8 ± 14.0 ml/m², p &lt; 0.01). While significant regression in LAVImin after AVR was observed in patients without post-operative symptom (40.4 ± 8.6 to 31.5 ± 8.6 ml/m², p &lt; 0.05), no regression in LAVImin after AVR was observed in patients with post-operative symptom (46.5 ± 13.4 to 54.8 ± 14.0 ml/m²).

Conclusions
Reverse remodeling of large LAVmin in patients with AS who underwent AVR was observed in post-operative asymptomatic group, but not in symptomatic group. These results suggest that reverse remodeling of large LAVImin after AVR could contribute to the post-operative asymptomatic status in patients with AS who underwent AVR.
P1531 Changes in mitral annular dynamics with three different types of annuloplasty devices: measurement using three-dimensional transoesophageal echocardiography
Authors: Ito S , Yoshitani K , Yahagi M , Onishi Y 
Published: January 2020

Abstract

OnBehalf
National Cerebral and Cardiovascular Center, Japan
Background/Purpose
Mitral annuloplasty plays a crucial role during mitral valve (MV) repair. The dynamics of the mitral annulus (MA) may be variously affected by the annuloplasty device. Therefore, we investigated the differences in MA dynamics when using a semi-rigid ring, semi-rigid band, and flexible ring.

Methods
We retrospectively reviewed 61 patients with mitral regurgitation who underwent MV repair, which included annuloplasty. Semi-rigid rings were used in 33 patients, flexible bands in 21, and semi-rigid bands in seven. Three-dimensional transoesophageal echocardiography (3D-TEE) images of the MV were recorded before and after annuloplasty. The 3D-TEE image datasets were analysed using semi-automated analysis software. We measured anterolateral–posteromedial (AL–PM) and anteroposterior (AP) diameter and height of the MV. The sphericity index (AP diameter divided by AL-PM diameter) and annular height to commissural width ratio (AHCWR) were calculated as the circular and saddle-shaped geometries, respectively. The differences in these values between end diastole (ED) and end systole (ES) were compared by t-test before and after mitral annuloplasty to analyse the MA among the semi-rigid ring, semi-rigid band, and flexible ring.

Results
Before annuloplasty (n = 61), the AL–PM diameter was significantly larger (ED: 4.26 ± 0.08 vs. ES: 4.24 ± 0.07, p = 0.016) and the sphericity index was significantly smaller (ED: 0.93 ± 0.01 vs. ES: 0.94 ± 0.01, p = 0.017) at ED than at ES. Table 1 shows the analysis after annuloplasty for each device. After annuloplasty, not every group demonstrated significant differences in AL–PM diameter or sphericity index. MA dynamics were reduced equally with the three devices.

Conclusion
Mitral annuloplasty reduced MA dynamics equally when using a semi-rigid ring, semi-rigid band, and flexible ring. There were no distinctive differences among the three devices in terms of maintaining flexibility and a saddle-shaped geometry.
MV dynamics after mitral annuloplasty Semi-rigid ring (n = 33) Flexible band (n = 21) Semi-rigid band (n = 7) ES ED P value ES ED P value ES ED P value AP (cm) 2.61 ± 0.38 2.67 ± 0.44 0.15 2.61 ± 0.38 2.67 ± 0.44 0.15 2.79 ± 0.44 2.80 ± 0.43 0.75 AL-PM (cm) 2.85 ± 0.31 2.91 ± 0.39 0.20 2.85 ± 0.31 2.91 ± 0.39 0.20 2.70 ± 0.39 2.73 ± 0.42 0.15 Height (cm) 0.49 ± 0.20 0.51 ± 0.21 0.35 0.63 ± 0.17 0.62 ± 0.17 0.48 0.63 ± 0.13 0.63 ± 0.13 1.00 SI 0.92 ± 0.09 0.92 ± 0.09 0.45 0.91 ± 0.09 0.91 ± 0.08 0.85 0.95 ± 0.12 0.95 ± 0.11 0.34 AHCWR(%) 17.1 ± 6.65 17.4 ± 6.67 0.56 20.4 ± 5.00 20.2 ± 5.10 0.52 21.3 ± 4.49 21.3 ± 4.80 0.95 Data are expressed mean ± standard deviation. AP: anterior posterior; AL-PM: anterolateral-posteromedial; SI: Sphericity index; AHCWR: annular height to commissure width ratio; ES: endsystole; ED: enddiastole.
Abstract P1531 Figure
P1538 Light exercise may induce an increase in the propagation velocity of naturally occurring shear waves
Authors: Strachinaru M , Keijzer L B H , Bowen D J , Geleijnse M L , Van Der Steen A F W , Bosch J G , De Jong N 
Published: January 2020

Abstract

Background
Shear waves (SW) are induced in the myocardium by the closure of the valves. Recent studies show variations in their propagation velocity with age, gender or pathology. However, these valve-induced waves occur during relaxation and contraction. This means that the instantaneous SW velocity, as measure for stiffness, might not only depend on the intrinsic elastic properties of the relaxed myocardium, but also on its contractility and the exact moment of valve closure. The latter can change with heart rate and loading conditions, which could induce variance in measurement.

Purpose
This study aimed to investigate the effect of light exercise on the propagation velocity of naturally occurring shear waves.

Methods
Ten healthy volunteers underwent high frame rate (over 500 Hz) color TDI studies at rest and during light physiological stress (handgrip exercise). Shear wave velocities were averaged over several heart beats. Values obtained were compared by using the Wilcoxon signed ranks test and a Bland-Altman analysis.

Results
The light physiological exercise test induced a small but statistically significant rise in diastolic blood pressure and heart rate (table). The shear wave velocity after aortic valve closure (ASW) could be quantified in each subject at rest and during stress. The shear wave tracking after mitral valve closure (MSW) was only feasible for 8 subjects at rest and 6 during stress. There was an average difference of 0.4 ± 0.3 m/s (LOA= -0.18 to 0.97 m/s) between stress and rest measurements for the ASW velocity, which was statistically significant(p = 0.01, Figure). For the MSW the average difference was 0.02 ± 0.5 m/s (LOA= -1.02 to 1.06 m/s), p = 0.9.

Conclusion
We observed a statistically significant rise in the shear wave velocity after aortic valve closure but not after mitral closure during a light exercise. Although the statistical power of this study is relatively small, the results may suggest that naturally occurring shear waves velocity can be influenced by heart rate and loading conditions.
Table Parameter Rest Stress P Age [yr] 30 ± 6 - - BMI [kg/m2] 22 ± 2 - - Heartrate [bpm] 62 ± 7 67 ± 8 &lt;0.01 Systolic blood pressure [mmHg] 106 ± 13 110 ± 10 0.08 Diastolic blood pressure [mmHg] 62 ± 9 67 ± 9 0.01 Aortic shear wave velocity [m/s] 3.26 ± 0.4 3.65 ± 0.7 0.01 Mitral shear wave velocity [m/s] 4.56 ± 0.7 4.83 ± 0.8 0.9
Abstract P1538 Figure
P1540 Imaging parameters vs. operator dependence of global longitudinal strain values
Authors: Blessberger H , Bergler-Klein J , Graf S , Syeda B , Wagner H , Kammler J , Steinwender C , Binder T 
Published: January 2020

Abstract

Background
Speckle tracking based global longitudinal strain (GLS) values have proven useful in the assessment of subtle changes in left ventricular function. From a clinical point of view, robustness and reliability of measured values are critical to ensure a valid patient assessment and follow-up. However, it is still a matter of debate if imaging parameters systematically alter measured strain values and if these changes are relevant as compared with GLS fluctuations that are caused by different operators or different studies by the same operator.

Methods
In a consecutive everyday patient population (n = 35), we recorded the apical four chamber view several times in each patient with different ultrasound machine settings (modification of gain, frame rate, sector depth, and transducer frequencies) using a commercially available ultrasound imaging system. Furthermore, apical four chamber views with ‘optimized’ imaging settings at the operators’ discretion were recorded by two different observers (obA/obB) in each subject to compute inter- and intra-observer variability. GLS values were calculated offline with a dedicated software. We fitted a linear mixed effects model with random intercept and slope to assess the effect of imaging parameters on GLS and compared the two investigators with Bland-Altman plots.

Results
Ejection fraction ranged between 10% and 76% and was correlated well with GLS (r = -0.78). Neither gain settings (range: -24 to 24 arbitrary units, p = 0.68) nor frame rate (range: 51-113 sec-1, p = 0.77) systematically changed measured GLS values. Conversely, higher sector depth increased (range: 12 to 24 cm, mean effect: -0.16%/cm; 95% CI -0.24% to -0.07%, p &lt; 0.01), and higher transducer imaging frequencies decreased absolute GLS values (range for harmonic imaging: 1.5/3.1 MHz to 2.0/4.3 MHz, mean effect 1.10%/MHz; 95% CI 0.61% to 1.59%, p &lt; 0.01). According to our data, a 12 cm increase of sector depth would translate into an average change of -1.87% GLS (95% CI: -2.87% to -0.86%), whereas a switch of the second harmonic imaging frequency from 3.1 MHz to 4.3 MHz would cause a 1.32% GLS change (95% CI: 0.73% to 1.91%). Intra- and inter-observer variability showed good correlation and limits of agreement (obA: mean difference [MD]: -0.20%; 95% limits of agreement [LOA]: -2.42% to 2.02%, p = 0.86, obB: MD: -0.10%; 95% LOA: -4.28% to 4.07%, p = 0.12, obA vs. obB: MD: -0.53%; 95% LOA: -3.68% to 2.62%, p = 0.92).

Conclusion
Overall, GLS values were robust and reproducible in our cohort of patients. In comparison, potential systematic changes of GLS values caused by modification of imaging parameters (sector depth/transducer frequency) were much less in number than GLS variations caused by different operators or different studies by the same operator.
P1551 Exercise echocardiographic determinants of exercise tolerance in aortic stenosis
Authors: Fazendas P , Francisco A G , Manuel A G , Pereira H , Almeida A G 
Published: January 2020

Abstract

Introduction
A variation of 20 mmHg in the mean aortic gradient in asymptomatic aortic stenosis (AS) was proposed as an indicator of severity during exercise echocardiography.

Objective
to identify echocardiographic predictors of exercise tolerance in AS and analyze the association of the variation in mean aortic gradient (MAG) with exercise tolerance.

Methods
prospective study of patients (pts) referred for testing with asymptomatic AS. We performed exercise echocardiography using the modified Bruce Protocol. Baseline, peak and recovery imaging was performed. Exercise tolerance was expressed as METS and % of predicted METS for age and sex.

Population
24 pts, 14 males, age 72+-9 years, body mass index (BMI): 28+-4 Kg/m2, etiology: bicuspid 6 pts, degenerative tricuspid 18 pts, 4 pts were in sinus rhythm, the remaining were in atrial fibrillation.

Results
baseline parameters: indexed aortic valve area (AVAi): 0,51+-0,13 cm2/m2, MAG 37+-12 mmHg, left ventricle: ejection fraction (LVEF): 63+-9%, cardiac index L/min/m2(CI) 3,2+-0,6, global longitudinal strain (LVGLS) -16+-3%, VTI ratio: 0,26+-0,05, valvulo-arterial impedance mmHg.ml-1.m2(Zva): 3,9+-0,9 . Peak parameters: AVAi: 0,54+-0,14 cm2/m2, MAG 53+-17 mmHg, LVEF: 69 (IQR 10)%, CI 3,2+-0,6, LVGLS -19+-5% , VTI ratio: 0,28+-0,06, Zva: 4,3+-1,4. Exercise tolerance: METS 6+-2, representing 86+-26% of the predicted exercise tolerance for age and sex.

Statistics
we performed an univariate analysis to identify the echocardiographic parameters associated with exercise tolerance, which were then used in a multiple regression analysis. A higher peak CI correlated with a higher exercise capacity (r = 0,5, p 0,01) and higher mean aortic gradient variation (r = 0,6 p &lt; 0,01). The strongest predictor was the peak CI (B coefficient 0,5, R = 0,75, R² 0,57): when corrected for age, sex and BMI, for each increase of 0,5 mL/min/m2 in the peak CI we would expect an increase of 1 MET. This model explains 57 % of the variation in exercise capacity in these patients.

Conclusions
higher mean aortic gradient variation is associated with higher exercise tolerance and the strongest determinant of exercise tolerance in AS is the peak CI.
P1552 Dobutamine stress echocardiography as a screening tool for coronary artery disease detection in patients with end-stage liver disease awaiting transplantation
Authors: Masoura C , Bonou M , Kapelios C , Dambasis D , Skouloudi M , Barbetseas J 
Published: January 2020

Abstract

Indroduction
The prevalence of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) is unknown. However, patients with CAD and ESLD are at increased perioperative risk during liver transplantation. Currently there is no standard protocol for CAD screening in patients with ESLD awaiting orthotopic liver transplantation. We present preliminary data of our experience with dobutamine stress echocardiography in those patients.

Methods
Fifty patients (26 males, mean age of 59 years) with end-stage liver disease awaiting transplantation and no history of CAD underwent dobutamine stress echo. The etiology of their hepatic disease was hepatitis B (6 patients), hepatitis C (6 patients), primary billiary cirrhosis (10 patients), sclerosing cholangitis (8 patients), alcoholic hepatitis (10 patients) and polycystic disease (2 patients), while 8 patients had end-stage liver disease of unknown etiology. Twenty-six patients had risk factors for CAD. Eighteen patients had one risk factor and only 8 patients had 2 risk CAD factors. All patients received dobutamine infusion (at escalating doses of 5, 10, 20, 30 and 40 μgr/kg/min), targeting a 85% or more of their age-predicted maximum heart rate. Atropine was administered in 6 patients.

Results
All 50 patients had normal inotropic response of left ventricle, without evidence of ischemia (100% studies were negative for ischaemia). No patient had major intolerance to dobutamine. Eight patients experienced hypotension responded to infusion of normal saline. One patient developed paroxysmal supraventricular tachycardia, which was treated with intravenous bolus of adenosine.
No patient had cardiovascular events during a follow-up ranging from 1 to 18 months. Twelve patients underwent liver transplantation without any periprocedural cardiovascular events.

Conclusions
Dobutamine stress echocardiography is a safe and reliable method for CAD screening in the labile patients with ESLD who are candidates for orthotopic liver transplantation. It seems that the prevalence of significant CAD in this high-risk population is low.
P1558 Diagnosis and prediction of late cardiotoxicity in non Hodgkin"s lymphoma by 3D echocardiography, vascular ultrasound, and cardiac biomarkers
Authors: Mihalcea D , Balinisteanu A , Cosmulescu G , Vladareanu A M , Vinereanu D 
Published: January 2020

Abstract

Funding Acknowledgements
Grant PCCDI 83/2018 (BIOVEA) and PN-III-P1-1-TE-2016-0669
CHOP chemotherapy in non-Hodgkin"s lymphoma (NHL) is limited by the risk of cardiotoxicity. Aim. To define new parameters, such as 3D LV deformation, arterial stiffness and biomarkers able to detect late cardiotoxicity. Methods. 69 patients (29 men, 59 ± 11 years) with NHL, scheduled to receive CHOP, with LVEF &gt; 50%, were assessed at baseline, at the end of chemotherapy and 1.5 years after therapy completion by 3D echo for LV EF and deformation-longitudinal, radial, circumferential, area strain (LS, RS, CS, AS), by Echo-tracking for pulse wave velocity (PWV) and by biomarkers (troponin I, NTproBNP). Cardiotoxicity was defined as a decrease of LVEF &lt;50%, with &gt;10% from the baseline value. Results. 12 patients (group I) developed cardiotoxicity, while 57 patients did not (group II). There was a significant reduction of LS, CS, AS and an increase of arterial stiffness, but group I had greater changes (p = 0.001) (table). LVEF decrease correlated with changes of LS, AS, PWV and troponin (r = 0.62,r = 0.46,r=-0.33,r=-0.31, p &lt; 0.05). LS reduction at the end of chemotherapy was the best independent predictor for LVEF decrease after 1.5 years from therapy completion (R²=0.41, p = 0.002). LS decrease with more than 23% at the end of treatment predicted late cardiotoxicity after 1.5 years (sensitivity of 84%; specificity of 73%). Conclusion. Assessment of 3D myocardial deformation, arterial stiffness and biomarkers is able to detect late cardiotoxicity and to predict further LVEF decline in NHL.
LV deformation and vascular parameters CHOP Group I Group II LS(-%) Baseline 22 ± 2 22 ± 2 Final 15 ± 2† 19 ± 2† After 1.5years 12 ± 1† 17 ± 1† CS(-%) Baseline 21 ± 2 21 ± 2 Final 15 ± 1† 18 ± 2 After 1.5years 13 ± 1† 16 ± 1† AS(%) Baseline 37 ± 3 38 ± 2 Final 29 ± 3† 35 ± 2† After 1.5years 25 ± 2† 32 ± 1† PWV(m/s) Baseline 7.1 ± 1.2 7.1 ± 0.9 Final 8.8 ± 1.1† 7.4 ± 1.1† After1.5years 10.4 ± 1.0† 8.1 ± 1.2† LS longitudinal strain; CS circumferential strain; AS area strain; PWV pulse wave velocity. † p &lt; 0.001.