bluuebunny/crossref_metadata_2025_split huggingface dataset:
P242 When there is no time for further imaging
Authors: Ata F , Abdelrahman A , Othman E , Abushahba G 
Published: January 2020

Abstract

Introduction
Cardiac tamponade (CT) is a clinical syndrome characterized by hemodynamic abnormalities resulting from an increase in pericardial pressure due to accumulation of fluid. Tamponade is one of the cardiac emergencies where urgent management steps are crucial and life saving.
Absolute goal of treatment in Cardiac tamponade is to relieve the intra-pericardial pressure and to reverse the hemodynamic shutdown, by removal of the pericardial fluid via pericardiocentesis or surgical drainage.
As much inevitable as it is, pericardiocentesis is relatively contraindicated when the effusion is associated with aortic dissection or myocardial rupture due to the potential risk of aggravating the dissection or rupture via rapid pericardial decompression and restoration of systemic arterial pressure.
Case description
A 44-year-Old transit passenger was admitted after she developed sudden onset of palpitations, vomiting and epigastric pain. She was in sinus tachycardia when brought to the Emergency department, within minutes’ patient went into cardiac shock with severe metabolic acidosis. She was admitted to ICU and subsequently intubated. Chest X-ray showed evidence of Pleural effusion with enlarged cardiac shadow, which prompted an urgent transthoracic echocardiogram. Echo findings were consistent with clinical cardiac tamponade with a large left pericardial mass compressing the lateral LV wall and aortic root, with a color flow from the mass toward the left coronary system.
Mean while the patient was rapidly deteriorating, with and patient was not stable to undergo further imaging (CT or MRI), urgent contrast echo was done to rule out vascular connection between the mass and pericardial fluid, The Echo contrast study showed no vascular connection from the mass to the pericardial space ,however there was a connection from the mass to the left coronary system as shown in the figure, based on these findings a pericardial drainage was done successfully.
These findings were confirmed by contrast CT scan after patient is stabilized.
Patient gradually improved clinically, was extubated successfully, the provisional diagnosis was suspicious of pheochromocytoma,however the final diagnosis not established as the patient travelled to home country for further management.

Conclusion
Some times, it may become clinically challenging to effectively rule out contraindications to a procedure by the gold standard modalities, specially when a patient is collapsing on the table and the clock is ticking. In such scenarios, immediate alternate approaches resulting in safe outcomes are indispensable. Likewise, in our case of emergent cardiac tamponade and a suspicious pericardial mass in a crashing patient, Transthoracic echo with Optison proved to be life saving to rule out vascular connections between cardiac mass and coronaries or pericardial fluid, when there was no time for definitive imaging modalities due to rapid deterioration of patient’s clinical status.
Abstract P242 Figure.
P1713 A case of quadricuspid aortic valve complicated with infective endocarditis diagnosed by 3D transesophageal echocardiography
Authors: Hashimoto G , Ide S , Hayama H , Makino K , Otsuka T , Suzuki M , Iijima R , Hara H , Moroi M , Nakamura M 
Published: January 2020

Abstract

Background
Quadricuspid aortic valve (QAV) is a rare congenital heart disease with an estimated incidence of 0.008% to 1.46%. The functional status of QAV is predominantly a pure aortic regurgitation. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic echocardiography (TTE) is suitable for the diagnosis but, transesophageal echocardiography (TEE), especially 3-dimensional (3D) TEE, is a tool for the accurate definition of the valve anatomy.

Clinical case
A 60-year-old female underwent a head CT for intermittent headaches for one month ago. She was admitted to neurosurgery in our hospital diagnosed of subarachnoid hemorrhage. Four mm aneurysm was found on the periphery of the right middle cerebral artery on CT examination, and a cerebral aneurysm coil embolization was performed with a catheter in emergency. The possibility of infectious cerebral aneurysm was pointed out, and we examined in cardiovascular internal medicine. TTE revealed moderate aortic regurgitation. The ventricular septum exhibits sigmoid septum. A mobile mass was found near the left ventricular outflow tract in the sigmoid septum. TEE revealed a hypoplasia cusp (accessory cusp) is found between non coronary cusp and right coronary cusp. Aortic valve leaflets have become thickened and regurgitation from the central part of the cusps. 3DTEE was able to more accurately visualize that only the accessory cusp was hypoplastic, and the size of the other three leaflets appears almost the same. Similarly, vegetation on the left ventricular outflow tract were clearly revealed by 3DTEE.
Based on the above, it was diagnosed that quadricuspid aortic valve complicated with infective endocarditis (IE) with aortic valve regurgitation. After treatment with antibiotics according to IE, surgical treatment was scheduled.

Discussion
QAV is a rare congenital heart disease, and TTE is an important imaging tool for accurate diagnosis. Furthermore, TEE, especially 3DTEE, was a more appropriate diagnostic method in QAV and IE.
Abstract P1713 Figure. 3DTEE
P1719 A rare complication of homozygous sickle cell disease and high output cardiac failure
Authors: Landells M , Mcaloon C J , Steeds R P 
Published: January 2020

Abstract

Introduction/Background
Sickle cell disease (SCD) is an autosomal recessive blood disorder characterised by chronic anaemia and abnormally shaped red blood cells. SCD impacts multiple organ systems causing effects on morbidity and mortality, including cardiovascular (CV). Long term SCD can have a significant impact on the heart through multiple pathways, including chronic anaemia, microvascular dysfunction and the development of hypertension and chronic kidney disease, leading to the development of a high-output state and adverse cardiac remodelling. We report a rare case of homozygous SCD with the development of high output cardiac failure complicated by the development of associated pulmonary hypertension.
Case summary
A 58 yr old female patient (Height 158cm, weight 51.25kg, cardiac index 4.01 L/min/m²) with known homozygous SCD (HbSS) undergoing regular transfusions for chronic anaemia was admitted following a routine transthoracic echocardiogram (Figure 1a & 1b) due to the presence of a moderate sized global pericardial effusion, severe tricuspid regurgitation, dilated right heart with impaired longitudinal function, and good left ventricular (LV) systolic function (LVEF Simpson’s biplane = 62 +/- 5%). In the months preceding this, the patient described progressive dyspnoea associated with decreasing workload and orthopnoea. On clinical examination there was evidence of right sided heart failure. Blood results demonstrated a longstanding anaemia (Hb 57 g/L) with MCV 109.6. NT-proBNP was 10233 ng/L. Cardiac magnetic resonance imaging demonstrated LV dilatation with hyperdynamic function, severe LV hypertrophy, and impaired longitudinal function (global longitudinal strain -9.7%). Cardiac output was elevated at 6.5 L/min. There was no late gadolinium enhancement and T2* mapping did not demonstrate cardiac iron loading (29.6ms). Right heart catheterisation confirmed pulmonary hypertension (pulmonary artery pressure 55/33, mean 46mmHg) due to left heart disease (PC wedge pressure (24/30, mean 24mmHg). The pericardial effusion was drained and the aspirate demonstrated a cellular infiltrate reflecting pericardial inflammation (moderate pus cells, no growth after 48hrs, total protein = 56 g/L, no histological evidence of malignancy). Additionally, the patient underwent intravenous diuresis and blood transfusion with improvement in clinical status.

Discussion
We report a rare cause of pulmonary hypertension due to elevated left ventricular end-diastolic pressure as a result of long-term high cardiac output in a patient who has established homozygous SCD. Long-term adverse cardiac remodelling in SCD is well described. Pulmonary hypertension is a rare multifactorial complication of this process and the precise mechanisms remain unclear. It confers a poor prognosis and the only current treatment is the management of the underlying condition. Pulmonary hypertension should always be considered in SCD patients with clinical and cardiac imaging evidence.
Abstract P1719 Figure 1
P1747 Left atrial strain identifies diastolic dysfunction in children with cardiomyopathies and correlates with invasive LV end-diastolic pressure
Authors: Sabatino J , Borrelli N , Aversani M , Filippini E , Paredes J , Josen M , Prasad S , Fraisse A , Indolfi C , Daubeney P , Di Salvo G 
Published: January 2020

Abstract

Background
2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its diagnostic performance in children is unknown.
Aim of this study is to investigate whether LA strain and strain rate are able to diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM).

Methods
The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiography and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). Cardiac catheterization was performed within 24 hours after the echocardiographic study in 9 children (mean age 9 ± 7 years) with clinical indication and the LV end-diastolic pressure was measured.

Results
No significant differences in mitral E/A, E/E’, pulmonary S/D ratios and indexed left atrial volumes were observed among the 3 CM groups.
LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. ROC curves showed area under the curve of 0.976 (p &lt; 0.001) for LA strain and 0.946 (p &lt; 0.001) for LA strain rate, to distinguish CTRL from CMs.
Moreover, univariate regression analysis demonstrated that peak LA strain had a strong significant inverse correlation with invasive LV end-diastolic pressure (r -0.892, p &lt; 0.001). On the other hand, invasive LV end-diastolic pressure had non-significant correlations with E’ avg (r -0.139, p = 0.721), E/E’ avg (r 0.238, p = 0.537), MV DT (r 0.485, p = 0.186) and LAVi (r 0.514, p = 0.157).

Conclusions
LA strain is able to recognize and classify DD in children with cardiomyopathies and accurately correlates with invasive LV end-diastolic pressures.
Abstract P1747 Figure.
P1772 Assesment of total atrial conduction time in patients with atrioventricular nodal reentrant tachycardia with and without drug-induced type 1 Brugada pattern and control subjects
Authors: Kocabas U , Hasdemir C 
Published: January 2020

Abstract

Background
Most forms of atrioventricular nodal reentrant tachycardia (AVNRT) are created by reentry between 2 (or more) atrial connections to the AV node. There is a high prevalence of drug-induced type 1 Brugada ECG pattern (DI-Type1-BrP) among patients with AVNRT. Atrial vulnerability and structural remodeling that leads to reentrant circuits in AVNRT is largely unknown. PA-TDI interval assessed by tissue Doppler imaging is a useful technique to determine total atrial conduction time (TACT) which reflects atrial remodeling and arrhythmic substrate.

Purpose
In this prospective study, we aimed to assess TACT in patients with AVNRT with and without DI-Type1-BrP and control subjects.

Methods
Study population consisted of 62 consecutive patients (age 44 ± 12 years; 74% women) undergoing electrophysiological study and ablation for symptomatic, drug-resistant AVNRT and 42 age and sex matched control subjects. All patients and control subjects underwent ajmaline challenge test and tissue Doppler imaging.

Results
A DI-Type1-BrP was uncovered in 24 of 62 patients with AVNRT (38.7%). PA-TDI interval was longer in patients with AVNRT with or without DI-Type1-BrP compared to control subjects (124 ± 12 ms vs 119 ± 14 ms vs 105 ± 11 ms; P &lt; 0.001, respectively). PA-TDI interval was similar in patients with AVNRT with or without DI-Type1-BrP (124 ± 12 ms vs 119 ± 14 ms; P = NS, respectively). PA-TDI interval was significantly correlated with P-wave duration on the surface ECG (r = 0.23; P = 0.02). Left atrial volume index and left atrial phasic functions were similar in patients with AVNRT with or without DI-Type1-BrP and control subjects.

Conclusion
TACT is prolonged in patients with AVNRT. Further studies are needed to determine the underlying factor(s) such as DI-Type1-BrP that leads to prolonged atrial conduction time.
P1781 Cardio-protective role of dexrazoxane co-administered with anthracyclines: long-term echocardiographic follow-up in adult survivors of pediatric cancer
Authors: Filomena D , Cimino S , Maestrini V , Petronilli V , Cantisani D , Mattiucci C , Schiavetti A , Fedele F , Agati L 
Published: January 2020

Abstract
Background Cardiovascular disease is a well-recognized cause of increased late morbidity and mortality among survivors of childhood cancer treated with anthracyclines. A decrease in left ventricular (LV) ejection fraction (LVEF) and fractional shortening may be observed during follow-up. Previous studies reported non-negligible prevalence of subclinical systolic dysfunction assessed with deformation imaging at short-, mid- and long-term follow up. Co-administration of Dexrazoxane has been shown to significantly reduce short-term and mid-term cardiotoxicity. The usefulness of dexrazoxane in preventing late (&gt;10 years) anthracycline cardiotoxicity remains under discussion.
Purpose Aim of this study was to assess cardiac function in long-term (&gt;10 years) survivors of childhood tumors treated with dexrazoxane/anthracycline association.
Methods Twenty cancer survivors previously treated with co-administration of anthracyclines and dexrazoxane for childhood renal tumors or sarcoma and a control group of 20 healthy non-athletic subjects matched for age, sex and body surface area were enrolled in the study. Echocardiographic measurements included 3D LVEF and LV and right ventricular (RV) global longitudinal strain (GLS). Cancer survivors were evaluated at median follow-up time of 21.5 years (range 10-26).
Results No evidence of cardiac toxicity, as defined by current guidelines, was reported in all survivors. None of survivors presented LVEF &lt; 50% or abnormal longitudinal strain, defined as a value &gt;2 SDs below the mean using sex-specific and age-specific strain values. No significant differences in standard and deformation imaging parameters were observed between survivors and controls (3D LVEF 58 ± 3 % vs 60 ± 5 % p = NS; LV GLS -21 ± 1 % vs - 21 ± 2 % p= NS; RV GLS - 23 ± 2 % vs - 23 ± 5 % p= NS). Moreover, considering subjects who received a cumulative dose of anthracyclines above the median (doxorubicin-equivalent dose ≥208 mg/m2) no significant differences were found as compared to the group receiving a lower dose.
Conclusions No evidence of cardiac toxicity was detected in all survivors. Our findings support the cardio-protective role of dexrazoxane in children undergoing anthracycline-based treatment.
Parameters Cancer survivors (n= 20) Controls (n= 20) P 3D LVEF (%) 58 ± 3 60 ± 5 NS LV GLS (%) -21 ± 1 -21 ± 2 NS RV GLS (%) -23 ± 2 -23 ± 5 NS 3 D LVEF: Three-Dimensional Left Ventricular Ejection Fraction, LV GLS: Left Ventricular Global Longitudinal Strain; LV; RV GLS: Right Ventricular Global Longitudinal Strain.
Abstract P1781 Figure. LV strain analysis in a survivor
P1785 Hemodynamic determinants of left atrial function in patients with primary mitral regurgitation
Authors: Tencer T , Bakkestroem R , Banke A , Moeller J E 
Published: January 2020

Abstract

Background
2D speckle tracking (2DSE) has been recently used as an advanced method for assessment of left atrial (LA) function.

Purpose
The aim of the study was to determine the association between LA function assessed with 2DSE and severity of mitral regurgitation, filling pressures and symptomatic status in patients with primary mitral regurgitation (MR).

Methods
61 patients (age 65 ± 9 years, 77% males) with primary mitral prolapse and moderate to severe MR (effective regurgitant orifice (ERO) &gt; 0.30 cm2) and left ventricular ejection fraction &gt; 60% were enrolled. Right heart catheterization during rest and exercise, and transthoracic echocardiography during rest was performed. Pulmonary capillary wedge pressure (PCWP) was measured at rest and peak exercise. Echocardiographic average values of LA peak contractile, conduit and reservoir strain were obtained using 2DSE in the apical 4 and 2 chamber views.

Results
LA volume index was less than 34 ml/m2 in 54 patients, and LA function based on 2DSE was abnormal in majority. LA function was associated with ERO (Figure). Patients with severe MR defined as ERO &gt; 0.40 cm2 had significant higher reservoir strain (27.5 ± 5.1% vs. 24.5 ± 5.1 %, p = 0.02) and conduit strain (16.0 ± 4.9 %, vs. 13.1 ± 3.2 %, p = 0.008), but LA peak contractile strain was unchanged (11.4 ± 3.4 % vs. 11.8 ± 3.5 %, p = 0.69). In contrast no association between LA function, symptoms and PCWP at rest or exercise was found in our cohort. In linear regression analysis MR (ERO &gt; 0.40 cm2) was associated with conduit (β=2.8, p = 0.02) and reservoir strain (β=3.0, p = 0.04) after adjustment for age, gender, symptoms and PCWP with exercise, whereas LA peak contractile was not.

Conclusions
LA function assessed with 2DSE was affected in patients with primary MR. Strain parameters were associated with severity of mitral regurgitation, but there was no association with symptomatic status or filling pressure at rest or exercise.
Abstract P1785 Figure
P1788 Prognostic value of stress echocardiography in preoperative risk stratification and management
Authors: Almeida I , Pereira R , Cruz I , Quadrado M , Almeida A R , Fazendas P , Joao I , Pereira H 
Published: January 2020

Abstract

Introduction
The prognostic value of pharmacologic stress echocardiography has been extensively demonstrated in patients undergoing noncardiac surgery since 42% of the perioperative complications are cardiac. Coronary artery stenoses can became flow-limiting due to hemodynamic fluctuations in this period leading to myocardial ischemia.

Purpose
Evaluation of prognostic value of pharmacologic stress echocardiography in preoperative risk stratification.

Methods
Single center retrospective analysis of patients’ data referred to perform a preoperative risk stratification through pharmacological stress echocardiography between January 2014- December 2018. Data was collected regarding clinical and echocardiographic parameters to predict perioperative cardiac complications (myocardial infarction and development of arrythmias) and evaluate the impact of the result of DSE in patients´ clinical management.

Results
Of 910 pharmacological stress echocardiograms, 106 were performed to evaluate preoperative risk. Patients´ mean age was 66 ± 11 years, 85% males. 64% had hypertension, 45% dyslipidaemia, 38% current smokers and 18% diabetes. 189% had previously myocardial infarction and 9% stroke. All patients were proposed to intermediate-high risk surgeries: 73% to vascular surgery, 14% to kidney transplant and 13% to other type of surgery (especially abdominal surgery). Most of the stress tests (64%) were performed with dobutamine and the others 34% with dipyridamole. 91% of stress echocardiography were negative, 6% positive and 4% inconclusive. The patients with a positive stress test was submitted to coronary angiography to treat relevant lesions and cardiovascular risk factors were optimized. 72% of the patients has already been submitted to the proposed surgery; in this population, there was a 5% rate of cardiac complications following the surgery, all in patients with previous negative stress echocardiography. Complications were non-ST elevation myocardial infarction in 1% and de novo atrial fibrillation in 4%. Half of the patients with a positive stress echocardiography were operated with no cardiac perioperative complications, possibly related to patient´s optimization before the surgery; in the other half it was decided not to perform the surgery due to the potential cardiac risk. Predictor factors for perioperative cardiac complications, evaluated through univariate and multivariate analysis, were age (odds ratios (OR) 1.232, confidence interval (CI) 1.043-1.456, p 0.007) and stroke (OR 0.057, CI 0.947-44.592, p 0.033).

Conclusion
In our study, patients with a positive stress echocardiography were optimized before the surgery leading to none cardiac perioperative complications, emphasizing the importance of this test in preoperative patients´ management.
P1790 Is there any role of exercise Doppler echocardiography to unmask pulmonary hypertension (PH) in patients with systemic sclerosis and baseline echocardiographic measurements for PH in the gray zone?
Authors: Rallidis L , Papangelopoulou K , Anthi A , Makavos G , Konstantonis D , Tsangaris I , Orfanos S , Iliodromitis E 
Published: January 2020

Abstract

Background
The usefulness of exercise Doppler echocardiography (EDE) is uncertain in identifying patients with pulmonary hypertension (PH). Recently the cut off value for the definition of PH was changed and was set at the level of mean pulmonary arterial pressure (PAP) &gt;20 mmHg, measured by right heart catheterization (RHC).

Purpose
We examined whether EDE can unmask the presence of PH in patients with systemic sclerosis (SSc) whose baseline echocardiographic assessment for PH is non-diagnostic.

Methods
Forty-one patients with SSc (2 men and 39 women; mean age 61.2 ± 10 years) underwent treadmill symptom-limited EDE using a modified Bruce protocol. Tricuspid regurgitation velocity (TRV) was recorded within 60 seconds after the termination of the test. Inclusion criteria comprised: preserved left (ejection fraction &gt;50%), and right ventricular function (tricuspid annulus plane systolic excursion &gt;15 mm), lack of left side moderate or severe valvulopathy, presence of mild or moderate TR, satisfactory exercise tolerance and baseline TRV in the range of 2.6-3.0 m/s. All patients had RHC within 48 hours after EDE.

Results
In 5 cases the quality of post-exercise TRV was poor and further analysis was confined to 36 patients. RHC confirmed the presence of PH (mean PAP &gt;20 mmHg) in 14 cases (38.9%). All patients had pulmonary capillary wedge pressure &lt;15 mmHg. The increase in TRV from baseline to post-exercise was 1.25 ± 0.6 m/s. Ten patients developed post-exercise TRV ≥3.7 m/s of whom in 8 RHC validated PH. Post-exercise TRV was positively correlated with mean PAP obtained by RHC (r = 0,652, p &lt; 0.001). A cut-off value of post-exercise TRV ≥3.7 m/s had a sensitivity of 57.1%, a specificity of 90% and a diagnostic accuracy of 77.8% in detecting PH validated by RHC.

Conclusions
EDE has a moderate diagnostic accuracy for the identification of PH in patients with SSc whose baseline echocardiographic measurements for PH lie in the gray zone.