bluuebunny/crossref_metadata_2025_split huggingface dataset:
P770 Does intraoperative transesophageal match postoperative echocardiography in mitral valve surgery?
Authors: Alves P , Marinho V , Branco C , Ramalho A R , Maldonado M J , Coutinho G , Prieto D , Goncalves L , Antunes P 
Published: January 2020

Abstract

BACKGROUND
Intraoperative transesophageal echocardiography (iTEE) has an important role in mitral valve (MV) surgery, but may have dissimilar parameters from postoperative echocardiography (post-TTE). We aimed to evaluate iTTE Doppler flow profile and compare with the post-TTE in MV surgery.

METHODS
We conducted a prospective, observational study of 126 patients that underwent MVsurgery during 2 years. iTEE evaluated mean pressure gradient (MPG) and functional area. Patients were re-evaluated with TTE, 72 hours after surgery (post-TTE). iTEE and post-TTE Doppler values were compared and correlated. Preoperative TTE (pre-TTE) parameters were also determined.

RESULTS
The mean age was 59 ± 18 years and 55% were female. The prevalence of severe mitral regurgitation (MR) was 77.6% and severe mitral stenosis (MS) 23.7%. Globally, mitral valve repair was performed in 71%cases (83% for MR and 15% for MS) and replacement in 29% (64% for MR and 46% for MS). Left ventricular ejection fraction (LVEF), systolic pulmonary artery pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE) assessed in pre-TTE and post-TTE, as also MPG and functional area in post-TTE and iTEE are depicted on table 1. There was a higher numerical difference in iTEE vs post-TTE MPG values in mechanical valves (n = 5) (3.5 ± 1.2 to 5.2 ± 1.6, difference of 1.65 ± 2.4mmHg), than in biological valves (n = 17) (3.1 ± 1.1 to 3.9 ± 1.5, difference of 0.8 ± 1.7mmHg). Globally, iTEE-derived MPG and functional area were strongly correlated with their post-TTE values (r2 0.7 and 0.8,p &lt; 0.001).

CONCLUSIONS
iTEE Doppler parameters were strongly correlated with postoperative TTE parameters, with minimal differences: postoperative MPG were +0.4 ± 1mmHg higher in MV repair and +1.0 ± 1.8mmHg in MV replacement. There was a global improvement in sPAP. Our study demonstrates the usefulness of iTEE and its importance in stablishing possible reference values for postoperative follow-up.
MR MS pre-TTE post-TTE P value pre-TTE post-TTE P value LVEF (± SD,%) 57 ± 9 52 ± 10 &lt;0.001 58 ± 6 56 ± 7 &lt;0.001 sPAP (± SD,mmHg) 42 ± 17 33 ± 9 &lt;0.001 47 ± 18 35 ± 6 &lt;0.001 TAPSE (± SD,mm) 18 ± 2 14 ± 3 &lt;0.001 18 ± 2 14 ± 3 &lt;0.001 MV repair MV replacement iTEE post-TTE P value iTEE post-TTE P value MPG (± SD, mmHg) 2.8 ± 1.5 3.1 ± 1.4 0.084 3.2 ± 1.4 4.2 ± 1.6 0.016 Functional Area (± SD, cm2) 2.8 ± 0.6 2.8 ± 0.7 0.665 2.8 ± 0.6 2.7 ± 0.8 0.653
P778 Evaluation of left auricular and ventricular subclinical function by strain imaging in a cohort of hereditary TTR + amyloidosis
Authors: Aceves Velazquez E D , Guzman Ayon A M , Gonzalez Duarte A , Vasquez Ortiz Z Y 
Published: January 2020

Abstract
Hereditary amyloidosis represents 10% of all amyloid deposit diseases. Cardiac involvement clinically presents as heart failure. As advanced imaging methods have become available, subclinical detection of cardiac involvement has become a must in those patients since it changes the prognosis of the disease. The objective of the present paper was to determine if echocardiographic parameters of auricular and ventricular mechanics better predict cardiac involvement compared to the classic echocardiographic parameters suggestive of amyloid deposit in the heart.
This was a prospective, observational and descriptive study of a cohort of 30 patients with diagnosis of hereditary TTR+ amyloidosis without known cardiac involvement. We performed 2 and 3D echocardiography with left auricular and ventricular mechanics by strain method. Each patient was evaluated at the beginning of the study and at a 1-year follow-up visit.
The grade of diastolic disfunction increased from a normal diastole in 67% of patients to only 53% at 1-year follow-up. The antero-posterior diameter of the left atrium increased (p = 0.04), the E/e’ Index also increased (p = 0.01), both suggestive of increased left ventricular filling pressures. The LVEF, as a classic parameter of left ventricular function remained normal in 97% of patients during follow-up. No differences were found in terms of systolic ventricular mechanics; however, diastolic mechanics were altered. Untwist was increased (p = 0.02) and the reservoir auricular function was decreased from 34 to 30% (p = 0.03). Table.
Echocardiographic strain and 3D echocardiography can show changes early in patients with cardiac involvement in patients with hereditary TTR+ amyloidosis.
Statistically significant results Variable Basal 1 year follow-up P Left atrial anteroposterior diameter (mm) 32.8 ± 5 35.1 ± 5.6 0.004 Ventricular mass (gr/m2SC) 70.7 (61-90.8) 82.6 (69.2-113.7) &lt;0.0001 Left ventricular telediastolic volume (ml) 37.2 ± 11 41.6 ± 11.6 0.03 Mitral A velocity (ms) 113.7 ± 28.6 130.5 ± 19.5 0.03 Lateral e mitral velocity (cm/s) 13.8 ± 5.5 12.4 ± 4.8 0.04 Mitral E/e’ index 7.9 ± 5.2 9.5 ± 5.5 0.01 Untwist 110.8 ± 49.9 127.5 ± 62.6 0.02 Reservoir auricular strain (%) 34.8 ± 8.6 30.8 ± 9.4 0.03 Telesystolic left atrial volume (ml) 25.9 ± 8.8 27.4 ± 11 0.01 Telediastolic left atrial volume (ml) 42.5 ± 12.9 40.7 ± 13.7 0.03 Left atrial ejection fraccion (%) 0.42 ± 0.20 0.34 ± 0.18 0.03 Table 1. Statistically significant results.
P783 Global longitudinal strain detects trastuzumab induced cardiotoxicity early in a clinical population
Authors: Grylls J , Ellis C , Ingram T , Lee E 
Published: January 2020

Abstract

Background
Trastuzumab is highly effective in the treatment of breast cancer, and is often used as an adjuvant therapy. Due to its potential cardiotoxicity, serial monitoring of cardiac function is vital. Ejection fraction (EF) by two-dimensional echocardiography is routinely used but has limitations in measurement variability. Myocardial deformation imaging, in particular Global Longitudinal Strain (GLS), can detect pre-clinical myocardial dysfunction. However, its use is not yet adopted into routine clinical practice.

Aims
Our aim was to ascertain if a clinically significant reduction in GLS (≥11% from baseline) occurred before the onset of EF reduction, in patients who developed cardiotoxicity whilst receiving trastuzumab.

Methods
Between January 2014 and January 2019, 235 consecutive patients received trastuzumab and underwent serial echocardiography at 3 monthly intervals at our institute. Cardiotoxicity is defined as a ≥10% EF reduction from baseline or an EF &lt;50%. Women who developed cardiotoxicity as defined by this change in EF were retrospectively studied.
Two-dimensional speckle tracking was used to derive peak longitudinal strain in each myocardial segment from the apical four-, three- and two-chamber view images. GLS was taken as the average value of all these segments. The median time to ≥11% GLS reduction and ≥10% EF reduction or EF &lt;50% was compared.

Results
Thirteen women (mean age 53 ± 9.5 years) developed cardiotoxicity. EF was 61.8 ± 4.4% at baseline and 45.7 ± 7.5% following therapy (p = 0.00). A ≥11% reduction in GLS from baseline was observed in all patients: GLS -20.2 ± 1.5% and -15.6 ± 2.1%, p = 0.00. The median time to cardiotoxicity as defined by EF and GLS was 6 months and 3 months, respectively (p = 0.031), as shown in Table 1. Repeatability analysis showed both EF and GLS measurements in our cohort have good measurement reproducibility. Inter-observer intraclass correlation (ICC) for EF and GLS were 0.912 and 0.913, respectively. Intra-observer ICC for EF and GLS were 0.925 and 0.900, respectively.

Conclusion
Cardiotoxicity developed in a significant portion (6%) of our patients receiving trastuzumab. As a reduction in GLS was detectable early and preceded that of EF by 3 months, this may represent a therapeutic window for initiation of cardio-protective medication, if and when the use of GLS is incorporated into routine practice for cardiotoxicity surveillance.
Table 1: Summary of Findings. Baseline Cardiotoxicity Paired t-test p value Median time of onset EF 61.8 ± 4.4% 45.7 ± 7.5% P &lt; 0.01 6 months* GLS -20.2 ± 1.5% -15.6 ± 2.1% P &lt; 0.01 3 months* *denotes exact sign-test p &lt; 0.05.
P813 Association of clinical and echocardiographic signs with atrial fibrillation in coronary artery disease patients: a propensity score matching analysis
Authors: Yaroslavskaya E I , Kuznetsov V , Gorbatenko E A 
Published: January 2020

Abstract

Background
It is known that atrial fibrillation (AF) and coronary artery disease (CAD) may be encountered coincidently in a large portion of patients. However, there are not so much data available about AF association with some clinical and echocardiographic signs in CAD patients.

Purpose
To find out the relationship between clinical and echocardiographic features and AF in CAD patients.

Methods
From local database of coronary angiography we selected patients with significant coronary stenosis (≥50% of lumen of at least one epicardial artery): 178 patients with chronic or paroxysmal AF and 331 patients without AF (the last group was selected by Propensity Score Matching with balancing by sex, age, body mass index, severity of chronic heart failure, prevalence of myocardial infarction, arterial hypertension, thyroid disease).

Results
Patients with AF compared to patients without AF often had higher heart rate (105 ± 32 vs 70 ± 13 beats/min, р&lt;0.001), lower Canadian Cardiovascular Society angina classes (III-IV - 52.9% vs 66.5%, р=0.041), lower triglycerides level (1.74 ± 1.08 mmol/l vs 1.94 ± 1.17 mmol/l, р=0.019). In echocardiographic data the groups did not differ in prevalence and severity of left ventricular (LV) wall motion abnormalities. However LV dimension (26.7 ± 3.6 mm/m² vs 26.1 ± 3.3 mm/m², p = 0.028), right ventricular diameter (13.9 ± 2.0 mm/m² vs 13.3 ± 2.0 mm/m², p &lt; 0.001), left atrial linear dimension (24.1 ± 3.2 mm/m² vs 21.6 ± 2.9 mm/m², p &lt; 0.001), LV myocardial mass (171.0 ± 40.0 g/m² vs 154.8 ± 38.3 g/m², p &lt; 0.001) were higher in AF patients. This group of patients more often demonstrated significant mitral regurgitation (49.1% vs 18.4%, р&lt;0.001) and impaired LV ejection fraction (56.2% vs 39.5%, р&lt;0.001). Coronary angiographic data showed that patients with AF more often had right coronary dominance (87.5% vs 80.4%, р=0.043), right coronary artery lesions (92.1% vs 85.8%, р=0.037), less often left main coronary artery lesions (16.3% vs 24.8%, р=0.027).

Conclusions
AF in CAD patients is associated with higher ventricular, left atrial dimensions, LV myocardial mass, significant mitral regurgitation and impaired LV ejection fraction and some peculiarities of clinical and coronary angiographic symptoms.
P819 Outflow graft twist occlusion in the heartmate 3 left ventricular assist system in 7 cases: analysis of potential mechanisms using computed tomography
Authors: Solowjowa N , Zimpfer D , Mueller M , Krastev H , Falk V , Schloeglhofer T H , Starck C H , Potapov E , Netuka I 
Published: January 2020

Abstract

Background
Twist of the outflow graft (OG) of the HeartMate 3 left ventricular (LV) assist device (HM3) with subsequent occlusion is a rare, but life-threatening complication.

Purpose
We evaluated if potential implantation technique dependent mechanisms of OG twist can be predicted by multislice computed tomography (MSCT).

Methods
We retrospectively analyzed clinical, echocardiographic and MSCT data of 7 patients with angiographically proven and surgically corrected OG twist and of 11 consecutive patients without any type of pump obstruction. MSCT parameters were: position of inflow cannula related to anatomical LV apex (1), angulation of axis of inflow cannula related to LV axis (2), orientation of outflow channel of the pump housing related to LV axis (3), OG course (4). Echocardiographic parameters were LV end-diastolic diameter (LVEDD) and aortic valve opening.

Results
Mean time from implantation to twist was 563 ± 161 days. Preoperative LVEDD (64.6 ± 9.8 mm vs. 67.4 ± 10.2 mm, p = 0.563) was similar. LVEDD reduction after implantation (20% vs. 28%) and prevalence of aortic valve opening was higher in the twist group (71% vs. 45%). The MSCT measurements showed a high degree of heterogeneity in both groups: (1) differed from superior to infero-lateral; (2) varied from cranial to caudal, lateral and medial; (3) varied from antero-septal to inferior. (4) showed an incidence of non-obstructive kinking of 29% and 36%, respectively.

Conclusion
Marked heterogeneity of the measured MSCT parameters was observed in both groups. No specific pattern or geometric relation could be attributed to the OG twist phenomenon.
P835 Mitral valve abscess complicating infective endocarditis
Authors: Hammad B , Saleh Y , Almaghraby A 
Published: January 2020

Abstract

Funding Acknowledgements
n/a

Background
Health care associated infective endocarditis (HAIE) accounted for u to 30% of infective endocarditis (IE) cases, it tends to affect patients with a poor clinical condition and represents a considerable in-hospital mortality.

Case
A 75-years old gentleman with end-stage renal failure secondary to polycystic kidney disease had commenced hemodialysis via a tunneled hemodialysis catheter 3 months ago, presented for pre-operative evaluation before vascular surgery for acute left lower limb ischemia, patient gave history of fever for the past month partially responding to antipyretics along with recent ischemic cerebrovascular stroke with no residual neurological deficits. On examination he had a blood pressure of 110/70 mmHg, a heart rate of 100 bpm, a temperature of 38oC, and a harsh pansystolic murmur over the apex. Laboratory results revealed leukocytosis elevated CRP and blood cultures were positive for staphylococcus aureus. Electrocardiography showed sinus tachycardia.

Methods and Results
2D-Trans-Thoracic Echocardiography (TTE) revealed the presence of echogenic rounded mobile mass measured 2x2 cm attached to the atrial surface of the posterior mitral valve leaflet. There was a severe mitral valve regurgitation and the regurgitant jet was directed anteriorly swirling around the mass. The left ventricle dimensions and function were normal. 2D-Trans-esophageal Echocardiography(TEE) was done for better visualization of the mass and it"s attachment. The mass was overlying the atrial surface of the posterior leaflet middle P2 scallop with a small echo-lucent cavity (abscess formation) in the leaflet in addition to another smaller mass at the atrial surface of the anterior leaflet. The aortic, tricuspid and pulmonary valves were normal in structure and function

Discussion
Echocardiography is a crucial imaging modality in a patient with multiple systemic emboli to rule out cardio-embolic source of embolization. TEE is of added value along with TTE in better definition of masses and detection of IE related complication.
While the patient was prepared for the vascular surgery to secure the ischemic limb his sensorium was disturbed and became unconscious immediate brain computed tomography showed severe intracranial hemorrhage and the patient died.

Conclusions
Patient with chronic kidney disease and on hemo-dialysis are highly vulnerable to health care related infective endocarditis and high clinical suspicion should be given in a situation of prolonged fever and embolic events. Mitral valve abscess is a rare complication of infective endocarditis and if occurs it leads to increase mortality. TEE should be an integral part of management of patients with IE to role out serious complications.
Abstract P835 Figure. Mitral valve infective endocarditis
P838 Accessory Mitral Valve Tissue in a 35-year-ol female with Significant Left Ventricular Outflow Tract Obstruction and Aortic regurgitation
Authors: Cataluna C , Dayag-Cabrera M , Baysa A 
Published: January 2020

Abstract
Accessory mitral valve tissue (AMVT) causing left ventricular outflow tract (LVOT) obstruction and aortic regurgitation is a rare congenital cardiac malformation.The true prevalence is not well known but latest literature review identified 104 cases of AMVT from 1963 to 2013.
We present a case of asymptomatic 35-year-old female who came in due to heart murmur. Chest X-ray showed a right-sided aorta and a dilated ascending aorta. An echocardiographic finding of a mobile serpiginous AMVT that parachutes into LVOT with significant gradient of 74 mmhg. There was mild restriction of the aortic right coronary cusp with moderate aortic regurgitation and other finding noted of persistent left superior vena cava. The patient underwent open heart surgery and had an excision of the AMVT and subcommissuroplasty of the right coronary cusp. Histological analysis of the excised specimen showed fragments of valvular tissue with fibrosis. There was no obstruction on repeat echo with mild aortic regurgitation. No postoperative complication noted and was discharged stable.
AMVT usually seen among young patients and it is uncommon among female adult population. LVOT obstruction and aortic regurgitation may caused by the AMVT. Echocardiography is an important modality in diagnosing and recognising such anomaly and the optimal treatment is surgery in the presence of significant LVOT obstruction.
Abstract P838 Figure. Intraoperative findings
P844 A stroke of bad fortune
Authors: Nguyen Nguyen N , Kadappu K 
Published: January 2020

Abstract

Case description
We report the case of a 78 year old man who was referred to our hospital following identification of an intracardiac mass on transthoracic echocardiogram (TTE). The study was for work-up of a recent left middle cerebral artery thromboembolic stroke, with successful endovascular clot retrieval. His only other active medical issue was metastatic prostate cancer with bony involvement, on palliative hormone therapy with a well controlled prostate specific antigen level. He was an ex-smoker and and had an ECOG performance status of zero. On physical examination, the patient was clinically well, with unremarkable cardiopulmonary auscultation.
The TTE demonstrated an echodense mass in the left atrium (LA), with Doppler colour giving a suggestion of its size (image A). The subsequent transoesophageal echocardiogram illustrated a large, well defined, heterogenous, echodense mass dominating the LA (image B). It was not adherent to the interatrial septum. There was no significant spontaneous echocontrast or thrombus formation in the left atrial appendage (LAA). Considering the location of the mass, the presumptive diagnosis of atrial myxoma was less likely. Differential diagnoses we considered included pure thrombus, infection and benign or malignant cardiac tumours. It was unlikely that this patient had a pure thrombus only considering the LAA was clear. He also did not have any non-specific or focal clinical features suggestive of infection. The patient went on to have a gated CT thoracic aortogram, which showed a contrast-enhancing soft tissue mass within the LA measuring approximately 50x40 millimetre, which invaded into the left inferior pulmonary vein, and was contiguous with a soft tissue mass in the left lower lobe of the lung (image C). He also had a positon emission tomography scan, which showed the highly metabolically active mass in the lung invading into the left inferior pulmonary vein, and as well as left atrium (image D). The patient underwent a biopsy of this left lower lung lesion, which confirmed squamous cell carcinoma of lung origin.
Due to the large tumour burden in the LA, the joint decision with medical and radiation oncology teams, was not to administer systemic chemo- or localised radiotherapy, as this would lead to high risk of tumour embolisation. The patient also had a short period of therapeutic anticoagulation with intravenous unfractionated heparin to treat the likely thrombotic coating to the left atrial tumour extension, but developed a retroperitoneal haematoma, and hence anticoagulation was ceased. The patient was referred to palliative care services, and returned back to the community.

Conclusion
Cardiac tumours, whether primary or secondary, are rare. They are most frequently identified on post-mortem examination. This case is unusual, in that the patient had a second primary tumour and has remained completely asymptomatic prior to embolic presentation, despite the large size of the mass.
Abstract P844 Figure 1.
P847 Echocardiographic imaging in primary cardiac tumour-leiomyosarcoma
Authors: Sharnam V , Husni D , Ong J , Ross F , Skarparis Y , Myagerimath S 
Published: January 2020

Abstract

Funding Acknowledgements
N.A
Primary cardiac tumours are rare entities with an incidence rate of 0.0017% to 0.019% of which 25% are malignant. Leiomyosarcomas, a form of primary cardiac sarcoma, accounts for 8-9% of all the cardiac sarcomas (1). Primary cardiac sarcomas typically present late with either quite advanced local cardiac symptoms or non-specific symptoms arising from metastasis (2). We herein report a rare presentation of leiomyosarcoma in a sixty-seven year old female Caucasian female, originally suspected following transthoracic echocardiogram.
A large mass filling the Left Atrium(L.A) with a degree obstruction to the Mitral Valve (M.V) was firstly noted on transthoracic echocardiogram. This mass had a broad base, appeared to be originating from the pulmonary veins and was not encapsulated. A small circumferential pericardial effusion was noted. Overall biventricular function was preserved and there was no evidence of pulmonary hypertension. A contrast-enhanced computed tomography scan of the chest, abdomen and pelvis was performed for staging which in addition to known cardiac mass revealed widespread bony metastases. A core biopsy of one of the lumbar paravertebral metastatic deposit was carried out to establish the diagnosis.
We hope to add to the pool of increasing overall understanding of primary cardiac sarcomas and share our fascinating echocardiogram findings. In addition, we believe this case supports our recommendation for general practitioners in the United Kingdom to have open access to requesting echocardiograms in order to identify such aggressive cardiac malignancies at an earlier stage, with the hope to improve prognosis.
Abstract P847 Figure. Depicting LA mass occupying the whole of