bluuebunny/crossref_metadata_2025_split huggingface dataset:
P277 RV remodeling by echo parameters in endurance and strength sport training
Authors: Moshkani Farahani M , Shirdel M 
Published: January 2020

Abstract

Introduction
With regular and long-term exercises, the heart undergoes changes that are called the adaptation of the heart in response to exercise or physiological changes, which contrasts with the pathological changes caused by hypertension and aortic valve stenosis. However, the exact effects of exercise on the structure and function of the heart depend on the type, intensity and duration of exercise, the amount of physical fitness, inheritance, and gender.

Materials and Methods
In this prospective clinical trial study, 40 subjects, including 20 in the endurance exercise group and 20 in the exercise group, were evaluated. Echocardiography was performed for all of these subjects before and after the exercises that was performed professionally for 8 weeks under the supervision of the trainer and the changes were recorded. The data were analyzed statistically by SPSS20 software. A significant level of 0.05 was considered.

Results
The mean ± standard deviation of the age was 20/80 ± 1/42 years. Significant decrease in mean RVSM was observed only in the strength group (P = 0.008). There was no significant difference in the endurance group . There was no significant difference between the two groups before the test in the mean TAPSE (P = 0.46). The mean of TAPSE in the endurance group was 0.22 ± 1.99 and in the strength group was 0.31 ± 1.95. There was no significant difference between the two groups (P 0.46). There was no significant difference between the two groups before the test in the mean E / e (P = 0.51). The mean E / e "in the endurance group was 0.47 ± 4.75 and in the strength group was 0.54 ± 5.50, and there was a significant difference between the two groups (P &lt;0.001). The mean SWDT in the endurance group was 0.12 ± 0.95 and in the strength group was 0.11 ± 1.06, and there was a significant difference between the two groups (P = 0.002). There was a significant increase in mean SWDT in the strength group after the test (P &lt;0.001) .There was a significant increase in mean PAP in the strength group (P = 0.007) .
There was a significant increase in mean LV mass index in the strength group (P &lt;0.001),with no significant difference between the two groups in mean FAC.

Conclusion
It seems that any kind of strength and endurance exercise affects the performance status, however, strength exercises have more effects which causes RV dysfunction. All indexes measured changed within normal level except for PAP that had abnormal changes after endurance exercise .
P278 Does recanalization of chronic total occlusion reflect on myocardial function?
Authors: Petrovic O , Juricic S , Trifunovic-Zamaklar D , Paunovic I , Rakocevic I , Gavrilovic N , Jovanovic I , Boskovic N , Aleksandric S , Ivanovic B , Djordjevic-Dikic A , Beleslin B , Vukcevic V , Stankovic G , Stojkovic S 
Published: January 2020

Abstract

Background
Percutaneous coronary intervention for chronic total occlusion (PCI CTO) is still high risk procedure and it is doubtful will it become standard of care. There is evidence that it can reduce angina but even silent ischemia represent ischemic burden that ultimately lead to left ventricle remodeling and electrical instability.

Purpose
Our aim was to access effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) on myocardial function.

Methods
We compared two groups of pts. First patients with percutaneous coronary intervention of chronic total occlusion with optimal medical therapy and second group - patients with only optimal medical therapy (control group). Echocardiographic exam was performed before randomization and after 6 months of follow-up. Doppler intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured. MPI (Myocardial performance index) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral wave (E) was divided by average peak early diastolic annular velocity (e"). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time intervals from 17 segments, reflecting myocardial contraction heterogeneity.

Results
A total of 94 age matched CTO patients (48 in PCI + OMT group and 46 in OMT) were analyzed. Changes in ejection fraction (EF), diastolic function represented by E/e", global cardiac function represented by MPI, global longitudinal strain (GLS) and myocardial dispersion changes were compared between groups. At follow up between groups in there was no significant change in ejection fraction (EF), diastolic function, GLS and mechanical dispersion, but there was improvement in MPI.

Conclusion
Myocardial performance index is sensitive marker which can detect subtle improvement in global myocardial function after recanalization of chronic total occlusion..
Variable PCI + OMT (n = 46) OMT (n = 48) ΔOMT vs. ΔPCI + OMT p value baseline At 6month follow up P value baseline At 6month follow up P value EF (%) 55.69 ± 8.56 54.83 ± 8.44 0.10 50.22 ± 11.71 51.42 ± 10.45 0.06 0.71 MPI 0.676 ± 0.99 0.632 ± 0.96 &lt;0.01* 0.593 ± 0.14 0.604 ± 0.12 0.22 &lt;0.01* E/e" 13.10 ± 6.90 12.05 ± 5,08 &lt;0.05* 14,12 ± 5.70 13.02 ± 5.62 &lt;0.05* 0.23 GLS (%) -14,38 ± 3,38 -15,22 ± 3,68 &lt;0.05* -13.33 ± 3.43 -13.29 ± 3.42 0.87 0.07 Mechanical dispersion (ms) 63.89 ± 26.22 57.35 ± 27.33 &lt;0.01* 53.30 ± 21.68 50.00 ± 22.40 0.05 0.06 Δ- percentage changes between baseline and at 6 month follow up
P279 Subclinical left ventricular dysfunction in patients with insulin resistence and hypovitaminosis D
Authors: Stevanovic A , Dekleva M , Ilic Pasquali N 
Published: January 2020

Abstract

Introduction
Patients with subclinical left ventricular diastolic and systolic dysfunction are at risc of future cardiac events.
Insulin resistance (IR) has been reported to be a strong risk factor for cardiovascular disease (CVD). Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction and vitamin D deficiency is also associated with increased risk of CVD, including hypertension, heart failure, and ischemic heart disease.

Aim
The aim has been to explore association of IR and vitamin D deficiency with subclinical left ventricular disfunction.

Method
The study consisted of 79 patients divided into two groups according IR, evaluated at baseline by the homeostasis model assessment method (HOMA-IR). v The HOMA1-IR index was calculated by the formula: HOMA1-IR = fasting plasma insulin (µU/ml) x fasting plasma glucose (mmol/L). The HOMA2-IR index was obtained by the program HOMA Calculator (free) download Windows version.
The cut-off values for IR were: HOMA1-IR &gt; 2.7 and HOMA2-IR &gt; 1.8; group of 41 patients, and group od 38 patients without of IR.
Parameters of left atrial and ventricular geometry were estimated by echocardiography. Tissue Doppler velocities were measured from medial and lateral annulus (e, a, s) including isovolumic contraction velocity (IVCv) and E/e Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking.

Results
In IR group level of 25-OH-D was deficient in 25 (61.2%), insufficient in 10 (25%) and sufficient in 6 (13.8%) patients and significantly lower compared to control group (46.8 ± 25.5 vs 61.5 ± 33.8, p &lt; 0.001).
Importantly, 25-OH-D was associated with global longitudinal strain (r= −0.21, &lt;0.05). Values of GLS (-19.9 ± 2.8 vs -26.6 ± 2.9; p &lt; 0.001) and IVCv (0.07 ± 0.02m/s vs 0.09 ± 0.03m/s; p &lt; 0.05) were significantly lower and E/e (9.11 ± 2.24 vs 7.18 ± 1.65; p &lt; 0.001) significantly higher in group of patients with IR.

Conclusion
The results showed that insulin resistence is asociated with subclinical LV diastolic and systolic dysfunction. Level of 25-OH-D was significantly lower in patients with insulin resistence suggests that vitamin D deficiency may have a certain contribution to the development of myocardial dysfunction in these patients.
Fortunately insulin resistance and vitamin D deficiency are a modifiable risk factors; the reduction of insulin resistance and increase the level of 25-OH-D may reduce CV risk in this group of patients.
P309 The use of echocardiographic parameters to predict clinical outcomes in AL-amyloidosis cardiomyopathy
Authors: Geenty P , Sivapathan S , Deshmukh T , Brown P , Boyd A , Kwok F , Richards D , Altman M , Stewart G , Thomas L 
Published: January 2020

Abstract

Background
AL-amyloidosis has a rapid clinical progression, with cardiac involvement associated with a particularly poor prognosis. Cardiac amyloidosis is diagnosed by either invasive biopsy or conventional echocardiographic parameters such as increased wall thickness, in the absence of other causes. More recently, novel parameters including 2D longitudinal strain have demonstrated diagnostic utility in a range of infiltrative cardiomyopathies including cardiac amyloidosis.
Aim/Method: We sought to evaluate traditional and novel echocardiographic parameters in their ability to predict adverse outcomes in a cohort of AL-amyloid patients. 80 patients who had transthoracic echocardiograms at a single centre were included. Comprehensive echocardiographic assessment was performed, including left ventricular ejection fraction (LVEF), LV Global Longitudinal Strain (GLS), LV mass (indexed to BSA). The primary endpoint was a composite of of major adverse cardiac events (MACE) and all-cause mortality, that was assessed by interrogation of the medical records on a specified censor date.

Results
At a mean follow-up (time from echo to censor date) of 5.4 ± 2.6years, 38/80 (47.5%) of patients experienced the primary endpoint of MACE or death, of which 25/80 (31%) were deaths. LVEF (59 ± 5.6%vs56 ± 6.4%, p = 0.04), GLS (17.4 ± 3.9%vs14.8 ± 4.9%, p = 0.01) basal longitudinal strain (12.3 ± 3.2%vs9.6 ± 3.9%, p = 0.002), indexed LV mass (107 ± 36g/m2vs130 ± 34g/m2, p = 0.06) and E/E’ (13.7 ± 4.9vs20.6 ± 9.6, p &lt; 0.001) were all significantly different between patients who experienced the primary endpoint and those that didn’t. The strongest predictors of outcome were E/E’ (AUC 0.74), LV mass (AUC 0.73) and the ratio GLS:LV mass (AUC 0.73). An E/E’ of 15 had a sensitivity of 71% and specificity of 69%, while an indexed LV mass of 108 had a sensitivity and specificity of 74% and 67% respectively. GLS to LV mass as a cutoff of 0.16 had a sensitivity and specificity of 70% and 69% respectively.

Conclusion
In a cohort of 80 patients with AL-amyloid cardiomyopathy, almost half (47.5%) reached the primary composite endpoint. Diastolic dysfunction as expressed as E/E’, and LV mass were the most powerful predictors of outcome, while global longitudinal strain and LV basal strain were also reduced, and showed superiority over LV ejection fraction in predicting prognosis.
P316 A feasible and accurate method for the assessment of early ventricular dysfunction in children with kawasaki disease: result from the MyoWoRK (myocardial work related to kawasaki disease) study
Authors: Borrelli N S , Di Salvo G , Sabatino J , Avesani M , Filippini E , Karagodova E , Spada M , Josen M , Fraisse A 
Published: January 2020

Abstract

Funding Acknowledgements
EACVI Training Grant

Introduction
Kawasaki disease (KD) is an acute vasculitis of unknown etiology. It is associated with high morbidity and mortality due to the development of coronary artery aneurysms and myocardial dysfunction.

Purpose
The aim of this study was to evaluate sensitivity and specificity of left ventricular (LV) pressure–strain loop (PSL) area, which reflects regional myocardial work and metabolic demand, in predicting subtle myocardial abnormalities in KD patients with coronaries aneurisms.

Methods
A total of 88 patients (59 male, age 8.95 ± 4.95 years) were included in our study. Among the children admitted in our institution with a diagnosis of KD during the study time frame, 42 patients (KDg) (29 male) with coronary artery dilatation (Z-score &gt;2.5) were selected. These cases were compared with 46 (30 male) age-matched controls (CTRg). Classical echocardiographic parameters of LV systolic function were normal in both groups, while global longitudinal strain (GLS) was decreased in 6 KD patients. Global work index (GWI) was calculated as the area of the LV PSL. From GWI, it was estimated also Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE). We also made a subgroup analysis between KD patients with normal GLS (&gt; -19 %) and control patients.

Results
Despite normal LV systolic function by routine echocardiography, compared to controls, KD patients had lower GWI (1448 ± 382 mmHg% in KDg vs 1751 ± 263] mmHg% in CTRg, p = 0.00003), GCW (1904 ± 390 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p= 0.0004) and GWE (94 ± 5 % in KDg vs 96 ± 2 % in CTRg, p= 0.01). There was not significant difference in GWW between the KDg and CTRg. When KD patients with normal GLS were analysed separately, they preserved a significant difference in GWI, GCW and GWE in comparison with controls (GWI: 1490 ± 347 mmHg% in KDg vs 1751 ± 263 mmHg% in CTRg, p = 0.0002; GCW: 1972 ± 321 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p = 0.004; GWE: 95 ± 3 in KDg vs 96 ± 2 % in CTRg, p= 0.04). No association was found between GWI, GCW, GWW, GWE and number or dimension of the involved aneurysmatic coronaries.

Conclusions
The estimation of myocardial work by PSL is a novel tool for the evaluation of patients with KD. GWI, GCW and GWE were significantly reduced in KD patients with dilated coronaries. In KD patients with normal GLS, estimation of GWI, GCW and GWE may be a sensitive indicator of myocardial dysfunction and an adjuvant criterion to avoid delayed diagnosis of KD.
Abstract P316 Figure. Myocardial work in KD and CTR.
P318 Left atrial dysfunction assessed by echocardiography in relation to left atrial fibrosis in patients undergoing ablation for atrial fibrillation
Authors: Pilichowska E , Baran J , Kulakowski P , Zaborska B 
Published: January 2020

Abstract

PURPOSE
Left atrial (LA) fibrosis is the hallmark of LA remodeling in atrial fibrillation (AF), alters LA function and may predict poor catheter ablation (CA) outcome. LA fibrosis may be assessed invasively using electroanatomical mapping (EAM) during electrophysiological study.
The aim was to assess LA function parameters in relation to degree of LA fibrosis derived from EAM in patients with AF.

METHODS
Patients (pts) n = 39 (79% males, mean age 56+/-10) with non-valvular AF were studied with TTE and TEE before first CA during sinus rhythm. LA strain (LAS) and strain rate (LASR) were analyzed in reservoir (r), conduit (cd) and contractile (ct) phases. The velocities of mitral A, E" and A" were measured with Doppler. E/E" and LA stiffness index - the ratio of E/E" to LASr were assessed. LA appendage flow velocity (LAAv) was measured in TEE. LA volume using biplane area-length method was calculated.
The EAM of LA was build using Carto System before CA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut-off &lt;0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA &lt;10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA &gt;40%) (table).

RESULTS
The mean LA volume was 35 ± 11 mL/m². The LAPA ranged from 2 to 78 % of LA surface. Reduced LA function was observed in the LAPA &gt;40% group. Extensive LAPA altered mainly LA compliance parameters. Traditional LA systolic function parameters did not differ in relation to degree of LAPA.

CONCLUSION
LA compliance is mostly affected by LA fibrosis, thus LA diastolic parameters may be useful in the noninvasive assessment of LA fibrosis. Whether these parameters should be a part of the proper selection of candidates for CA requires further studies.
LA function parameters LA parameters Group 1 LAPA &lt;10% n = 13 Group 2 LAPA &gt;10% &lt;40% n = 13 Group 3 LAPA &gt;40% n = 13 P-value Group 1 + 2 vs 3 Mitral A 0.55 ± 0.10 0.55 ± 0.24 0.73 ± 0.32 0.077 A" 9.19 ± 1.74 7.85 ± 1.43 7.92 ± 2.40 0.376 LASr 31.48 ± 4.52 26.48 ± 8.79 19.63 ± 6.76 &lt;0.001 LAScd 17.30 ± 3.05 15.44 ± 6.93 10.91 ± 4.04 0.003 LASct 14.18 ± 5.36 11.05 ± 3.67 8.72 ± 4.78 0.024 LASRr 1.22 ± 0.19 1.24 ± 0.21 0.92 ± 0.20 &lt;0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 &lt;0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 &lt;0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178
P327 Concordance between regadenoson stress echocardiography and spect-MIBI (99mTc) in patients with suspected myocardial ischemia
Authors: Echarte J C E M , Menendez P M S , Iglesias I I G , Vara J V M , Borrego J B R , Sevilla A I S M , Rodriguez E R P , Garrote C G C , Fernandez F F V 
Published: January 2020

Abstract

Background
Regadenoson is a selective A2A adenosine receptor agonist approved for the detection of myocardial with SPECT-MIBI. To date, few studies have appraised the utility of this drug using transthoracic echocardiography with the same purpose. We designed this prospective study to evaluate the diagnostic agreement between these two techniques used simultaneously to detect myocardial ischemia. We report our first results evaluating the concordance between both techniques.

Methods
Patients enrolled were referred to our clinic for the evaluation of chest pain. Myocardial perfusion imaging was performed with regadenoson (400 µg ) which was injected before 99mTc-MIBI. Stress and rest sets of images were evaluated for relative uptake of the radiotracer in order to detect and characterize perfusion defects. The echocardiogram was acquired 60-90 seconds after the administration of the drug using a standardized technique. Two independent observers (one cardiologist and one specialist in nuclear medicine) interpreted the images, both unaware of the result of the complementary technique.

Results
One hundred twenty five patients were included, 69 (55%) of them males. Median age was 73 years (IQR 65-79). One hundred seventeen patients had both studies interpretable. Thirty-nine (32.5%) patients had had a diagnosis of ischemic heart disease before the study (either a myocardial infarction or a coronary revascularization). The median pre-test probability of coronary artery disease in those without a true previous diagnosis was 30.5% (16.0-50.8), being 50% in the intermediate risk (15-85%) and 49% in the low risk stratum (less than 15%). Significant reductions is systolic and diastolic blood pressure were detected with regadenoson [systolic 134 (21) mmHg Vs 131 (23) mmHg, p &lt; 0.001; diastolic: 78 (12) mmHg Vs 73 (13) mmHg, p &lt; 0.001], with a striking increase in heart rate: 67 (13) bpm Vs 91 (17) bpm, p &lt; 0.001. More patients had a SPECT test showing myocardial ischemia (28% Vs 16%; p &lt; 0.001). Agreement between both tests were 84%. The kappa index obtained from this sample was 0.34 (CI95% 0.15-0.53). Segregating those patients without a history of coronary artery disease (n = 81), the positive test rate were 14% for echo and 20% for SPECT-MIBI (p = 0.019). Kappa index was even lower: 0.29 (CI95% 0.02-0.56). Conclusions. SPECT-MIBI provides more positive tests than stress echocardiography when regadenoson is used as the stressor agent. The concordance between tests is low.
P330 Blunted heart rate reserve during vasodilator stress echocardiography in diabetic and renal failure patients
Authors: Bellino M , Ferraro D , Silverio A , Peluso A P , Soriente L , Provenza G , Ascoli R , Iuliano G , Prota C , Polito M V , Cogliani F , Maiellaro F , D"auria F , Picano E , Citro R 
Published: January 2020

Abstract

Funding Acknowledgements
None

Background
A blunted heart rate reserve (HRR) during dipyridamole stress echo (SE) is a marker of cardiac autonomic dysfunction associated with poor outcome, independently of inducible ischemia, underlying coronary artery disease (CAD) and beta-blocker therapy. Patients with diabetes and/or renal failure have higher prevalence of underlying autonomic dysfunction.
Aim. To assess the value of HRR in patients undergoing dipyridamole SE.

Methods
We prospectively recruited a sample of 61 patients with known or suspected CAD (mean age 75 ± 10 years; 34 males, 55,7%; 50% on beta-blockers at the time of testing). Coexistent atrial fibrillation or previous pacemaker implantation were considered as exclusion criteria. Three groups were identified a priori: non-diabetic with normal renal function (n = 43, Group 1); diabetics, with normal renal function (n = 14, Group 2); severely impaired renal function on dialysis (n = 4, Group 3). All patients underwent dipyridamole SE (0.84 mg/kg in 10"). Wall motion score Index (WMSI) was calculated with a 17-segment score of left ventricle, each segment scored from 1= normal to 4= dyskinetic. HRR was measured by ECG as the peak/rest HR ratio.

Results
A positive SE (stress WMSI&gt; rest WMSI) was present in 2 patients of Group 1 (4.7%), 4 of Group 2 (28.6%) and no patient in Group 3. Heart rate was different, although not significant, among the 3 groups both at rest (66.1 ± 11.1 vs 64.6 ± 8.5 vs 79.0 ± 8.0, p = 0.050) and at peak stress (83.8 ± 12.6 vs 75.3 ± 10.3 vs 86.5 ± 11.1, p = 0.059). Of note, HRR was statistically different among groups (1.29 ± 0.20 vs 1.19 ± 0.14 vs 1.09 ± 0.06, p &lt; 0.047; see figure). There was no difference in HRR between patients off and on-beta-blockers (1.19 ± 0.16 vs 1.24 ± 0.24, p = 0.421) and with or without positive SE (1.20 ± 0.14 vs 1.25 ± 0.20, p = 0.530). Overall, HRR ≤ 1.17 (median value) was reported in 39.5% of Group 1, 71.4% of Group 2, and 100% of Group 3 pts (p = 0.024). No significant correlations between HRR and peak WMSI (p = 0.183) or age (0.062) were reported.

Conclusion
HRR is frequently abnormal in patients referred for SE testing, especially in presence of concomitant diabetes and advanced renal failure. The blunted chronotropic response is a simple, imaging independent marker of cardiac autonomic dysfunction and may usefully complement the conventional evaluation with regional wall motion abnormalities during vasodilator SE.
Abstract P330 Figure title: HRR box plots