bluuebunny/crossref_metadata_2025_split huggingface dataset:
P230 Pulmonary embolism due to hepatocellular carcinoma: A rare presentation
Authors: Hassan Abdelnabi M , Saleh Y , Almaghraby A , Tok O , Shehata H , Abdel Samad S 
Published: January 2020

Abstract

Introduction
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors and the second leading cause of cancer-related deaths. HCC is a highly progressive cancer with a high rate of metastasis. Intra-cardiac involvement with HCC is quite rare with a very poor prognosis. Acute pulmonary embolism is a very rare presentation of hepatocellular carcinoma (HCC) complicated with tumor thrombi into the inferior vena cava (IVC), right atrium (RA) and right ventricle (RV) with very poor reported prognosis.

Case presentation
A 72-years old hepatitis C virus (HCV) positive male patient for 20 years but he didn’t receive any treatment. He was admitted at our medical faculty with decompensated liver failure and resolved hepatic encephalopathy. He started complaining of acute onset of dyspnea. On clinical examination, he was tachypneic, tachycardic with thready pulse, distressed with deep icteric tinge. He had a massive ascites and bilateral lower limb pitting oedema. His electrocardiogram (ECG) showed sinus tachycardia. Urgent transthoracic echocardiography (TTE) revealed a large solid mass extending through the IVC to RA (Figure 1 Panel A) with another highly mobile cauliflower mass at the RV apex occupying the RV cavity, protruding into RA through TV and nearly obliterating RVOT into pulmonary artery. (Figure 1 Panel B, C, D). Due to patient’s frailty and hazards of contrast medium in an already impaired renal status of him, no further contrast study was performed. Only conservative and supportive measures were initiated for the management of his deteriorated general condition but unfortunately, he passed away shortly after.

Conclusion
Cardiac involvement in HCC rarely occurs and usually develops in advanced stages of HCC. The main mechanism of metastasis into the cardiac cavity is through a direct vascular extension of the tumor to the right side via hepatic vein and IVC. Acute pulmonary embolism in the setting of HCC is a quite rare manifestation of HCC that usually occur due to tumor thrombi in the IVC, RA and RV. The reported prognosis of HCC with intra-cardiac involvement is very poor, with a mean survival of 1 to 4 months at the time of diagnosis.
Abstract P230 Figure. TTE of HCC invading RVOT
P1582 Outcomes, predictors and treatment of intraatrial reentrant tachycardias in Adult with Congenital Heart Disease
Authors: Cambronero Cortinas E , Moratalla-Haro P , Gonzalez-Garcia A E , Avila-Alonso P , Bret-Zurita M , Rivero-Jimenez N , Peinado-Peinado R , Oliver-Ruiz J M 
Published: January 2020

Abstract

Introduction and objectives
Atrial tachycardia (AT) is a major late complication in congenital heart disease (CHD) after surgery. These arrhythmias arise between areas of anatomical barriers or in fibrotic tissue/scars. In our study we examined the clinical predictors of AT.

Methods
A retrospective study of cases and controls in adult patients with CHD was performed. We have included consecutively 71 patients with AT and 71 controls matched by gender, age and type of CHD located in the same database. Medical records, electrocardiograms and echocardiograms were reviewed. Multivariate analysis of the risk factor (logistic regression) and analysis of adverse cardiovascular events (Kaplan-Meier) were performed.

Results
Systolic pressure of subpulmonary ventricle ≥40mmHg (HR:7, 95%CI:2.4-18, p = 0.001), right atrium (RA) dilatation≥21cm2 (HR:3, 95%CI:1.2-7.6, p = 0.005), significant tricuspid regurgitation (HR:4, 95%CI:1.3-10, p = 0.018) were identified as main risk factors for AT. Patients with AT had worse outcomes with more major adverse cardiovascular events (86% vs 14%, P = 0.006), and a 58% free survival events compared to 98% of patients without AT at 8 years of follow-up (p = 0.01). The treatment of the first episode of AT was electrical cardioversion (38%), pharmacological cardioversion (13%), heart rate control (20%). Antiarrhythmic treatment was not been given in 30% of the patients 73% of them had percutaneous ablation as first choice treatment. Ablation was performed in 40 pacientes and 6 patients have recurrences. In total, 24 patients have recurrences of AT. Previous Maze (OR 9 (IC al 95% 1.5, 50), p = 0.016) and surgical paliative shunt (OR 21 (IC al 95% 2.3,192), p = 0.007) were identified as main risk factor for AT recurrences.

Conclusions
The main risk factors identified for AT were RA dilatation, raised systolic pressure of subpulmonary ventricle and significant tricuspid regurgitation. The main risk factors for AT recurrences were previous Maze and surgical paliative shunt. Early treatment of these arrhythmic problems is mandatory in order to improve the prognosis in this group of patients.
Abstract P1582 Figure. Central illustration of AT in CHD
P1585 Cardiac magnetic resonance estimated extracellular volume fraction, but not native T1 mapping, detects scar in patients referred for cardiac resynchronization therapy
Authors: Kjellstad Larsen C , Duchenne J , Galli E , Aalen J M , Kongsgaard E , Lyseggen E , Sirnes P A , Bogaert J , Linde C , Penicka M , Donal E , Voigt J-U , Smiseth O A , Hopp E 
Published: January 2020

Abstract

Funding Acknowledgements
The study was supported by Center for Cardiological Innovation

Background
Myocardial scar burden (focal fibrosis) is associated with poor response to cardiac resynchronization therapy (CRT), and should preferably be detected prior to device implantation. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is considered reference standard for scar detection, but is not available in renal failure. Diffuse fibrosis is assessed by T1 mapping CMR with or without calculation of extracellular volume fraction (ECV). The method is vulnerable to partial volume effects, thus subendocardial tissue is most often not included in mapping analyses. Whether the contrast-free native T1mapping could replace LGE in the preoperative evaluation of patients referred for CRT is unknown.

Purpose
To investigate if native T1 mapping and calculation of ECV can adequately detect scar in patients referred for CRT.

Methods
Scar was quantified as percentage segmental LGE in 45 patients (age 65 ± 10 years, 71% male, QRS-width 165 ± 17ms) referred for CRT. In total 720 segments were analyzed, and LGE≥50% was considered transmural scar. T1-mapping before and after contrast agent injection was performed in all patients. ECV was calculated based on the ratio between tissue T1 relaxation change and blood T1 relaxation change after contrast agent injection, corrected for the haematocrit level. The agreement between native T1/ECV and scar was evaluated with receiver operating characteristic (ROC) curves with calculation of area under the curve (AUC) and 95% confidence interval (CI).

Results
LGE was present in 255 segments, 465 segments were without LGE. Average native T1 in segments with LGE was 1028 ± 88 ms, and 1040 ± 60 ms in segments without LGE (p = 0.16). The corresponding numbers for ECV were 38.7 ± 10.9% and 30.0 ± 4.7%, p &lt; 0.001. Native T1 showed poor agreement to scar independent of scar size (AUC = 0.532, 95% CI 0.485-0.578 for scars of all sizes, and AUC = 0.572, 95% CI 0.495-0.650 for transmural scars). ECV, on the other hand, showed reasonable agreement with scar of all sizes (AUC = 0.777, 95% CI 0.739-0.815), and good agreement with transmural scars (AUC = 0.856, 95% CI 0.811-0.902). (Figure)

Conclusion
The contrast-free CMR technique T1 mapping does not adequately detect scars in patients referred for CRT. Adding post contrast T1 measurements and calculating ECV improves accuracy, especially for transmural scars. Future studies should investigate if diffuse fibrosis could be predictive of CRT response.
Abstract P1585 Figure. Detection of transmural scars
P1589 Yield of invasive coronary angiography following the UK NICE 2016 guideline expansion of CT coronary angiography
Authors: Fyyaz S , Hudson J , Olabintan O , Katsigris A , David S , Plein S , Alfakih K 
Published: January 2020

Abstract

The UK National Institute of Health and Care Excellence (NICE) updated chest pain guidelines in 2016 and recommended CT coronary angiography (CTCA) as the first line investigation for all patients presenting with new stable chest pain and the removal of the pre-test probability risk scoring. There is a concern that using CTCA in populations with higher likelihood of coronary artery disease (CAD), can lead to higher rates of downstream testing with invasive coronary angiography (ICA). We implemented the NICE 2016 guideline and audited the downstream testing after CTCA. We also evaluated the performance of the ESC risk score (ESC RS).
Methods
We undertook a retrospective search of the radiology database from January 2017 to June 2018. CTCA reported CAD degree of stenosis as normal/minimal stenosis, mild (30-50%), moderate (50-70%), or severe (&gt;70%).

Results
In total 652 patients underwent CTCA (mean age 55 yrs; 330 male). 92 patients were found to have moderate or severe stenosis. 69 of them were referred directly to ICA, with 63 undergoing ICA and confirming severe CAD in 40 patients, a yield of 63%. 18 patients with moderate stenosis were referred for stress echo (SE) with one positive result. In total 35 patients went on to be revascularised.
62 patients were found to have mild stenosis. The majority of patients (n = 462) had normal/minimal stenosis. There were 36 inconclusive studies.
The ESC RS was calculated retrospectively with the following results:
70 patients had an ESC RS &lt;15% and 2 (3%) were found to have moderate stenosis. 427 patients had an ESC RS 15-50%; 17 (4%) had severe stenosis and 32 (8%) moderate stenosis. 149 patients had an ESC RS 50-85%; 17 (11%) were found to have severe stenosis and 23 (15%) moderate stenosis. Lastly 2 patients had an ESC RS &gt;85% and one had moderate stenosis.
Conclusions
Our results demonstrate that CTCA is an effective first line test for most patients with new stable chest pain as the majority were found to have normal/minimal disease. In the patients that went on to have ICA, CTCA had a relatively high yield of detecting severe CAD (63%). This was achieved with some use of SE as a gatekeeper to ICA, particularly in patients with moderate CTCA stenosis. SE should be used more after CTCA in patients with moderate stenosis, as a gatekeeper to ICA.
The ESC RS was predictive of significant CAD but overestimated the likelihood of CAD.
Abstract P1589 Figure. Severe CTCA stenosis of the LAD
P1599 Longue term outcome after surgical repair of complete atrioventricular septal defect: 2D versus 3D echocardiographic evaluation
Authors: Ciuca C , Angeli E , Careddu L , Di Dio M , Petridis F , Ragni L , Hasan T , Donti A , Gargiulo D , Balducci A 
Published: January 2020

Abstract

Purpose
Assessment of longue term follow-up after surgical repair of Complete Atrioventricular Septal Defect (cAVSD). Evaluation of 3D versus standard 2D echocardiographic accuracy during the last follow-up.

Methods
43 patients were included in this study. Mean age at surgical repair was 7 months, 48.8% of patients were male; 67.4% had Down Syndrome. Mean time follow-up was 13 ± 6 years. During the last follow-up 2D and 3D echo evaluation were performed.

Results
All patients were alive and had a NYHA class I at the last follow-up. Survival free from new cardiac surgery at 13 years was 86%. During follow-up a progressive moderate to severe/severe mitral regurgitation (MR) was observed in 6 patients (16.3%) while 4 patients developed a progressive left ventricular outflow tract obstruction (LVOTO); overall 5 patients underwent new cardiac surgery (3 for MR and 2 for LVOTO). Echocardiographic evaluation showed: LV end diastolic volume 55.7 ± 13.0ml/m2, LV ejection fraction 64 ± 5%, left atrium volume 24.9 ± 13.9ml/m2, right ventricle systolic pression 21.0 ± 2.0 and a LVOT gradient 14.6 ± 16.4 mmHg. Mitral valve evaluation is evidenced in Table 1. Predictor factors of severe MR during follow-up were the cleft area and depth and the presence of anterior leaflet prolapse. Cohen’s kappa evidenced a good correlation between 2D and 3D VC evaluation with a higher sensibility of 3D evaluation to identify severe MR, data confirmed by the ROC curve analysis (Figure A and B).

Conclusions
Clinical outcome after cAVSD surgical repair is excellent with a low rate of reintervention. 3D echo evaluation is more sensitive to identify both predictors and severity of MR ì.
LAST Follow-up echocardiography 2D evaluation 3D evaluation Mitral Valve evaluation Vena contracta, mm 4.8 ± 2.5 5.3 ± 2.5 Regurgitant volume, ml 25 ± 20 ERO, cm2 0.17 ± 0.13 Mean gradient, mmHg 4 ± 2.4 Residual cleft, n(%) A1 A2 A3 30 (90.7) 4 (9.3) 33 (76.8) 6 (13.9) Cleft area,cm2 0.19 ± 0.21 Cleft depth, mm 5 .0 ± 2.9 Valve thickening, n(%) 14 (13.6) Leaflet Prolapse, n (%) Anterior Leaflet Prolapse, n (%) Posterior Leaflet Prolapse, n (%) 30 (69.7) 25 (58.1) 10 (23.2) Single papilary, n(%) 10 (23.2)
Abstract P1599 Figure.
1640 Pulmonary valve in carcinoid disease: be suspicious of functional assessment
Authors: Gamarra Lobato A L , Rojas A M , Cecconi A , Dominguez L , Benedicto A , Diego G , Nogales M T , Monguio E , Munoz D , Perich J , Montes A , De Rueda C , Jimenez C , Jimenez L J , Alfonso F 
Published: January 2020

Abstract
Carcinoid heart disease occurs in 50% of patients with carcinoid syndrome, especially on serotonin-secreting neuroendocrine tumors (NET) [1, 2]. Carcinoid heart disease"s typical findings are carcinoid plaques, composed of smooth muscle, myofibroblasts and endothelium. These plaques, most frequently localized on the right side valvular cusps and leaflets, produce fixation and retraction, causing regurgitation and/or stenosis [3, 4, 5]. Left-sided heart disease is rare (&lt;10%), as serotonin is purified in the pulmonary circulation [3, 6, 7].
We present the case of a 67 year old female patient with previous history of right ovarian NET. She presented with dyspnea (II-III NYHA functional class), and slight edema in lower limbs. She denied symptoms of carcinoid syndrome before or after the ovarian surgery.
Examination showed an increased jugular venous pulse.
Transthoracic echocardiography (TTE) showed severely dilated right cavities and a rigid, immobile tricuspid valve, with massive tricuspid regurgitation (Panel A, 1). Anatomy of
pulmonary valve was not properly visualized but jet area of pulmonary regurgitation was small (Panel A, 2). Left cavities and valves were intact.
As TTE was not anatomically conclusive, a cardiac magnetic resonance (CMR) and a cardiac computed tomography (CCT) were performed to assess the carcinoid involvement of pulmonary valve.
CMR showed severely dilated right ventricle with mild impairment of systolic function (Panel A, 3). Based on phase contrast imaging, pulmonary regurgitation fraction was 14%,
suggestive of a mild grade. However, CCT showed a diffuse thickening of the pulmonary valve, with complete opening during diastole (Panel A, 4, arrowhead). Finally, the patient underwent replacement of tricuspid valve and pulmonary valve for biological prosthesis without complications.
Our case is remarkable because it highlights the limitations of the functional assessment of pulmonary regurgitation in the presence of a concomitant massive tricuspid valve regurgitation, since the rapid equalization of pressure between pulmonary artery and right ventricle reduces the expression of pulmonary regurgitation. For these reason, the anatomic assessment of the pulmonary valve is mandatory to stage the involvement of pulmonary valve in carcinoid disease.
Abstract 1640 Figure. Panel A
1644 Unusual management of dislodged TAVR prosthesis, Nightmare in Cath lab
Authors: Alnabti A , Abushahba G , Abujalala S , Khalifa E , Alkhulaifi A M , Carr C 
Published: January 2020

Abstract

Introduction
The Trans aortic valve replacement( TAVR) is well established technique that is basically designed for patient with sever aortic stenosis with high surgical risk.
We describe a TAVR procedure was complicated with valve dislodgment and treated without surgical intervention

Case report
75 year old Female Patient hypertensive, diabetic, Hypothyroidism and Atrial Fibrillation on oral anticoagulation.
Her transthoracic echocardiography(TTE) showed sever critical aortic valve stenosis and calculated aortic valve are was 0.6 cm² and Peak gradient is 68mmhg and mean 46 mmHg , sever Left ventricular dysfunction and estimated EF 25 % .

The CT Aortogram showed
The aortic annulus maximum transverse diameter measures was 30 mm and the anteroposterior diameter was 25 mm. The sinus of Valsalva measures 37 mm was Sino tubular junction measures 24 mm and the proximal ascending aorta measures 39 mm.
There is no evidence of coronary artery disease by the CT coronary angiogram.
Because of depressed LV function, it was decided to do the TAVR with ECMO (Extra Corporeal Membrane Oxygenation) support. Based on CT measurements, CoreValve29 was selected
The native valve is pre dilated then CoreValve29 was advanced. Unfortunately valve was larger than the aortic annulus and during trial to valve deployment ( Fig A) ,valve jumped into proximal ascending aorta in opining position just few centimeters from coronary ostium ( Fig B).
We advance balloon for maximum dilatation of core valve 29 to ensure fixation of valve in ascending aorta and complete opening of valve leaflets.
A second smaller valve (coreValve26) was advanced through the dislodged valve and crossing through its leaflet of first core valve (which settled in aorta) and successfully reaches the aortic annulus and confirming proper positioning of the coreValve26 and then deployed safely
The coreValve26 was deployed in acceptable position and coreValve29 was hooked and well-fixed to 26 valves in proximal ascending aorta (Fig C).
Coronary flow was secured and confirmed by aortic root injection (Fig F).
Patient kept supported on ECMO before and during the TAVR procedure.
The patient tolerated the procedure and was stable hemodynamically throughout the procedure.
Successful ECMO weaning and patient hemodynamically remained stable with Total bypass time on ECMO was 142 minutes.
Post procedure chest X ray showed two corValves hooked together in aortic root and ascending aorta in (Fig D).
Follow up TTE showed improved EF systolic LV function (EF 39 %). Normal functioning aortic valve prosthesis.

Conclusion
Up to our knowledge, this is the first case that valve dislodgment was treated percutaneously not required urgent surgical intervention.
Although it is one case report, however it could open the ideas for new approach how to manage difficult cases with dislodged valve with percutaneous approach.
Abstract 1644 Figure.
1676 Prediction of different causes of mortality by exercise echocardiography in women
Authors: Peteiro Vazquez J C , Bouzas-Mosquera A , Pertega S , Barbeito-Caamano C , Broullon F J , Vazquez-Rodriguez J M 
Published: January 2020

Abstract

Exercise echocardiography (ExE) can predict overall and cardiovascular mortality. We aimed to assess the value of ExE for the prediction of cardiovascular (CV), cancer (CA) and non-cardiovascular non-cancer (NCV-NCA) death in women.

Methods
Retrospective analysis of prospectively collected data on 4,714 women (age 64 ± 11 years) with a first treadmill ExE performed in our center for known/suspected coronary artery disease. Exclusion criteria were significant valve disease, cardiomyopathy, congenital heart disease, and age &lt;18 year-old. Ischemia was defined as the development of new wall motion abnormalities (WMAs) with exercise; abnormal ExE as ischemia or resting WMAs. A good functional capacity was defined as a maximal workload of 10 metabolic equivalents (METs). The end point was death (CV, CA or NCV-NCA).

Results
During a follow-up of 4.6± 4.7 years (interquartile range 0.04-8.0 years) there were 345 CV, 164 CA, and 203 NCV-NCA deaths. Multivariate analysis included clinical characteristics, resting echocardiography, exercise testing and peak exercise echocardiography. Different clinical characteristics predicted CV death, along with maximal achieved workload in Metabolic Equivalents (METs: Hazard Ratio [HR] = 0.92, 95% Confidence Interval [CI] = 0.88-0.96, p &lt; 0.001) and ExE variables. CA death was independently predicted by age and achieved METs (HR = 0.93, 95% CI =0.87-0.99, p &lt; 0.02). Similarly NCV-NCA death was predicted by clinical characteristics (age, diabetes mellitus, diuretics, nitrites) and also by achieved METs (HR = 0.83, 95% CI= 0.78-0.88, p &lt; 0.001). Nor ischemia nor abnormal ExE increased the risk for CA or NCV-NCA death. Annualized CV deaths were almost quadruple in women with bad functional capacity as compared to those with good functional capacity (2.2% vs. 0.6%, p &lt; 0.001). The same occurred for NCV-NCA death (1.4% vs. 0.3%, p &lt; 0.001), whereas CA deaths were double in patients with bad functional capacity (0.9% vs. 0.4%, p &lt; 0.001).
In conclusion, an ExE study can predict not only CV death, but death due to CA or to NCV-NCA. Fit women based on the achievement of 10 METs during exercise testing, have less chance of death from any cause.