bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1587 Echochardiographic estimation of the impact of long-term treatment with Trimetazidine on myocardial dysfunction in patients with ST elevation myocardial infarction
Authors: Svanidze T , Saralidze T , Mamatsashvili I , Bediashvili T 
Published: January 2020

Abstract
Outcome of ST elevation acute myocardial infarction (STEMI) is usually complicatedby congestive heart failure (HF) that impacts quality of life and prognosis.
Spectrum of myocardial injury depends on intensity of impaired myocardial perfusion and on existing metabolic state. Metabolic changes occurring during early hours of myocardial infarction include increased secretion of catecholamines and production of circulating free fatty acids (FFAs). As myocardium depends on aerobic metabolism increased FFAs exert toxic effect on myocardium resulting in metabolic mismatch, decreased cardiac function and arrhythmias.
Our aim was to diminish signs of HF after STEMI especially in patients (P)who could not undergo reperfusion therapy because of different reasons.We used long-term metabolic therapy (MT) with TrimetazidineMR(TMZ)just from the first day of STEMI during 3 months.
Evaluation of heart function was based on ECG, Holter monitoring and echocardiographic (Echo) data received before and after treatment. We observed 50 P with STEMI who could not undergo reperfusion therapy. All were treated with standard therapy according to guideline. 35 of them (I group) additionally were treated with TMZ 80 mg p/o once a day for 3 months. The rest15 patients represented II - control group. P including in these groups were comparable according to echocardiographic data. These Patients did not reveal any life-threatening arrhythmias in the acute stage of MI and any prognostically indifferent arrhythmias in the following period.
Echoinvestigation in dynamic (before treatment and after 3 months) showed significant improvement of ejection fraction (EF by 14,2%) and stroke volume (SVby14,8%) in patients with STEMI treated with TMZwhile in control group EF (by 4,5%) and SV (by 6,8%) wereincreasedslightly. After 3 months improvement of diastolic function was also prominent in patients treated with TMZ that was revealed by decreased diastolic volume. In patients treated with MT end diastolic diameter (EDD) diminished by 4,8%, end systolic diameter (ESD) - by 5,7%, end diastolic volume (EDV) - by 9,3% and end systolic volume (ESV) - by 14,9% while in control group EDD was decreased by 1,9%, ESD - by 2,8%, EDV - by 4,7% and ESV - by 4,1%. Diastolic dysfunction was also estimatedaccording to left ventricular filling pressure (LVFP) E/ethat was especially interesting in P with HF with mid-range and preserved EF. Before treatment (LVFP) was increased in 17 P from the first group and in 7 P in control group. In the first group increased LVFP significantly decreased in 12 P and moderately in 5, while in control group LVFPwas only decreased moderately in 4and slightly in 3 P.
The received data make it relevant to useTMZmetabolic therapy for effective treatment of HF in patients with STEMI. MT not only improves the course of disease, but diminishes rehabilitation period as well.
P1588 micro rna expression profiling may predict cardiac remodeling after stemi
Authors: Ikonomidis I , Vlastos D , Katsanos S , Gazouli M , Thymis J , Triantafyllou C , Varoudi M , Andreadou I , Triantafyllidi H , Makavos G , Kapelouzou A , Vrettou A R , Frogoudaki A , Cokkinos D , Iliodromitis E K 
Published: January 2020

Abstract

Background
MicroRNAs have been recognised as important modulators of cardiovascular function. However, their proﬁling in ischemic heart disease and contribution to cardiac remodeling has not been deﬁned.

Methods
We examined 40 patients with STEMI and 20 healthy controls. MicroRNA expression proﬁling was carried out within 48 hours of the index ischemic event, measuring the expression of microRNA-144,-150,-499 (cardioprotective action), -21, and -208 (remodeling stimuli). In addition, every patient was evaluated by echocardiography, which was repeated after a 2-year follow-up period.

Results
Left-ventricular end-systolic volume (LVESV) and left-ventricular end-diastolic volume (LVEDV) decreased (from 57.7± 6.3 to 48.6± 5.2, p &lt; 0.05 and from 102.1± 7.1 to 85.9 ± 5.7, p &lt; 0.05, respectively) while the ratio of early mitral inﬂow velocity to mitral annular early diastolic velocity (E/e’) did not change (from 9.32± 0.6 to 9.56± 0.8, p= NS). Mir-208 and -499 expression within 48 hours of STEMI (1.91± 0.43/U6sn and 1.7± 0.48/U6sn respectively) were signiﬁcantly positively correlated with a reduction in LVESV, LVEDV, and E/e’. In speciﬁc, mir-208 expression was associated with an absolute (r= -0.41, p &lt; 0.05) and a percent reduction (r=-0.45, p= 0.03) in LVEDV and an absolute reduction in E/E’ (r= 0.46, p &lt; 0.05), while mir-499 was associated with an absolute (r= -0.4, p &lt; 0.05) and percent reduction (p= -0.38, p &lt; 0.05) in LVESV. Mir-499 median value (1.78[1.292.01]) predicted reverse remodelling (LVESV reduction by &gt;15%) with satisfactory speciﬁcity (0.82).

Conclusion
Mir- 208 and -499 expression may contribute to cardiac remodeling after STEMI, while mir-499 could be used as a prognostic marker of reverse remodeling.
P1597 15-year follow-up of regional right and left ventricular function after the Senning operation: a colour-Doppler myocardial imaging study
Authors: Moya A , Roggen L , Troost E , De Meester P , Budts W , Van De Bruaene A 
Published: January 2020

Abstract

OnBehalf
Ana Moya, 1994

Introduction
Although the development of right ventricular (RV) dysfunction in patients who underwent an atrial switch procedure is a major concern, long-term follow-up data on the evolution of myocardial function over time, especially using deformation myocardial imaging, is still lacking.

Purpose
This study aimed (1) at evaluating regional (base-mid-apex) RV and left ventricular (LV) function using Colour-Doppler myocardial imaging over a 15-year follow-up period (longitudinal analysis) and (2) at comparing results with age- and gender-matched controls (cross-sectional analysis).

Methods
For the longitudinal analysis, we compared systolic and diastolic function between 2004 and 2019 in 10 Senning patients. For the cross-sectional analysis, we compared the subaortic RV (sRV) of Senning patients with the RV and LV of matched controls and the subpulmonary LV (spLV) of Senning patients with the LV of matched controls.

Results
The longitudinal analysis (2004-2019) of sRV function showed a significant decrease in peak systolic strain (-16.9 ± 7.1% vs -12.0 ± 4.0%; P = 0.045), peak systolic strain rate (-1.1 ± 0.3s-1 vs -0.8 ± 0.4s-1; P = 0.003) and peak early diastolic velocity (-2.0 ± 1.2 cm/s vs -1.0 ± 0.5 cm/s; P = 0.036) at the apex. spLV function showed a significant decrease in peak systolic velocity (mid: 5.6 ± 1.8 cm/s vs 3.7 ± 1.1 cm/s; P = 0.013 and apex: 5.0 ± 1.7 cm/s vs 2.1 ± 1.2 cm/s; P = 0.011) and peak systolic strain rate (mid: -1.7 ± 0.5s-1 vs -1.0 ± 0.4s-1; P = 0.048).
The cross-sectional analysis revealed significant lower values for peak systolic velocity, peak systolic strain rate, peak systolic strain at all myocardial regions of the sRV when compared to both LV and RV of matched controls (all P &lt; 0.05). Similarly, early and late diastolic velocity were lower when compared to controls (P &lt; 0.05). The spLV showed lower values for peak systolic velocity and peak systolic strain rate (mid and apex, P &lt; 0.05), but not for peak systolic strain when compared to the LV of matched controls.

Conclusion
Our study shows little change in systolic and diastolic sRV function over a 15-year period, except in the apical region. Interestingly, there was a decline of spLV systolic function which may be of clinical value. On the other hand, when compared to age- and gender-matched controls, both the sRV and spLV of Senning patients exhibit significantly decreased measurements of longitudinal systolic and diastolic function.
P1600 Aortic dilatation in patients with chronic descending aorta dissection is related to maximum false-lumen systolic flow deceleration rate as evaluated by 4D-flow MRI
Authors: Ruiz Munoz A , Guala A , Teixido-Tura G , Dux-Santoy L , Sao-Aviles A , Lopez-Sainz A , Granato C , Servato L , Casas G , Gonzalez-Alujas T , La Mura L , Galian L , Ferreira I , Evangelista A , Rodriguez-Palomares J F 
Published: January 2020

Abstract

Background
Due to improved surgical strategies a growing number of patients survive acute aortic dissection. Patent false lumen (FL) is common in chronic dissection and it has been associated with poor prognosis, which is mainly driven by FL expansion. Several variables indirectly related to flow characteristics have been associated with progressive aortic dilation. We aimed to evaluate whether the maximum systolic flow deceleration rate (MSDR) in the FL, quantified by 4D-flow MR, is related to FL dilation in chronic type B aortic dissection.

Methods
Twenty-nine patients with a patent FL after aortic dissection and a prior follow-up of at least 3 years underwent contrast-enhanced 4D-flow MR. Marfan patients were excluded. Time-resolved FL flow acceleration was calculated in a 5 cm-long volume of the descending aorta around the level of the pulmonary bifurcation. MSDR was determined as the maximum minus the minimum acceleration in systole over the corresponding time interval (Figure 1a). Aortic growth rate (GR) was measured as the difference between final and initial maximum FL diameters obtained by angio-CT divided by follow-up duration. Population was divided into tertiles based on GR.

Results
Demographic and clinical variables were similar among GR tertiles (Table). MSDR was lower in patients with a GR &lt;1mm/year (group 1) compared to both the other two patient groups (p = 0.009 and 0.003 for groups 2 and 3, respectively) (Figure 1c). MSDR showed a marked positive linear correlation with GR (R = 0.481, p = 0.008) (Figure 1b).

Conclusions
The MSDR in the FL of chronic type B aortic dissection is linearly related to FL growth rate and discriminated between tertiles of aortic dilation. Prospective longitudinal studies are need to unveil possible prognostic value of this parameter.
Table Group 1 (n = 9) Group 2 (n = 10) Group 3 (n = 10) p-value Age (years) 63.44 ±13.54 62.50 ± 13.60 64.56 ± 6.67 0.902 BSA (m2) 2.00 ± 0.18 1.77 ± 0.20 1.94 ± 0.12 0.213 Men 6 (86%) 4 (57%) 4 (100%) 0.210 Hypertension 4 (66%) 5 (71%) 4 (100%) 0.438 Atheroclerosis 1 (17%) 1 (14%) 0 (0%) 0.699 Initial Diameter (mm) 45.00 ± 7.69 36.00 ± 4.20 37.00 ± 6.48 0.078 Final Diameter (mm) 49.50 ± 6.74 44.86 ± 5.70 59.25 ± 9.84 0.049 Follow-up (year) 11.83 ± 8.79 7.82 ± 3.34 8.08 ± 4.05 0.921 GR (mm/year) 0.27 ± 0.29 1.18 ± 0.26 2.64 ± 0.97 &lt;0.001 MSDR (cm/s3) 1212.18 ± 467.61 2410.54 ± 1034.30 2558.16 ± 1098.06 0.005
Abstract P1600 Figure 1
P1604 T1 mapping in asymptomatic patients with extracardiac sarcoidosis
Authors: Panovsky R , Doubkova M , Holecek T , Machal J , Feitova V , Masarova L , Opatril L , Kincl V 
Published: January 2020

Abstract

Funding Acknowledgements
LQ1605 from the National Program of Sustainability II (MEYS CR)

Introduction
Sarcoidosis is a systemic granulomatous disease affecting in particular the respiratory tract. Estimated 5% of these patients have clinical symptoms of heart involvement. Real number of patients with cardiac sarcoidosis is thought to be higher (around 20-30%), because the granulomatous process is sometimes asymptomatic. Cardiac magnetic resonance (CMR) including T1 relaxation time measurement could potentially detect early asymptomatic stadia of sarcoidosis of the heart.

Purpose
The aim of this study was to assess T1 mapping in detection of early cardiac involvement in asymptomatic patients with sarcoidosis.

Methods
One hundred twenty patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis and without any heart disease history were included. One hundred thirteen of them underwent CMR examination at 3,0 MR scanner. Cine images for assessment of left ventricular (LV) volumetric and functional parameters, and pre- and post-contrast Saturation method using adaptive recovery times for cardiac T1 mapping (SMART1map) and Modified Look-Locker Inversion recovery (MOLLI) images were acquired for assessment of native T1 relaxation time and extracellular volume (ECV). The measured parameters were compared between sarcoidosis patients and 22 healthy controls.

Results
Sarcoidosis patients had not enlarged LV (end-diastolic volume 119 ± 24ml vs 97 ± 20ml, p = NS) and normal global and regional systolic LV function – LV ejection fraction (EF) 65 ± 5% vs 66 ± 7% (p = NS). Mean native T1 relaxation time was not prolonged - 1464 ± 93 msec vs 1482 ± 88msec (p = NS) measured by SMART1map and 1317 ± 60 msec vs 1313 ± 83msec (p = NS) measured using MOLLI sequence. Similarly, mean ECV value was not increased - 16,3 ± 3,4% vs 17,9 ± 3,7% (p = NS) measured by SMART1map and 30,9 ± 2,9msec vs 30,7 ± 5,0% (p = NS) measured using MOLLI sequence.

Conclusion
Myocardial native T1 relaxation time was not prolonged and ECV was not increased in asymptomatic patients with extracardiac sarcoidosis.
1633 Final non-invasive echo-guided assessment of left atrial pressure after percutaneous edge-to-edge procedure for mitral regurgitation
Authors: Gavazzoni M , Zuber M Z , Pozzoli A P , Taramasso M T , Maisano F M 
Published: January 2020

Abstract

Background/Introduction. Recently the central role of hemodynamic invasive monitoring during MitraClip (Abbott Vascular, Santa Clara, CA, USA) procedure has been raised. After removal of Steerable Guide Catheter (SGC) at the end of procedure, iatrogenic interatrial septum defect determines acute sub-clinical hemodynamic changes depending on right atrial (RA) and left atrial (LA) pressures. The possibility to assess LAP non-invasively by Doppler -echocardiography at the end of the procedure allows to quantify real hemodynamic impact of reduction of MR and leaves the door open to further therapeutic decisions (such as closure of iatrogenic IASd).

Purpose
This prospective study aimed to assess the role of evaluation of post-procedural mean trans-atrial gradient with continuous-wave (CW) Doppler (DPmean-IAS) in estimating final m-LAP after removal of SGC.

Methods
We prospectively performed the computation of trans-atrial CW- Doppler tracing for estimation of mean-transatrial gradient (meanGp-LA-RA) in patients treated with MitraClip; we added the estimation of central venous pressure (CVP) according to: i) dilatation of superior vena cava (IVC, mm); ii) presence or not of systolic excursion of IVC (end-inspiratory excursion was not evaluable in patients under sedation); iii) hepatic vein dilatation. The sum of CVP estimated and meanGp-LA-RA (mmHg) represents the m-LAP-Echo-measured at the end of procedure. This value has been compared with m-LAP measured invasively before removal of SGC. We tested the inter-rater reliability with the Intra-class Correlation Coefficient for comparing this method with the gold standard (invasive assessment of LAP).

Results
we included 19 patients; aetiology of MR was degenerative in 89% of cases. Basal m-LAP was 15 ± 13,3 mmHg and decreased by 32% by the end of procedure (mean-LAP at the end: 10,1 ± 3,3 mmHg, p &lt; 0.001). At the end of the procedure mean Gp-LA-RA was 2.5 ± 1.2 mmHg and CVP 7.5 ± 3.5; the m-LAP-Echo-measured was 9.6 ± 2.4. The delay in time of computation of m-LAP by echocardiography with respect to last invasive assessment available was computed and settled around 5 minutes (IQR 3-9 min). The inter-rater reliability with the Intra-class Correlation Coefficient was high: 0.8, (CI95% 0.647-0.948, p &lt; 0.01); with Bland-Altman test we could assess that bias of measures was acceptable for this clinical context with upper concordance limit of 2,7 mmHg and lower of 4,7 mmHg, with a bias of 0,9 mmHg, not relevant for this clinical purpose.

Conclusions
The present study represents the first validation of a Doppler-based method for non invasively assessing post-procedural LAP in percutaneous mitral valve interventions requiring transeptal approach. Follow up is needed for correlate this value with clinical outcomes.
1634 3D transoesofageal echocardiography in detection of anterior leaflet laceration during mitraclip implantation
Authors: Mariani M , Cerillo A G , Maffei S , Marchi F , Benedetti G , Zezza L , Cerone E , Paradossi U , Sorbo S , Pizzino F , Chiappino S , Trianni G , Al Jabri A , Ravani M , Berti S 
Published: January 2020

Abstract

Background
MitraClip is a percutaneous way of treatment of mitral regurgitation. Recent trials demonstrate its value in modifying prognosis of patients with functional mitral regurgitation. During MitraClip implant imaging with 3D TEE is mandatory to guide the procedure and monitoring the results. Unfortunately, laceration of mitral leaflets is a well-described complication of Percutaneous Mitral valve repair by implantation of MitraClip. 3D TEE can be useful even to detect complication of the procedure and in particular leaflets lacerations. Here we describe a case where 3D TEE was capable to recognize and visualize a laceration in the anterior leaflet (AL) and we assume some mechanisms leading to this complication.

Methods
An 83 years old man with post-ischemic severe functional mitral regurgitation underwent to MitraClip implantation. The mitral valve shows a severe tenting and annulus was deformed and dilated.
The procedure was performed under fluoroscopic and 3D TEE guidance (Philips iE33). Due to the large central regurgitation and large coaptation gap, we decide to implant MitraClip XTR, this is the larger device 5 mm longer.

Results
A single MitraClip XTR was implanted in the central scallop (A2-P2) in the region of the larger jet, after device positioning a further jet was detected in the region of implant and the original jet was unchanged.
Using 3D color complete volume and X-plane reconstructions we recognize that the jet originates between the clip and the basal aspects of AL. Without color Doppler in 3D zoom and X plane reconstruction, a continuum solution was suspected in the body of AL but the shadow of the delivery system partially masked the region. After removal of the device, perforation of AL was clearly depicted also with 3D zoom without color Doppler. The patient was surgically treated and inspection confirmed the laceration and shows a worn thin AL. The laceration of AL can be caused by the tension on a thinned tissue carried out by the large device. The severe tethering and annular dilatation with a marked distance between anterior and posterior leaflet at the tip of the device may have been a determinant factor in the tear occurrence.

Conclusion
3D TEE can clearly depict lacerations of leaflets during MitraClip implantation. Preoperative extensive analysis of valve geometry and inspection of leaflets searching for a thinned region can avoid intraoperative complications. The distance between leaflets at the expected tips of the MitraClip can be a predictive parameter of tension applied on the leaflets and of the risk of tearing.
Abstract 1634 Figure. Image 1
1636 Endomyocardial biopsy of right atrial mass with unfortunate consequence of right-to-left shunt
Authors: Kam K H K , Au D R , Lee PROF 
Published: January 2020

Abstract

Funding Acknowledgements
Nil
A 43-year old lady complained of dyspnoea with elevated jugular venous pressure. Transthoracic echocardiography (TTE) showed massive pericardial effusion [Figure 1A] with a huge heterogeneous mass (5x9cm) attached to right atrial free wall [Figure 1B]. Therapeutic pericardiocentesis yielded blood-stained pericardial fluid with negative for tumour cells.
Endomyocardial biopsy (EMB) was performed under transthoracic echocardiography (TTE) and fluoroscopy guidance. Right after procedure, there was a significant desaturation which could not be reversed by high flow oxygen supplement. The acute hypoxaemia was secondary to right-to-left shunt through a wide-open patent foramen ovale (PFO) as shown by transoesophageal echocardiography (TOE) [Figure 2A-D].
Transcatheter PFO closure was performed under TOE guidance with immediate correction of hypoxemia. [Figure 3]. Subsequent Computer Tomography demonstrated a large vascular mass at right atrium abutted onto the basal right ventricle and tricuspid valve [Figure 4] without evidence of tumor embolism.
The histological diagnosis confirmed it was a cardiac sarcoma. Given the infiltrative nature of cardiac sarcoma with significant right ventricular (RV) inflow obstruction, a debulking surgery was done rather than a complete curative resection. She was referred to oncologist for adjuvant chemotherapy.
We postulated that there is a shift in tumour location, i.e. more towards the tricuspid valve orifice which results in elevated right ventricular inflow obstruction which triggers the acute right-to-left shunting through PFO.
Abstract 1636 Figure. EMB
P240 Thebesian veins draining to the left ventricle mimicking left ventricular non-compaction
Authors: Durrer-Ariyakuddy K , De Boeck B W , Cuculi F , Kobza R , Staempfli S F 
Published: January 2020

Abstract

Description
We report about a 59-year old asymptomatic woman initially presented with lateral T-wave inversions in a routine ECG. Echocardiography suggested isolated left ventricular non-compaction (LVNC). An additional cardiac magnetic resonance imaging (cMRI) showed positive diagnostic criteria for LVNC. Six years later a diagnostic coronary angiogram revealed by a coincidence extensive shunting from the left coronary arteries to the left ventricle through Thebesian veins (sinusoids). Finally color Doppler flow confirmed that the irregular anatomy of the LV was not a result of incomplete LV compaction but due to the coronary anomaly.
Initial work up
A 59-year old asymptomatic woman presented with lateral T-wave inversions in a routine ECG. Echocardiography suggested isolated left ventricular non-compaction (LVNC) with deep recesses and a systolic non-compacted to compacted ratio in short axis of &gt;2. To confirm the diagnosis cardiac magnetic resonance imaging (cMRI) was performed. Quality was not optimal due to premature contractions and insufficient breath-hold, but positive diagnostic criteria for LVNC (as described by Petersen, Left ventricular non-compaction: insights from cardiovascular magnetic resonance imaging. JACC, 2005 July 5;46(1):101-5) were reported (Figure 1A).
Diagnosis and Management
Six years later, the patient was referred to our institution for catheter ablation of a suspected paroxysmal supraventricular tachycardia causing palpitations. Since the patient also complained about recurrent chest pain, a coronary angiogram was performed in the same session and revealed a chronic total occlusion of the right coronary artery. However, also extensive shunting from the left coronary arteries to the left ventricle through Thebesian veins (sinusoids) was observed (Figure 1B, arrows).
Follow-up
In light of this new finding, echocardiography was repeated and color Doppler flow revealed diastolic filling of the recesses not from the LV cavity but from the coronary system, confirming that the irregular anatomy of the LV was not a result of incomplete LV compaction but due to the coronary anomaly (Figure 1C, apical short axis view, upper panel color Doppler in diastole, lower panel color M-mode). To exclude concurrent LVNC a cardiac CT was performed, confirming that the recesses, which initially led to the diagnosis of LVNC, exhibited diastolic flow from the coronary system (Figure 1D).

Conclusion
This case exemplifies that for the diagnosis of LVNC all echocardiographic criteria as defined by Oechslin and Jenni (Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity. EHJ, 2011 June;Volume 32, Issue 12, Pages 1446–1456) need to be fulfilled – including color Doppler assessment of flow in the recesses. Consequently, it illustrates that cMRI alone is not sufficient for the diagnosis of LVNC but both echocardiographic and cMRI criteria need to be applied.
Abstract P240 Figure.