bluuebunny/crossref_metadata_2025_split huggingface dataset:
505 Car accident, an unusual cause of acute severe mitral regurgitation due to anterolateral papillary muscle rupture
Authors: El Jattari H , Snijders E , Laga S , Van Berendoncks A 
Published: January 2020

Abstract

A 52-year-old man was admitted to the emergency department of the University Hospital after being involved in a car crash. At first he was alert with stable vital parameters. There was bilateral rales on lung auscultation, without further prominent aberrant findings at the initial clinical examination. Shortly after, he became agitated with respiratory distress, resulting into respiratory insufficiency. Computed tomography (CT) scan of the thorax showed multiple rib fractures, a translated sternal fracture and pulmonary contusion. After intubation and stabilization he was transferred to the Intensive Care Unit (ICU), where his respiratory and cardiovascular parameters progressively worsened, leading to cardiogenic shock. An urgent chest X-ray revealed a tension pneumothorax with mediastinal shift to the right, for which a chest tube was inserted in the left hemithorax. No or little improvement was seen after this intervention. Therefore, an emergency transthoracic echocardiography (TTE) was performed. Subcostal view showed a severe mitral regurgitation with a mass in the left atrium. Because of a limited transthoracic window, we proceeded to a transoesophageal echocardiogram (TEE). A completely ruptured anterolateral papillary muscle of the mitral valve was seen, protruding in the left atrium and resulting in severe mitral regurgitation (Figure). Other echocardiographic findings were a hyperdynamic systolic function of the left ventricle, a hypo-contractile right ventricle with a mild-to-moderate quantity of pericardial effusion. Taking into account the increased cardiovascular risk profile of the patient, a coronary angiography was performed and showed normal coronary anatomy. Consequently, urgent surgical intervention was performed. Perioperative assessment confirmed the earlier described echocardiographic findings. Due to severe laceration of the left ventricular wall at the level of the attachment site of the anterolateral papillary muscle, reconstructive surgery was not possible. The anterolateral papillary muscle head with the attached mitral valve leaflet was fully excised with repair of the concealed myocardial rupture site. A mechanical mitral valve prosthesis and an intra-aortic balloon pump for hemodynamic support were placed. After four days the balloon pump was removed and the tenth day after admission the patient was extubated.

Conclusion
Acute severe mitral regurgitation due to papillary muscle rupture is a rare but potential fatal complication of a blunt trauma. TOE is essential in early diagnosis.
Abstract 505 Figure 1
553 Acute re-distribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling
Authors: Duchenne J , Aalen J M , Cvijic M , Larsen C K , Galli E , Bezy S , Beela A S , Winter S , Penicka M , Hopp E , Kongsgard E , Donal E , Fehske W , Smiseth O A , Voigt J U 
Published: January 2020

Abstract

Background
In patients with dilated cardiomyopathy and left bundle branch block (LBBB), different regions of the left ventricle (LV) have been shown to perform different amounts of work. In this study, we investigate the acute impact of cardiac resynchronization therapy (CRT) on regional LV work distribution and its relation to long-term reverse-remodelling.

Methods
We recruited 140 heart failure patients, referred for CRT. Regional myocardial work was calculated from non-invasive echocardiographic segmental stress-strain-loop-area before and immediately after CRT. The magnitude of volumetric reverse-remodelling was determined from the change in LV end-systolic volume (ESV), 11 ± 3 months after implantation. Characteristics of patients with the lowest and highest quartile of LV ESV reverse remodelling (LV ESV reduction of less than 10% and LV ESV reduction of more than -48%) were compared.

Results
Before CRT, myocardial work showed significant differences among the walls of the LV (Figure A). CRT caused an acute re-distribution of myocardial work, on average with most increase in the septum and most decrease laterally (all walls p &lt; 0.05) and lead to a homogeneous work distribution (Figure B). The acute change in the difference between lateral and septal wall work (Δ Lateral-to-septal work) correlated significantly with LV ESV reverse-remodelling (r = 0.63, p &lt; 0.0001). The smallest changes in work were seen in the patients with the least LV ESV reverse remodelling (Figure C, red markers), while patients with the most LV ESV reverse remodelling showed the largest changes in work (Figure C, green markers). In multivariate linear regression analysis, including conventional parameters such as pre-implant QRS duration, LV ejection fraction, LV end-diastolic volume and global longitudinal strain, the re-distribution of work across the septal and lateral walls appeared as the strongest determinant of volumetric reverse-remodelling after CRT (R²=0.393, p &lt; 0.0001).

Conclusions
The acute re-distribution of regional myocardial work between the septal and lateral wall of the left ventricle is an important determinant of long term reverse-remodelling after CRT-implantation. Our data suggest that modification of regional loading is the mode of action of CRT treatment.
Abstract 553 Figure.
557 Left ventricular diastolic function is a predictor of volumetric response to cardiac resynchronization therapy
Authors: Galli E , Aalen J , Duchenne J , Larsen C , Hubert A , Saade E , Le Rolle V , Leclercq C , Smiseth O , Voigt J U , Donal E 
Published: January 2020

Abstract

Background
Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aims of the study are: 1) to assess diastolic patterns in patients undergoing CRT; 2) to evaluate the role of DF in predicting CRT-response.

Methods
193 patients (age: 67 ± 11 ms, QRS width: 167 ± 21 ms, LVEF 28 ± 8%) were prospectively included in this multicentric study. 2D-standard echocardiography was performed before CRT and at 6-month follow-up (FU). DF was assessed according to recommendations from grade I to III. In case of data in the "grey zone", DF was defined as "indeterminate". A reduction of left ventricular (LV) end-systolic volume &gt;15% at FU identified CRT-responders (CRT-R).

Results
At 6-month FU, 132 patients (68%) were CRT-R. Figure 1 shows DF parameters in the overall population, CRT-R, and CRT-non responders (CRT-NR) before and after CRT. At multivariable analysis, grade I diastolic dysfunction at baseline was a significant independent predictor of CRT response (OR 3.02, p = 0.001) (Table 1). The addition of grade I diastolic dysfunction to a model including clinical (sex, NYHA class, ischemic cardiomyopathy) and echocardiographic parameters (LV size), significantly increase the model power for the prediction of CRT-response (χ2: 29 vs 44, p = 0.001).

Conclusions
Before CRT, DF parameters are significantly altered in CRT-NR with respect to CRT-R. Moreover, CRT-NR experience a significant deterioration of DF after CRT. In our population, grade I diastolic function at baseline was a significant independent predictor of positive response to CRT.
Table 1 Univariable analysis Multivariable analysis Age 1.01 (0.99-1.05) 0.25 Males 0.36 (0.17-0.76) 0.008 0.57 (0.22-1.47) 0.25 CAD 0.21 (0.11-0.40) &lt;0.001 0.31 (0.15-0.65) 0.002 NYHA 0.52 (0.31-0.88) 0.01 0.57 (0.22-1.47) 0.25 QRS 1.01 (0.99-1.02) 0.44 LVEDV 0.99 (0.99-1.00) 0.003 0.98 (0.97-1.01) 0.18 LVESV 0.99 (0.98-0.99) 0.005 1.01 (0.99-1.03) 0.28 LVEF 1.00 (0.97-1.05) 0.63 Grade I DD 4.13 (2.16-7.91) &lt;0.0001 3.02 (1.26-7.23) 0.001 Grade II DD 0.57 (0.40-0.80) 0.001 0.87 (0.35-2.19) 0.79 Grade III DD 0.76 (0.58-1.02) 0.06
Abstract 557 Figure.
563 Early systolic function is impaired in patients with heart failure and preserved ejection fraction and is a more important predictor of clinical outcomes than diastolic function
Authors: Gu H , Webb J , Razavi R , Shah A , Carr-White G , Chowienczyk P 
Published: January 2020

Abstract

Funding Acknowledgements
British Heart Foundation

Aims
First-phase ejection fraction (EF1), the ejection fraction up to the time of maximal ventricular contraction may be impaired in heart failure with preserved ejection fraction (HFpEF), with homeostatic mechanisms preserving the overall ejection fraction. We examined whether EF1 is impaired and whether it predicts adverse outcomes in patients with HFpEF.

Methods and Results
We examined EF1 in patients with HFpEF diagnosed according to European Society of Cardiology guidelines, in subjects with pre-clinical diastolic dysfunction and in control subjects with no evidence of heart failure. The predictive value of EF1 for a combined end-point of re-hospitalisation for heart failure and death from any cause was compared to that of conventional echocardiographic and other indices. There was a progressive impairment of EF1 in patients with diastolic dysfunction and HFpEF compared to those without evidence of heart failure (P &lt; 0.001). In 180 HFpEF patients followed for a median of 14.7 months, 101 patients reached the primary endpoint (61 deaths and 40 hospitalisations). EF1 was the most powerful predictor of events (table 1). A cut-off value of 19.4% gave hazard ratios (for EF1 &lt; 19.4% compared to ≥19.4%) of 3.04 (figure 1), (95% confidence interval 2.014 – 4.604, P &lt; 0.001) unadjusted, and 2.976 (1.887 – 4.695, P &lt; 0.001) adjusted for age, gender, other echocardiographic indices (including EF, E/e’ ratio, stroke volume and left atrial volume index) and N-terminal pro-brain natriuretic peptide.

Conclusion
Early systolic function is impaired in HFpEF and is a powerful predictor of clinical outcomes. Therapies targeted at improving early systolic function may improve outcomes in HFpEF.
Table 1 HR CI (95%) P value Age 1.020 1.001 - 1.039 0.042 Female Gender 1.989 1.254 - 3.156 0.003 ln NT-proBNP 1.354 1.096 - 1.672 0.005 Haemoglobin 0.992 0.980 - 1.005 0.225 eGFR 0.997 0.988 - 1.006 0.568 Structural Heart Disease 0.748 0.439 - 1.274 0.285 Diastolic Dysfunction 0.694 0.445 - 1.082 0.107 Ejection Fraction 1.031 0.996 - 1.068 0.082 Stroke Volume index 0.963 0.940 - 0.986 0.002 TPAVF 0.995 0.980 - 1.005 0.230 EF1 0.900 0.869 - 0.932 &lt;0.001 Multivariate analysis of predictors of events
Abstract 563 Figure 1 Kaplan-Meier Curve
565 Impact of right atrial physiology on heart failure and adverse events after myocardial infarction
Authors: Schuster A , Backhaus S J , Navarra J L , Stiermaier T , Rommel K P , Koschalka A , Kowallick J T , Lotz J , Bigalke B , Kutty S , Gutberlet M , Hasenfus G , Thiele H , Eitel I 
Published: January 2020

Abstract

Background
Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion needs further evaluation.

Methods
1235 MI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation MI and 440 with non ST-elevation MI). Right atrial (RA) performance was evaluated using cardiac magnetic resonance myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa) and associated strain rates (SR) in a blinded core-laboratory. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post MI.

Results
RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with clinical onset of heart failure and MACE independently of RV systolic function (multi-variable analysis HR 0.95, 95% CI 0.91-0.99, p = 0.006) while RV systolic function was no independent prognosticator (HR 0.98, 95% CI 0.96-1.00, p = 0.055). Furthermore, RA conduit strain identified low- and high-risk groups within patients with relatively preserved and reduced RV and LV systolic functions (p &lt; 0.019 on log rank testing).

Conclusions
Right atrial impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT derived quantification of RA strain.
616 Aortic stenosis: changing with age?
Authors: Ramos Jimenez J , Hernandez S , Plaza Martin M , Zamorano Gomez J L 
Published: January 2020

Abstract
Introduction and aim
Aortic stenosis (AS) represents the main valve disease, thus, addressing its epidemiology and natural history becomes crucial. The aim of the present study is to shed light in the differences appearing with age in severe AS.
Methods
Observational, multicentre and prospective study of consecutive cases. Patients with severe AS, defined as aortic valve area (AVA) &lt;1.0 cm2, and preserved left ventricle ejection fraction (LVEF≥50%) were included. Subjects under and above 85 years were compared. Low gradient (LG) was defined by mean transaortic gradient (MG) &lt;40 mmHg and low flow (LF) by indexed stroke
volume (iSV) &lt;35 mL/m2. LV geometry was defined according to current chamber quantification guidelines.
A p-value &lt;0.05 was considered significant.
Results
A total of 636 patients were included, with slight predominance of females (53.9%; n = 343). No differences were found in AVA, LVEF, end-diastolic indexed values, LV mass or LV geometry between both age groups. MG and SVi were significantly lower in people over 85, who also presented more frequently with atrial fibrillation (AF) and significant mitral (MR) and tricuspid regurgitation (TR). Flow and gradient pattern vary significantly as shown in the graphic.
Conclusions
In our cohort, flow and gradient pattern in severe AS varies with age, despite no differences in LV geometry. This contrasts with previously assumed, relating LF and LG to more severe concentric hypertrophy. LF and LG can be explained by AF, significant MR and TR affecting more frequently those over 85.
Age-related differences in severe AS Less than 85 y.o. ≥85 y.o. p-value AVA (cm2) 0.73 (± 0.16) 0.72 (±0.18) 0.46 LVEF (%) 65 (±7.9) 64 (±7.8) 0.21 MG (mmHg) 41 (±14.2) 37 (±13) 0.04 iSV (mL/m2) 40 (±11) 36 (±11) 0.01 iLVEDV (mL/m2) 47 (±16) 45 (±16) 0.07 iLVMass (g/m2) 126 (±36) 127 (±36) 0.66 Normal geometry (%) 3.9 2.5 0.64 Concentric remodelling (%) 24.3 24.4 Concentric hypertrophy (%) 64.2 66.4 Eccentric hypertrophy (%) 7.6 6.7 AF (%) 12.3 19.3 0.04 Significant MR (%) 11.3 18.7 0.02 Significant TR (%) 50.4 65.7 &lt;0.01 iLVEDV indexed LV end-diastolic volume iLVMass: indexed LV mass
Abstract 616 Figure. Age-related flow and gradient pattern
P635 Echocardiographic-fluoroscopic fusion imaging: a new technology applied in pediatric ventricular tachycardia ablation
Authors: Jone P , Runciman M , Collins K K 
Published: January 2020

Abstract

Introduction
Eleven-year-old male presented with nonsustained ventricular tachycardia presented for ablation of ventricular tachycardia located on the left lateral wall that is likely associated with anterolateral papillary muscle. Although he was asymptomatic, his atria have become dilated over time thus he was scheduled for a catheter ablation. Echocardiographic-fluoroscopic fusion imaging has shown transseptal puncture using this technology is safe and required less time in crossing the atrial septum; however, fusion imaging with 3D echocardiography overlay of left ventricular papillary muscle onto fluoroscopy has not been used in ventricular tachycardia ablations.

Purpose
The purpose of this clinical case was to evaluate the application of this new technology of echocardiography-fluoroscopy fusion imaging to guide left ventricular tachycardia ablation.

Methods
Echocardiographic-fluoroscopic fusion imaging was used for transseptal puncture and a 3D echocardiographic image of the left ventricle with anterolateral papillary muscle was overlaid onto fluoroscopy (Figure 1). The radiofrequency catheter was used to ablate the left anterolateral papillary muscle. With fused imaging, the ablation catheter was seen at the left anterolateral papillary muscle, and care was taken to prevent perforation of the lateral wall of the left ventricle.

Results
With fusion imaging of the left anterolateral papillary muscle overlaid onto fluoroscopy, the lateral wall of the left ventricular was also delineated. The catheter was easily visualized with fusion imaging to prevent perforation of the left ventricle while radiofrequency ablation was performed (Figure 1).

Discussion
3D echocardiography provides excellent soft tissue definition of the lateral wall of the left ventricle and papillary muscle while fluoroscopy provides clear visualization of the ablation catheter. The ability of fusion imaging to overlay the 3D echocardiographic images onto fluoroscopy allowed for easy visualization of the anterolateral papillary muscle while the radiofrequency ablation was performed to avoid lateral wall perforation of the left ventricle. Future studies of echocardiographic-fluoroscopic fusion imaging should evaluate the potential to reduce procedure time and improve patient outcomes.
Abstract P635 Figure.
P636 A unique case of purulent pericarditis resulting in cardiac tamponade
Authors: Shah H , Le V K 
Published: January 2020

Abstract

Introduction and case report description
A 54-year-old male with no past cardiac disease was experiencing a productive cough, fevers, chills, and shortness of breath for 3 days in the community. His dyspnea worsened significantly, and he then presented to the emergency room. He admitted to using intravenous recreational drugs. His initial vital signs included a temperature of 38.2 degrees Celsius, a heart rate of 116 beats per minute, and a blood pressure of 88/42 mmHg. He had a positive pulses paradoxus with a decrease in systolic blood pressure of 14 mmHg on inspiration.

Description of the problem and procedures
This presentation was consistent with cardiac tamponade. He had an emergent echocardiogram showing a large pericardial effusion in the apical-four-chamber view (Image 1, A), including collapse of the right ventricle during diastole (Image 1, B, Green Arrow). There were also fibrin strands seen in a modified parasternal long axis view (Image 1, C, Blue Arrow). He had an emergency pericardiocentesis using real-time ultrasound guidance, which drained 400 mL of thick brown purulent fluid. A pigtail catheter was inserted to allow for continued drainage. Immediately afterwards, the patient’s blood pressure normalized, and his shortness of breath improved significantly.
Using the ultrasound, the physician also saw bilateral pleural effusions. The larger left pleural effusion was drained, and a pigtail catheter was inserted into the left pleural space. After confirming that there was no post-procedure left pneumothorax, the right pleural effusion was also drained.
An echocardiogram after the pericardiocentesis showed a significant decrease in the size of the pericardial effusion (Image 1, D).
The patient was started on broad-spectrum antibiotics, which was then narrowed after cultures from both the pericardial fluid and pleural fluid grew methicillin-susceptible Staphylococcus aureus.

Discussion
Cardiac tamponade results in increased compression of the cardiac chambers due to raised pericardial pressures. As it progresses, it can result in significant impairment in venous return, cardiac output, and blood pressure. This is a life-threatening condition if it is not promptly treated. In this case, the patient had a methicillin-susceptible Staphylococcus aureus empyema which spread contiguously into the pericardium and resulted in cardiac tamponade.

Conclusions and implications for clinical practice
This case highlights the clinical benefits of being proficient in performing a point-of-care ultrasound because a bedside echocardiogram by the physician immediately confirmed the diagnosis and allowed for safer drainage of the pericardial effusion using ultrasound guidance to decrease the chance of causing a perforation of the ventricle. Using ultrasound, the clinician was also able to promptly diagnose the pleural effusions and urgently drain them, which was necessary for achieving source control in order to fully treat the infection.
Abstract P636 Figure. Image 1. Cardiac Tamponade
P680 Aortic arch myxoma with multiple peripheral embolism.
Authors: Starzyk K , Pietrzyk E , Starzyk Z , Gluszek S , Wozakowska-Kaplon B 
Published: January 2020

Abstract
We report an unusual localisation of myxoma, the most common primary cardiac neoplasm. A 58-year-old woman was admitted to surgery department with exacerbation of abdominal discomfort and symptoms of lower limb claudication.The abdominal CT showed embolism in the upper mesenteric artery arms with intestinal ischemia, in the minor renal arteries with kidney infarcts and in the minor arteries of lower extremities. She was urgently, succesfully operated and partial resection of the small intestine was performed. The chest angio-CT conducted three days after the operation revealed additional structure in the aortic arch. Local aortic arch dissection with a thrombus was initially suspected. Echocardiography showed homogenous tumor on the minor curvature of the aortic arch, with a base of 11 mm of width, reaching down with the blood stream towards the descending aorta. The aortic wall was linear, with no signs of dissection or atherosclerotic lesions, echogenicity indicated rather solid mass. The patient was operated cardiosurgically and tumor of a myxoma type was confirmed intraoperatively. Another, small tumor of the same type was found below isthmus, in a descending aorta. Partial resection of aortic arch, alloplasty of aortic arch with the use of a dacron prosthesis were performed. The tumor below the isthmus was removed, without resection of aortic wall, due to the high risk associated with the widening of the procedure. Multimodality imaging with the essential role of echocardiography is useful especially in differential diagnostics of the atypically localized tumors causing diffuse peripheral embolization.
Abstract P680 Figure. Aortic arch myxoma tumor