bluuebunny/crossref_metadata_2025_split huggingface dataset:
P953 When one problem is not enough.
Authors: Craveiro N , Cardoso G , Saraiva M , Vieira M J , Moura A R , Alves M , Pitta M L , Peres M , Martins V 
Published: January 2020

Abstract

Background
Syncope is a serious complication of significant aortic valve stenosis. Left ventricular outflow obstruction, abnormal arterial and venous vasodilatation and arrhythmic events are usually the most common pathophysiological mechanisms. Structurally abnormal native valves with turbulent abnormal flow are a substrate for infective endocarditis in the elderly population.

Clinical Case
We report the case of an 74 year-old woman with a past history of hypertension, type II diabetes, dyslipidemia and degenerative severe aortic stenosis waiting valve replacement surgery who presented to the emergency department with syncope. Elevated inflammatory markers, fever and leukocyturia raised the hypothesis of urinary tract infection. Empirical antibiotic was initiated and the patient was admitted to the Internal Medicine ward. Evolution was unsatisfactory with evolution to cardiogenic shock. Urgent transthoracic echocardiogram showed dilated right cavities, mild pericardial effusion and high gradient flow between the left ventricle and right cavities with an unstructured calcified high mobility aortic valve with perivalvular abscess. Patient was transferred to a tertiary center for emergent surgery. A biologic aortic valve and pericardial bovine patch at the proximal membranous septum was implanted. Six-week empirical antibiotic treatment for endocarditis was completed after surgery. Initial blood cultures and native valve culture were negative. Residual restrictive left to right shunt was observed by TTE evaluation. The patient was discharged home and is doing well at follow-up.

Conclusion
Left-to-right shunt with subsequent cardiogenic shock is a non-common complication of aortic valve endocarditis. Patients presenting with syncope in the context of aortic stenosis must have a careful initial evaluation and mechanical complications excluded.
Abstract P953 Figure. EuroEcho2019
P959 Handheld echocardiography in a real world scenario: concordances compared to standard echo reports
Authors: David Lechinewski L , Vieira I P , Clausell N , Moura L A Z , Barnes M , Tsang T , Gavazzoni Blume G 
Published: January 2020

Abstract

Background
Handheld echocardiography devices(HH) arise as a common tool in clinical examination and screening for various cardiovascular disorders. Despite of it, studies with this method are small, with unselected patients and limited scope of diagnostic comparison.

Purpose
Assess the usefulness of the new miniaturized HH and compare its concordances with the standard high definition echocardiography study(STD).

Methods
Between April and May of 2016 adult patients who were scheduled to regular STD, were also submitted to a HH exam. Experienced sonographers performed and an experienced echocardiographer reviewed the STD exam, and an experienced echocardiographer performed and reviewed the HH study - reviewers were blinded to the other study results. STD exams included 2-dimensional images, Color Doppler and hemodynamics analysis. With the HH hemodynamic assessment was not performed as the machine does not include such technology. Agreement between the reports was analyzed.

Results
110 patients were included. Mean age was 62.4 ± 16.7 years. The κ values(Table) show good correlation between HH and STD on the analysis of left ventricular global and segment functions, right ventricle size and function, mitral and aortic stenosis. On the evaluation of left ventricle hypertrophy, mitral and aortic regurgitations the correlation was modest, while poor correlation was found for pulmonary and tricuspid regurgitations.

Conclusion
In a daily practice scenario with experienced hands, HH demonstrates good results for the assessment of ventricles size and function, while the evaluation of right heart valves was the least reliable performance. Dissemination of HH should occur with considerations and caution.
K Values for Echocardiography Analysis Echocardiography analysis K value Global estimated LV dysfunction 0.85 Wall motion abnormalities 0.78 LV hypertrophy 0.6 RV size 0.83 RV function 0.82 Mitral regurgitation 0.42 Aortic regurgitation 0.56 Mitral stenosis 0.96 Aortic stenosis 0.82 Tricuspid regurgitation 0.26 Pulmonary regurgitation 0.25 LV: left ventricle; RV: right ventricle.
P960 Response of alveolo-capillar membrane diffusion to mitral regurgitation in heart failure with reduced ejection fraction
Authors: Bandera F , Ghizzardi G , Agnifili M , Pizzocri S , Boveri S , Losito M , Labate V , Alfonzetti E , Guazzi M 
Published: January 2020

Abstract

Background
In HFrEF patients, high pulmonary vascular resistances (PVR) imply a combined increase of both pre- and post-capillary pressures, associated with worse outcome. Mitral regurgitation (MR) may play a role in this complex physiopathology. We sought to investigate MR impact on lung DLCO and pulmonary vascular hemodynamic in HFrEF patient.

Methods
27 HFrEF patients (age 69 ± 9; LV EF 34 ± 6) underwent right heart catheterization, rest and exercise echocardiography, right ventricle 3D assessment and lung alveolo-capillary membrane DLCO. We identified 2 subgroups divided by normal (&lt;3 WU, n= 20) or abnormal (&gt;3 WU, n = 7) PVR.

Results
Abnormal PVR patients showed increased pulmonary artery pressures and TPG, reduced CO and pulmonary artery compliance. Total DLCO was not significantly different between groups. The membrane component (Dm) and the alveolar volume (Va) were significantly reduced in abnormal PVR group, while the capillary volume (VC) showed a strong trend toward higher values. Abnormal PVR group had a very high percentage of moderate-to-severe MR. The TASPE/SPAP ratio and the circumferential component of RV systolic function were significantly reduced in abnormal PVR group.

Conclusion
The presence of severe MR is associated with alveolar-capillary membrane remodeling (lower Dm), worse hemodynamic profile (higher PA pressures, lower PA compliance and higher PA resistance) and worse right ventricle to pulmonary circulation coupling (lower TAPSE/SPAP and lower 3D RV circumferential EF) in this cohort of HFrEF patients. These results confirm the adequacy of using therapeutic strategies aimed to solve valvular disease.
P967 Profile of arrhythmia in pregnant women with different WHO class is similar
Authors: Wisniowska-Smialek S , Lesniak-Sobelga A , Kostkiewicz M , Rubis P , Holcman K , Podolec P 
Published: January 2020

Abstract

Background
Arrhythmia is the most common cardiac complications during pregnancy especially in women with structural heart disease. Methods: Since January 2015 till December 2018 the consecutive 150 pregnant women with different maternal cardiovascular risk according to WHO classification: 100 in WHO I and II (gr 1);50 in WHO II-III, III, IV were enrolled. Each woman had 24-hour Holter- ECG monitoring during at least 2 trimester. Results: Except mild ventricular arrhythmia i.e ventricular extrasystole &gt; 1000 per 24 hour, which occured more often in group1, we did not observe any significant differences in arrhythmic profile of pregnant women with different WHO risk classification (table 1). Delivery: Caesarean section was more frequent in gr 2 (86% vs 62%) but rate of stillbirths were similar among groups. Maternal death did not occurred, there was 2 (4%) foetal mortality in gr 2. Mean duration of pregnancy, children length and birthweight were significantly higher in gr 1(table1).Conclusion: Arrhythmias during pregnancy occurred particularly on the substrate of structural heart disease. According to our observation pregnant women with potentially higher risk of maternal cardiovascular events did not reveal significant arrhythmia including conduction disturbances in comparison to women in WHO class I or II.
Holter monitoring resultes Parameter Group 1; no 100 Group 2, no 50 P value Age 31(27-34) 31(28-33) 0,36 NYHA 1,34 1,32 0,76 SVE &gt; 1000/d 2(2,15%) 2(5,88%) 0,28 VE &gt; 1000/d 20(19,23%) 3(5,88%) 0,03 SVT 6(6,5%) 4(11,43%) 0,35 sVT 1(1%) 0 0,65 nsVT 8(8,79%) 3(8,57%) 0,96 AF/AT 0 2(4%) 0,54 AV I 5(5%) 3(6%) 0,32 AV II Mobitz I 1(1,1%) 1(2%) 0,53 AV III 0 1(2%) 0,41 Duration (weeks) 39(38-40) 37,1 0,017 Weight (grams) 3220+-641 2840+-767 g 0,02 Caesareon section 54(62%) 33(86%) 0,00 Stillbirths 22(21,57% 8(17,78%) 0,6
P968 Subcostal M-mode echocardiography of tricuspid annular motion helps recogntion of heart arrhythmias
Authors: Drinkovic N , Drinkovic Jr N 
Published: January 2020

Abstract
Recognition of supraventricular arrhythmias and differention between supraventricular and
ventricular rhythm abnormalities in ECG can sometimes be difficult due to indiscernible P
wave. 1D echocardiography of tricuspid annular motion can quickly and reliably detect atrial contraction (Picture 1, figure 1a.) which has a characteristic appearance for majority of supraventricular arrhythmias. Since subcostal approach is almost always reliable, it allows simple and rapid recognition and differentiation between supraventricular arrhythmias, e.g. atrial fibrillation (Picture 1, figure 1b.) from atrial flutter and nodal rhythm. Detection of atrial contractions enables recognition of AV dissociation in ECG, which helps in differentiation between supraventricular and ventricular arrhythmias. This technique is also useful in checking the function and mechanical efficiency of atrial pacing.
Figure 1a. Atrial contraction / sinus rhythm
RA = right atrium
A = atrial contraction
Figure 1b. Atrial fibrillation
RA = right atrium
a = fibrillary contractions
Abstract P968 Figure. Picture 1
P971 The echocardiographic phenotype in patients with cardiac amyloidosis and heart failure with preserved ejection fraction
Authors: Perez Gil M D M , Mora Llabata V , Saad A , Sorribes Alonso A , Faga V , Arbucci R , Bertolin Boronat J , Serrats Lopez R , Lowenstein J 
Published: January 2020

Abstract

BACKGROUND
New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural.
PURPOSE.
To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA).
METHODS.
Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF &gt; 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º).
We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV.

RESULTS
There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA.
However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table).

CONCLUSIONS
In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV.
Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p &lt; 0.001 &lt; 0.01 0.46 0.46 &lt; 0.01 &lt; 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.
P977 CT phenotype of high-risk atherosclerotic plaques causing an acute coronary syndrome compared to silent vulnerable plaques
Authors: Hodas R I , Opincariu D , Rat N , Rodean I , Chitu M , Benedek I , Benedek T 
Published: January 2020

Abstract

Funding Acknowledgements
PlaqueImage.- research grant no. 103544/2016, contract number 26/01.09.2016 -

Background
Previous studies demonstrated that plaque morphology has a crucial role in the development of an acute coronary syndrome (ACS). However, not all vulnerable coronary plaques produce an ACS and the prediction power of various vulnerability features to predict an acute coronary event in a close future, has not been elucidated so far.

Objective
We aimed to use multi-slice computed tomography angiography (CTA) for assessment of morphological characteristics of culprit lesions producing an ACS in the next several months after CT assessment, in comparison with morphological characteristics of unstable coronary atherosclerotic plaques which did not trigger an ACS.

Material and methods
We analyzed 40 patients in whom CTA revealed presence of unstable coronary lesions, exhibiting at least one marker of vulnerability: napkin ring sign (NRS), spotty calcium (SC), positive remodeling (PR) or presence of low attenuation plaque (LAP), divided in 2 groups: group 1 - 20 patients who developed an ACS in the next 6 months following CTA examination, and group 2 – 20 patients matched for age, gender and risk factors, who did not present any cardiovascular event 6 month after CTA assessment. Post-processing of multi-slice CTA images was performed in order to assess morphological characteristics and CT-derived markers of atherosclerotic plaque instability.

Results
Similar mean values of plaque length (17.1 +/- 5.9 mm vs 16.9 +/- 3.4 mm; p = 0.6) and total atheroma volume (188.1 +/- 104.7 mm3vs 186.4 +/- 90.7 mm3; p = 0.8) were obtained for both groups. The mean number of vulnerability markers was 1.6 in group 1 vs 1.2 in group 2 (p = 0.07). However, atherosclerotic lesions in patients from group 1 presented significantly higher values of lipid-rich atheroma (9.8 +/- 10.8 mm3vs 2.6 +/- 1.0 mm3; p = 0.01) and remodeling index (1.14 +/- 0.3 in group 1 vs 0.89 +/- 0.19 in group 2, p = 0.04). At the same time, atheromatous plaques in patients who developed an ACS during the 6-months follow-up showed in a significantly higher proportion LAP (45% in group vs 10% in group 2, p = 0.03) and PR (15%in group 1 versus 5% in group 2, p = 0.04), but not NRS (30% vs 25%, p = ns) or SC (65% vs 40%, p = 0.2).

Conclusions
Atherosclerotic plaques producing an ACS exhibit a different phenotype than unstable plaques that remain silent. The CTA profile of atheromatous plaques producing an ACS includes the presence of low attenuation, positive remodeling, higher RI and lipid-rich atheroma. Presence of these features in high-risk coronary plaques identifies very high risk patients, who can benefit from adapted therapeutic strategy in order to prevent the development of an ACS.
P979 Subclinical left ventricular dysfunction and silent myocardial ischemia in asymptomatic middle-aged patients with type 2 diabetes mellitus
Authors: Kisko A , Lesko J , Dernarova L , Kishko N 
Published: January 2020

Abstract
Early detection of silent myocardial ischemia (SMI) in asymptomatic middle-aged patients (pts) with type 2 diabetes mellitus (T2DM) may be important due to the generally poor prognosis and early myocardial involvement in this specific subgroup of diabetic population.
Our goal was to evaluate whether subclinical left ventricular (LV) systolic dysfunction assessed by two-dimensional speckle-tracking echocardiography (2D-STE) is independently related to SMI detected by MPI (gated SPECT myocardial scintigraphy) and if it could provide incremental information over baseline characteristics to identify it. We have tested the hypothesis that the myocardial mechanics significantly differ in asymptomatic middle-aged diabetics, depending on the presence or absence of SMI.
In total, 60 consecutive middle-aged (&lt;60 years; 42 males, 70.0%) asymptomatic T2DM pts were enrolled into the study. MPI was performed in one-day protocol according to the EANM procedural guidelines, and SMI was diagnosed consensually by two experts as myocardial perfusion abnormalities without associated symptoms. The T2DM pts were subdivided into two groups according to the results of MPI, namely SMI group (n = 11) and non-SMI group (n= 49) Global longitudinal peak systolic strain (GLPSS) was measured from two- and four-chamber views cines using Automated Function Imaging (Vivid S6, GE). Subclinical LV dysfunction was defined as GLPSS of &gt; -20%.
Prevalence of SMI in T2DM pts was 18,3%. All pts in SMI group (n = 11) were of male gender, and disease duration ≥ 5 years. Pooled data from 2D-STE showed significant reduction in mean absolute GLPSS values (p&lt;.001). Further more, pts in SMI group had more impaired GLPSS when compared with patients in non-SMI group (-16.1 ± 1.5% vs. -20.4 ± 1.8%, P &lt; .01). At multivariate analysis, male gender, an amount of epicardial adipose tissue and erectile dysfunction in men were independently associated with SMI. The addition of the LV GLPSS values to other selected independent clinical variables significantly improved the ability to predict SMI in these patients (χ(2) = 48.62; P = .001).
Asymptomatic middle-aged T2DM pts with SMI showed a more impaired LV GLPSS compared with patients without silent ischemia. The presence of subclinical LV systolic dysfunction provides significant incremental value for the identification of SMI in asymptomatic middle-aged diabetics.
P987 Comprehensive systolic right ventricular longitudinal strain analysis in congenital heart disease patients with different right ventricular loading conditions
Authors: Van Berendoncks A , Bowen D J , Mcghie J , Cuypers J A , Kauling M , Roos-Hesselink J W , Van Den Bosch A E 
Published: January 2020

Abstract

Background
Right ventricular (RV) function is recognized as a prognostic factor in congenital heart disease (CHD). Speckle tracking analysis might reveal subclinical systolic dysfunction. Accurate assessment of global (GLS) and regional strain measurements of the RV remain challenging. We previously introduced a novel four-view approach with all RV walls visualized in their long axis from one apical view using 2D multi-plane-transthoracic echocardiographic (TTE) iRotate mode.
Aims
To extensive evaluate GLS of the entire RV using iRotate echocardiography in CHD patients with different RV loading conditions compared with healthy subjects.
Methods and Results
One-hundred forty-two CHD patients with different RV loading conditions were recruited from the outpatient clinic and compared with 89 age, gender and BSA matched healthy controls. CHD patients were divided in 5 groups: 42 patients with volume overloaded (VO)RV (at least moderate pulmonary or tricuspid regurgitation (TR) and/or an atrium septum defect), 16 patients with pressure overloaded (PO) RV (defined as TR velocity &gt; 2.8 m/s), 34 patients who met both criteria for volume and pressure overloaded RV (P + VO), 30 patients with systemic RV and 27 with normal RV loading conditions. TAPSE and Fractional area change (FAC%) were significantly lower in all CHD subgroups vs healthy controls (p &lt; 0.05). Within the CHD group, TAPSE, FAC% and TDI S` did not differentiate systemic RV from PO RV, whereas RV function was significantly better in RV VO and RV VO + PO compared with systemic RV.
GLS was significantly lower in patients with CHD compared with healthy subjects. Within the CHD groups, GLS values of systemic RV were lower (p &lt; 0.05), but no significant difference could be observed between the other subpulmonic RV loading conditions (Figure).

Conclusion
Comprehensive RV function analysis reveals decreased RV function in all CHD subgroups compared with healthy subjects. GLS showed RV systolic function to be the worst in the systemic RV but however could not differentiate between subpulmonic RV groups confirming the load independent functional analysis capacity of GLS.
Abstract P987 Figure.
P988 The newly discovered congenital heart disease in grown-up patients: untimely diagnosis or echocardiographic casuistry?
Authors: Legkonogov A , Legkonogova L G 
Published: January 2020

Abstract

Purpose of the study. Evaluation of the reasons for the untimely diagnosis of congenital heart disease (CHD) in adults and elderly patients.
Material and methods. 30000 people over the age of 25 who underwent transthoracic and transesophageal echocardiography were examined.

Results
CHD for the first time were revealed in 417 of 30000 patients (1,39%) including 41 of 5346 patients over 60 years of age (0,77%). The most often CHD was atrial septal defect (ASD) – 179 patients, and ventricular septum defect (VSD) was significantly less diagnosed (48 cases). In 98 cases, an aortic valve bicuspidy was identified with hemodynamically significant aortic valve stenosis and / or insufficiency. Coarctation of the aorta was detected in 25 patients, in 16 cases it was combined with a bicuspid aortic valve. The diagnosis of Ebstein"s anomaly (AE) was established in 16 patients, patent ductus arteriosus (PDA) in 15 patients, isolated pulmonary artery stenosis - 12, congenitally corrected transposition of the great arteries (CCTGA) - 6, tetralogy of Fallot - 5, congenital aneurysm of the sinus of Valsalva (CASV) - 5, congenital aneurysm of the ascending part and the arch of the thoracic aorta - 4, Lutembacher syndrome - 2, congenital mitral insufficiency - 2, mesocardia - 2 cases. In patients with CHD over 60, secondary ASD prevailed (28 observations); less frequently were discovered VSD (4), CCTGA (3), CASV (4), PDA (1), AE (1).

Conclusion
Untimely detection and difficulties in primary diagnosis of CHD in adults and elderly patients can be due to established diagnostic stereotypes, when the results of clinical observation and instrumental examination were interpreted in favor of manifestations of coronary artery disease, arterial hypertension, chronic heart failure, acquired valvular heart disease, cardiomyopathies etc. In addition, overestimation of concomitant age-related structural and functional changes of the heart and improper medical monitoring may be important.