bluuebunny/crossref_metadata_2025_split huggingface dataset:
1234 The cardiac isovolumetric contraction time is an independent predictor of cardiovascular morbidity in the general population
Authors: Saed Alhakak A , Mogelvang R , Jensen G B , Gislason G , Biering-Sorensen T 
Published: January 2020

Abstract

Background
Color Tissue Doppler imaging (TDI) M-mode through the mitral leaflet is an easy and precise method to obtain the cardiac time intervals including the isovolumic contraction time (IVCT), the isovolumic relaxation time (IVRT) and the left ventricular ejection time (ET). The myocardial performance index (MPI) is defined as [(IVCT + IVRT)/ET]). It is our hypothesis that the duration of the cardiac time intervals can reveal early cardiac dysfunction.

Purpose
Our aim was to investigate if the cardiac time intervals can be used to predict cardiovascular morbidity in the general population.

Methods
A total of 1,915 participants from the general population (mean age 58 ± 16 years, 42% male) underwent a general health examination including TDI echocardiography. The IVCT, IVRT and ET were measured. The primary endpoint was the composite of ischemic heart disease (IHD), heart failure (HF) and atrial fibrillation (AF). Participants with previous IHD, prevalent HF and AF were excluded (n = 336).

Results
During a median follow-up time of 11 years, 277 (17.5%) participants reached the composite endpoint. Assessing the association between IVCT and the composite outcome, the risk of IHD, HF and AF increased with 20% per 10ms increase in IVCT (per 10 ms increase: HR 1.20; 95% CI (1.11-1.30), p &lt; 0.001; figure). The association remained significant even after multivariable adjustment for clinical and echocardiographic parameters (per 10ms increase: HR 1.11; 95% CI (1.01-1.22), p = 0.037).
IVRT, LVET and MPI were significant predictors of the composite outcome in unadjusted analysis (p &lt; 0.001 for all). However, none remained significant after multivariable adjustment.
Additionally, the IVCT provided incremental prognostic information, as assessed by a significant increase in the net reclassification improvement (NRI) index, beyond the SCORE risk chart (continuous NRI, 0.266; 95% CI, 0.093-0.386) and the ACC/AHA Pooled Cohort Equation (continuous NRI, 0.252; 95% CI, 0.078-0.371).

Conclusion
In a low risk general population, the IVCT provides novel and independent prognostic information on the long-term risk of cardiovascular morbidity.
Abstract 1234 Figure.
P1334 Multimodal imaging assessment of a very rare cause of heart failure in adults
Authors: Darabont R O , Balinisteanu A E , Rimbas R C , Nicula A , Vinereanu D 
Published: January 2020

Abstract

Introduction
Congenitally Corrected Transposition of the Great Arteries (CCTGA) is a rare defect consisting in the abnormal twisting of the heart during fetal development. As a result, the two ventricles and their valves are reversed. CCTGA is frequently associated with other cardiac abnormalities. 25% of patients are developing heart failure, related to perfusion mismatch (the morphological left ventricle is supplied by a single coronary artery), and to the progressive deterioration of the structural right ventricle situated on the systemic side of the circulation.

Case report
A 45-year-old male was referred to our hospital for fatigue and dyspnea, occuring in the last five months. Physical examination revealed tachypnea, a slightly intense systolic murmur at the apex, and pulmonary congestion, in the absence of cyanosis, peripheral edema or jugular venous distension. Heart rate and blood pressure were normal. Usual laboratory work-up indicated increased levels of NT-proBNP, without any other abnormalities. ECG presented signs of pressure overload of the systemic ventricle (Figure Ia). Transthoracic echocardiography (TTE) highly suggested the diagnosis of CCTGA, due to atrioventricular valve displacement, with the morphological tricuspid valve closer to the apex in 4-chamber view (Figure Ib). TTE showed also dilated and dysfunctional left ventricle, mild left atrioventricular regurgitation, and normally functional right ventricle. Cardiac computed tomography emphasized a specific feature of CCTGA: the parallel emergence of aorta and pulmonary trunk, with the aortic arch crossing over the left pulmonary artery (Figure Ic). Cardiac magnetic resonance imaging confirmed dilatation and low ejection fraction of the systemic ventricle (20%), and displayed presence of trabeculations and the moderator band in the systemic ventricle (Figure Id). None of these evaluations found additional cardiac structural anomalies. Thus, patient was diagnosed with heart failure due to isolated CCTGA.
Discussions and relevance of case report. This case emphasizes a very rare cause of heart failure in adults. CCTGA is reported in 0.5-1% of all congenital diseases, especially in males. Isolated CCTGA accounts for less than 10% of all cases, and represents the phenotype that is usually diagnosed in adulthood. In the absence of associated anomalies, the prognosis of these patients is particularly affected by the occurrence of heart failure in the 4th or 5th decade of life. Meanwhile, this case highlights the importance of a multimodal approach in CCTGA, and the specific contribution of each imaging method in the process of an accurate diagnosis.
Abstract P1334 Figure I
P1355 Short-term cardiac side-effects from radiotherapy in women with breast cancer
Authors: Witkowski T , Konat-Baska K , Dupla D , Maciejczyk A , Matkowski R , Jankowska E A , Kosmala W 
Published: January 2020

Abstract

Introduction
Breast cancer radiotherapy provides an apparent benefit for long-term survival and local recurrence rate. However, there is still much concern about the early and late radiation-induced cardiac toxicity. Therefore, various radiotherapy techniques have been developed to reduce the cardiopulmonary radiation doses in patients with left-sided breast cancer, who are at particular risk of developing post-radiation cardiac injury.

Aim
We sought to investigate the early effect of radiotherapy on left (LV) and right ventricular (RV) function in females subjected to this treatment.

Methods
Fifty left-sided breast cancer patients , who underwent adjuvant radiotherapy between May 2017 and May 2018 were included in the study. Forty-nine enrollees were initially treated with breast conserving surgery, and 1 - with mastectomy and axillary lymph node resection. Adjuvant radiotherapy was carefully planned to minimize the radiation side effects and 37 patient received radiotherapy with deep inspiration breath hold technique and 13 patients with free breathing technique. In most cases (n = 33), 3D conformal tangential field radiation therapy was applied, 13 patients received radiotherapy with dynamic-Rapid-Arc technique with additional 3D fields, and 4 patients underwent radiotherapy only with Rapid-Arc technique. Before surgery and 3 months after radiotherapy, echocardiography with measurement of conventional cardiac function parameters, as well as LV and RV longitudinal deformation analysis by speckle tracking technique was performed, and venous blood for biomarkers - galectin-3 reflecting myocardial fibrosis and NT-proBNP was sampled.
Results At a mean follow-up of 97 ± 19 days , there were no significant changes in any of the studied cardiac systolic or diastolic function parameters (Table). There were no relationships between the change in LV longitudinal strain at follow-up and type of radiotherapy, as well as type of radiotherapy gating (both R = 0.02, p = 0.90). Similarly, no analogous associations were demonstrated for RV longitudinal strain (R = 0.02, p = 0.88, and R = 0.04, p = 0.77, respectively). No significant changes were found post radiotherapy in serum galectin-3 (7.2 ± 2.6 ng/ml vs. 6.8 ± 2.5 ng/ml; p = 0.58) and NT-proBNP (83 ± 68 pg/ml vs. 84 ± 54 pg/ml; p = 0.90).

Conclusions
Breast cancer radiotherapy with the use of contemporary planning techniques shows an excellent early cardiac safety.
Abstract P1355 Figure.
P1364 Contractile reserve predicts reverse remodelling after successful percutaneous mitral valve repair in patients with functional mitral regurgitation
Authors: Mortelmans P , Debonnaire P , Paelinck B P , De Bock D , Coussement P , Claeys M J , Van De Heyning C M 
Published: January 2020

Abstract

Background
Recent randomised trials have shown conflicting results regarding the usefulness of percutaneous mitral valve repair using MitraClip in patients with severe functional mitral regurgitation (FMR). At present, it remains unclear whether patients with FMR and advanced heart failure might benefit from MitraClip therapy. Moreover, it has been shown that left ventricular reverse remodelling (LVRR) post-MitraClip is associated with a favourable outcome.

Purpose
We sought to assess whether baseline contractile reserve (CR) can predict LVRR and improvement of LV ejection fraction (EF) in FMR patients undergoing MitraClip therapy.

Methods
Consecutive patients with symptomatic severe FMR referred for MitraClip were recruited in two tertiary centres. All patients were scheduled for a semi-supine bicycle exercise echocardiography before and 6 months after the intervention. Patients who were not able to perform an exercise test and who did not complete 6 month follow up were excluded from further analysis. Baseline CR was obtained by subtracting peak exercise LVEF from LVEF at rest. LVRR was defined as a 10% decrease in LV end systolic volume (ESV) at follow-up.

Results
34 patients completed 6 month follow up (61% male, age 71 ± 10 years, LVEF 32 ± 8%). LVRR was observed in 15 patients (44%). We found a trend towards a moderate correlation between baseline CR and relative decrease in LVESV at 6 months (Pearson Rho -0.321, p = 0.064). This correlation became significant in a sub-analysis considering only patients with post-procedural FMR grade ≤2 (n = 27; Pearson Rho -0.444, p = 0.020). In contrast, LVRR was not related to baseline LVEF, LV dimensions or volumes. Furthermore, baseline CR was strongly correlated with an increase of LVEF at 6 months post-MitraClip in these patients (Pearson Rho 0.653, p &lt; 0.001).

Conclusion
CR predicts LVRR and improvement of LVEF in patients with FMR after successful MitraClip therapy (reduction of FMR towards grade ≤2), in contrast to resting indices of LV dysfunction and dilatation. More studies with outcome data are needed to determine whether CR is a useful parameter to identify patients with FMR who might benefit from MitraClip therapy.
P1376 The utility of platelets indices in predicting the presence of left atrial appendage thrombus in patients with atrial fibrillation
Authors: Vijan A , Delcea C , Andrus A , Daha I , Dan G A 
Published: January 2020

Abstract

Background
Atrial fibrillation (AF) is the most frequent arrhythmia with a high risk for thromboembolic events. The presence of left atrial appendage (LAA) thrombus is associated with a greater risk for stroke, yet few papers investgated predictor factors for LAA thrombus. Platelets indices-Mean platelet volume (MPV) and plateletcrit (PTC)-have been correlated with platelet reactivity, thrombogenicity and a high cardiovascular risk.

Purpose
The aim of this study is to determine if MPV-to-PCT and MPV-to-platelet (PLT) ratios could predict the presence of LAA thrombus in nonvalvular AF patients.

Methods
This retrospective study includes 112 patients screened with trans-esophageal echography (TEE) for LAA thrombus from January 2018 to Aprilie 2019. We excluded patients with manifest, deep vein thrombosis, pulmonary trombembolism and malignancies. The platelets indices were measured on admission.
ROC curve analysis and the Youden index associated criterion was used to determine the cut-off values and Chi –square test to estimate associated risks.

Results
The focus group consisted of 112 AF patients, with a mean age of 67 ± 10.02 and 52.3% males. 71% patients had persistent AF, 19.64% (22) patients had LAA thrombi.
Higher MPV-to-PCT, respectively MPV-to-PLT ratios were associated with LAA thrombus. In ROC curve analysis MPV-to-PLT ratio (AUC 0.618 95% CI 0.521 to 0.708, p = 0.0729) and MPV-to-PCT ratio (AUC 0.627, 95% CI 0.530 to 0.716, p = 0.05) predicted LAA thrombi, with a cut-off value of &gt;38 for MPV-to-PCT and &gt;0.049 for MPV-to-PLT ratio.
Patients with an MPV-to-PCT ratio &gt; 38 had a risk ratio of 1.21 (95% CI 1.03 - 1.44, p = 0.039) and those with an MPV-to-PLT ratio&gt; 0.049 a risk ratio of 1.27 (95%CI 1.03 - 1.58, p = 0.01 ) of having a LAA thrombus.

Conclusion
Platelets indices are cost efficient, readily available thrombogenesis biomarkers that could be auxilliary parameters useful for the associtation of LAA thrombi in non-valvular AF patients undergoing TEE before cardioversion. We suggest the cut-off values of MPV-to-PCT&gt; 38 and MPV-to-PLT &gt; 0.049 to be considered as risk indicator.
P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction
Authors: Sakaguchi E , Yamada A , Hoshino M , Takada K , Hoshino N , Kawada Y , Yamabe S , Ozaki Y 
Published: January 2020

Abstract

Purposes
We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission.

Methods
We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (&gt; 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events.

Results
Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p &lt; 0.0001, log-rank).

Conclusion
A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.
P1391 Global longitudinal strain in chronic asymptomatic aortic regurgitation: a meta-analysis
Authors: De Campos D , Teixeira R , Botelho A , Saleiro C , Lopes J , Puga L , Ribeiro J M , Sousa J , Goncalves L 
Published: January 2020

Abstract

BACKGROUND Previous studies have shown that left ventricle global longitudinal strain (GLS) assessed with 2D-speckle tracking echocardiography, is an independent predictor of outcome in asymptomatic moderate to severe chronic aortic regurgitation (AR) patients.

OBJECTIVES
To assess GLS impact on mortality and need for aortic valve replacement (AVR) or symptom development in chronic asymptomatic AR patients and preserved left ventricular ejection fraction (LVEF).
METHODS A literature search was performed according with these key terms "aortic regurgitation" and "longitudinal strain." The primary endpoint was all-cause mortality. Secondary end-points were: a composite of all-cause mortality, need for AVR or symptom development; and only AVR plus symptom development. Data was pooled using random-effects meta-analysis models. Pooled Hazard Ratio (HR) was performed using its log transformation and inverse variances as weights were then calculated for each study .
RESULTS Six studies were included, with a total of 1,571 asymptomatic patients with at least moderate AR and preserved LVEF. There were 996 events (death, AVR, symptom development) reported during follow-up. Pooled adjusted mortality HR tended to be higher for patients with worse GLS (1.14 [0.96–1.35], P = 0.13, I2 51%). GLS performed better in predicting AVR or symptom development (mean difference -0.72 [-1.29, -0.15], P = 0.01, I2 88%), with an estimated HR of 1.36 ([1.01–1.84], P = 0.04, I2 65%).
CONCLUSIONS In asymptomatic chronic moderate to severe AR patients, impaired GLS was associated with adverse cardiac outcomes. Left ventricular GLS may offer incremental value on risk stratification as well as on decision-making.
Abstract P1391 Figure 1
P1395 New predictors of burned-out phase in hypertrophic cardiomyopathy
Authors: Adamczak D M , Rogala A , Antoniak M , Oko-Sarnowska Z 
Published: January 2020

Abstract

BACKGROUND
Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium. The structural and functional abnormalities cannot be explained by flow-limiting coronary artery disease or loading conditions. HCM has a benign course, however approximately 5% of these patients suffer from the end-stage of the disease. The so-called burned-out phase, characterized by systolic dysfunction with a left ventricular ejection fraction ≤50%, is often associated with wall thinning and chamber dilation. These patients should have more frequent clinic visits and have a more intensive treatment plan. They are also candidates for heart transplantation. Currently there are no risk factors of progression to burned-out phase before the onset of heart failure symptoms. Therefore, the potential risk factors: left ventricular global longitudinal strain (GLS), left ventricular average strain (ASI), right ventricular average strain (RV-ASI) and left atrial volume index (LAVI), have been examined. GLS, derived from speckle tracking echocardiography, and ASI, derived from tissue doppler imaging, are the sensitive and noninvasive methods of assessing the ventricular function. LAVI more accurately characterizes the size of the left atrium, which usually increases in the course of the disease.

METHODS
A total of 252 patients with HCM (aged 20-88 years, 49,6% were men), treated in our Department have been enrolled in the study. GLS, ASI, RV-ASI and LAVI assessment has been made in addition to standard echocardiographic examination. Burned-out was characterized as systolic dysfunction with a left ventricular ejection fraction ≤50%.

RESULTS
5.6% patients in the study population were diagnosed with burned-out phase in hypertrophic cardiomyopathy.
The t-Student test and t-Student test with Cochran-Cox adjustment showed statistically significant differences of GLS and ASI values between burned-out and non-burned-out groups; p = 0.000001 and p &lt; 0.000001, respectively. Average and median values of GLS in burned-out group were -7.4% ± 2.9%, -7.1% and -15.3% ± 4.3%, -15.4% in non-burned-out group. For ASI those values were respectively -7.6% ± 2.2%, -7.1% and -12.9% ± 4.5%, -13.0%.
The Mann-Whitney test showed statistically significant differences of RV-ASI and LAVI values between burned-out and non-burned-out groups; p = 0.000208 and p = 0.005302, respectively. Median value of RV-ASI in burned-out group was -15.8% and -27.1% in non- burned-out group. Median value of LAVI in burned-out group was 52.6 ml/m2 and 37.8 ml/m2 in non-burned-out group.

CONCLUSIONS
Each of the proposed new risk factors of burned-out development was statistically significant in the study population. Therefore, all HCM patients should have regular echocardiographic examinations and those with deteriorating values of new parameters should become the subjects of intensified medical care.
P1462 Additive value of global longitudinal strain measurement in patients with known or suspected ischaemic heart disease undergoing stress echo
Authors: Castellano F , Lupo A , Nugara C , Triolo O F , Evola G , Di Lisi D , Trapani R , Novo S , Novo G 
Published: January 2020

Abstract
BACKGROUND
Speckle-tracking echocardiography (STE) can be applied in a large variety of clinical conditions.
Global longitudinal strain (GLS) shows high diagnostic accuracy for the detection of myocardial
ischemia as it reflects changes in subendocardial fibers deformation that are more exposed to
ischemic damage, even before alterations in segmental kinetics are revealed.
PURPOSE
Aim of our study was to assess whether the measurement of global longitudinal strain during
stress-echo can provide additional information compared to the assessment of conventional
parameters such as left ventricular ejection fraction (LVEF) and wall motion abnormalities. We
also evaluated the added value of strain in patients with complete (CRP) and incomplete
revascularization (IRP).
METHODS
We enrolled 69 patients, 39 with known (IHD) and 30 with suspected ischaemic heart disease
(SIHD) with indication to perform a stress echocardiogram. Inclusion criteria were: known or
suspected CAD, age &lt;85 and &gt;18, adeguate acoustic window. Cardiological evaluation and stress
echo were performed in all patients. Primary end point was evaluating whether in patients with
negative stress test the presence of reduced GLS identifies patients with an adverse prognosis at
follow up and to assess if in IRP and negative stress test there is evidence of left subclinical ventricular
dysfunction identifiable by GLS analysis compared to CRP.
RESULTS
LVEF was significantly reduced in IHD patients compared to SIHD patients (54 ± 7vs 60 ± 4 at rest;
55 ± 8vs62 ± 3 at peak; p &lt; 0.0001). We also observed a significant reduction of GLS in IHD patients
compared to SIHD patients (-16.7 ± 4,3vs-19 ± 2.2 - p = 0.07 at rest, -18 ± 4.6vs22 ± 3.4-p = 0.004 at
peak). In CRP patients GLS did not change significantly with a tendency to improve (-17.6 ± 4 at rest
vs -19 ± 4.5 at peak - p = 0.4). Instead in IRP patients, significant reduction of GLS was observed at
peak (17.5 ± 0.7 at rest vs 14.2 ± 0.3 at peak, p value 0,03). LVEF did not significantly differ in CRP
(54 ± 5 at baseline vs 55 ± 7 at peak, p = 0.5) and IRP (52 ± 9 at baseline vs. 52 ± 9 at peak, p =
0.9) .
CONCLUSIONS
Our study shows that strain analysis during stress echocardiography can provide additional information in identifying a subclinical reduction of myocardial function at baseline and
a reduction in contractile reserve under stress, secondary to coronary flow reduction. Being GLS a
powerful prognostic marker probably patients with negative stress test and incomplete
revascularization, reduced baseline GLS and reduction of GLS at peak exercise represent a population at higher risk of coronary artery disease progression and development of left ventricular dysfunction who need a closer follow up. To verify our hypothesis we plan to increase our sample size and to
prospectively follow up our patients.