bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1382 Evidence for longitudinal aorta strain relationship with noninvasive left ventricular myocardial work: another component for the ventricular-aorta coupling?
Authors: Armenis I , Demerouti E , Motsi A , Athanassopoulos G 
Published: January 2020

Abstract

The force required to produce longitudinal strain of the aorta represents an often overlooked mechanical load imposed on the left ventricle (LV). 2D speckle tracking strain analysis (2D-SpTa) may be applied on aorta wall in order to evaluate regional longitudinal strain (AoSTR). A noninvasive method for measuring LV myocardial work (MW) has been recently proposed, based on 2D-SpTa combined with estimated pressure curve.
Aim of the study was to assess the relationship of both LV conventional functional indices and the new MW ones with the aorta function estimated by AoSRT in normals and to interrogate the potential effect of aging.

Methods
Fifty four normals, 24 males (M) and 30 females(F), age: 52 ± 13 (25-75 years), were selectively studied, provided that they had an efficient image quality to apply both AFI analysis for MW estimation and ascending aorta interrogation for AoLSTR (EchoPac GE) .
LAoLSTR was measured in the posterior aorta wall (apical long axis view). Aortic wall borders were traced longitudinally adjusting width using 4 points of interest. The first point was put at the sinotubular junction and approximately 3-4 cm of the ascending aorta were analyzed. 2D-SpTa divided the regions of interest into proximal, middle and distal segments and the respective peak LAoSTR were considered.
The following indexes of MW were estimated: GWI (global work index = total work from mitral valve closure to mitral valve opening), GCW (global constructive work = total work contributing to pump function, namely due to shortening during isovolumic contraction and ejection and lengthening during isovolumic relaxation), GWW (global wasted work = elongation during isovolumic contraction/ejection and shortening during isovolumic relaxation), GWE (global work efficiency = fraction of GCW/[GCW + GWW]).
AFI derived LV strain (LVGS), biplane LV ejection fraction and stroke volume (SV) were also calculated.

Results
LAoSTR in any wall position was not affected by age. LAoLSTR of the proximal segment was related to both EF and LVGS (r = 0.31, p = 0.03 and r=-0.28 p = 0.05, respectively). Middle and distal LAoSTR were not related to either EF or LVGS. SV was not related to any of LAoSTR.
LAoSTR of the proximal segment was related to both GWI and GCW ( r = 0.34 p = 0.016 and r = 0,31 p = 0.03 respectively).
LAoSTR of the middle and distal segments were not related with any LV MW parameters.

Conclusion
Longitudinal aorta strain evaluation by 2D-SpTa is feasible and it is related with functional performance of the LV estimated by either conventional or MW indices based on 2D-SpTa. Moreover , the longitudinal performance of the proximal segment of the aorta above the sinotubular junction is linked to the constructive component of the LV myocardial work thus providing an alternative evidence for the LV ventricular–aorta coupling which was independent from aging.
P1398 Echocardiographic continuous monitoring of exercise stress test using probe fixation device
Authors: Wdowiak-Okrojek K , Wejner-Mik P , Bednarkiewicz Z , Lipiec P , Kasprzak J D 
Published: January 2020

Abstract

Background
Stress echocardiography (SE) plays an important role among methods of noninvasive diagnosis of ischemic disease. Despite the advantages of physical exercise as the most physiologic stressor, it is difficult (bicycle ergometer) or impossible (treadmill) to obtain and maintain the acoustic window during the exercise. Recently, an innovative probe fixation device was introduced and a research plan was developed to assess the feasibility of external probe fixation during exercise echocardiography on a supine bicycle and upright treadmill exercise for the first time.

Methods
37 subjects (36 men, mean age 39 ± 16 years, 21 healthy volunteers, 16 patients with suspected coronary artery disease) were included in this study. This preliminary testing stage included mostly men due to more problematic probe fixation in women. All subjects underwent a submaximal exercise stress test on a treadmill (17/37) or bicycle ergometer (11/37). Both sector and matrix probes were used. We assessed semi-quantitatively the quality of acquired apical views at each stage – the four-point grading system was used (0-no view, 1-suboptimal quality, 2-optimal quality, 3-very good quality), 2-3 sufficient for diagnosis.

Results
The mean time required for careful positioning of the probe and image optimization was 12 ± 3 min and shortened from 13,7 to 11,1 minutes (mean) in first vs second half of the cohort documenting learning curve. At baseline, 9 patients had at least one apical view of quality precluding reliable analysis. Those patients were excluded from further assessment. During stress, 17 patients maintained the optimal or very good quality of all apical views, whereas in 11 patients the quality significantly decreased during the stress test and required probe repositioning. The mean image quality score at baseline was 2,61 ± 0,48 and 2,25 ± 0,6 after exercise. Expectedly, good image quality was easier to obtain and maintain in the supine position (score 2,74 ± 0,44) points as compared with upright position (score 2,25 ± 0,57).

Conclusion
This preliminary, unique experience with external probe fixation device indicates that continuous acquisition and monitoring of echocardiographic images is feasible during physical exercise, and for the first time ever - also on the treadmill. This feasibility data stem from almost exclusively male patients and the estimated rate of sufficient image quality throughout the entire test is currently around 60%. We are hoping, that gaining more experience with the product could increase the success rate on exercise tests.
Abstract P1398 Figure. Treadmill and ergometer stress test
P1401 The prognostic value of the reduction of coronary flow velocity reserve in non-ischemic heart failure patients
Authors: Borguezan Daros C , Ciampi Q , Zanella H , Cortigiani L , Gaibazzi N , Rigo F , De Castro E Silva Pretto J L , Djordjevic-Dikic A , Amor M , Merlo P M , Citro R , Colonna P , Lowenstein J , Torres M A R , Picano E 
Published: January 2020

Abstract

OnBehalf
Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging

Background
Coronary microvascular abnormalities determining a reduction of coronary flow velocity reserve (CFVR) have been described in patients (pts) with non-ischemic heart failure (HF).

Aim
To assess the prognostic value of CFVR in HF.

Methods
In a prospective, observational, multicenter study, we recruited 333 pts with angiographically normal coronary arteries: 105 patients with HF and preserved (&gt;50%) ejection fraction (HFpEF); 71 with HF and mid-range (40-50%) ejection fraction (HFmrEF); 157 with HF and reduced (&lt;40%) ejection fraction (HFrEF). All patients underwent vasodilator SE with dipyridamole (0.84 mg/kg) in 10 accredited laboratories of 5 countries (Argentina, Brazil, Italy, Mexico, Serbia). CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed wave-Doppler assessment of LAD flow. In all patients we also assessed left ventricular contractile reserve (LVCR) based on force (systolic blood pressure/end-systolic volume) Abnormal cutoff values were ≤2.0 for CFVR and ≤1.1 for LVCR. All pts were followed-up.

Results
After a median follow-up time of 15 months, 78 events occurred: 36 hospital admissions for acute decompensated heart failure, 23 deaths, 16 worsening in NYHA functional class, 2 stroke and 1 late revascularization. Event-free survival was best in patients with preserved CFVR and LVCR and worst in pts with reduced CFVR and impaired LVCR, with intermediate values for patients with either one (CFVR or LVCR) abnormal results: see figure. A preserved CFVR was associated with a better 24-month event-free survival than reduced CFVR in a subset analysis in pts with HFpEF (HR = 16.2, 95% CI, 1.8-145.1, p = 0.001) and in HFrEF (HR = 3.06, 95% CI, 1.6-5.6, p &lt; 0.001). A multivariable analysis in the overall group of HF pts identified a reduced CFVR as the only independent predictor of event-free survival (HR = 3.455,95% CI 1.723-6.929).

Conclusions
A reduction in CFVR identifies a high risk subset in HF patients, outlining a shared role of coronary microvascular abnormalities as a marker and potential therapeutic target of HF, independently of underlying EF.
Abstract P1401 Figure. Event-free survival based on CFVR-LVCR
P1410 Right ventricle to pulmonary circulation coupling is primarily defined by the circumferential right ventricle function
Authors: Bandera F , D"alesio G , Ghizzardi G , Losito M , Boveri S , Alfonzetti E , Guazzi M 
Published: January 2020

Abstract

Background
Right ventricle to pulmonary circulation (RV-PC) coupling plays a pivotal role during the physical effort. The RV-PC uncoupling can be easily identified by the TAPSE/SPAP ratio, a prognostic marker based on RV longitudinal function and its afterload (SPAP).We sought to explore the relationship between the functional capacity (peak VO2 and VE/VCO2) and the RV-PC coupling, using both a standard and 3D-based echocardiographic assessment of RV.

Methods
eighty-seven patients (age 72 ± 10 years; LV EF 53 ± 15%) underwent rest echocardiography with 3D RV assessment and cardiopulmonary exercise test. RV EF was measured using the 4D RV TomTec software. The 3D mesh of the RV model was post-processed using a custom developed software. This provided longitudinal (EFlong) and circumferential (EFcirc) components of EF. RV-PC coupling was assessed with the TAPSE/SPAP ratio and with similar parameters obtained by using 3D components of RV systolic function over SPAP (EF/SPAP, EFlong/SPAP and EFcirc/SPAP ratio). All variables were correlated with peakVO2 and VE/VCO2.

Results
Correlations between peakVO2 and TAPSE (0.409, p = 0.006), SPAP (-0.597, p &lt; 0.001), RV EF (0.555, p &lt; 0.001), RV EFlong (0.327, p = 0.03), RV EFcirc (0.587, p &lt; 0.001) were modest, while TAPSE/SPAP (0.641, p &lt; 0.001), EF/SPAP (0.751, p &lt; 0.001), EFlong/SPAP (0.610, p &lt; 0.001) and EFcirc/SPAP (0.775, p &lt; 0.001) showed stronger correlations. VE/VCO2 showed a similar relationships although the correlations were weaker [TAPSE (-0.523, p &lt;0.001), SPAP (0.617, p &lt; 0.001), RV EF (-0.412, p = 0.006), RV EFlong (-0.232, p = 0.129), RV EFcirc (-0.454, p = 0.002), TAPSE/SPAP (-0.561, p &lt; 0.001), EF/SPAP (-0.516, p = 0.001), EFlong/SPAP (-0.429, p = 0.008) and EFcirc/SPAP (-0.541, p &lt; 0.001)].

Conclusions
RV-PC coupling is associated with both peak VO2 and VE/VCO2. The use of 3D-derived markers of RV-PC coupling showed a better correlation with the peak VO2, while there were no differences for VE/VCO2. The circumferential component of RV systolic function seems to emerge as a dominant determinant of RV-PC coupling, as well as of functional capacity.
P1415 Obesity and epicardial fat in a Spanish infant population by echocardiography
Authors: Aristizabal Duque C H , Fernandez Cabeza J , Blancas Sanchez I M , Ruiz Ortiz M , Delgado Ortega M , Rodriguez Almodovar A , Pan Alvarez Osorio M , Romo Pena E , Fonseca Del Pozo F J , Romero Sardana M , Mesa Rubio D 
Published: January 2020

Abstract

Introduction
Childhood obesity is currently a mayor public health problem. There is a direct relationship between a high body mass index with a higher cardiovascular morbimortality. Among child population 4 out of 10 individuals are overweight, the prevalence of overweight is 26 per cent and the prevalence of obesity is 12,6 per cent. The epicardial fat is a heart visceral adiposity index, may play a role in the coronary atherosclerosis pathogenesis, a chronic inflammatory disease and in heart disease. The rise in the epicardial fat is considered as a target organ injure in child population.

Aims
To know the relationship between childhood obesity and echocardiographic parameters of epicardial fat, as a target organ injure among the child Mediterranean population.

Methods
Randomly, we selected a sample of children and adolescents of primary and secondary education, in a rural town of 2864 inhabitants of southern Spain. We include children between 6-17 years. We performed transthoracic echocardiography, with measurements of 2D epicardial fat, in systole in parasternal long axis (PLA) and parasternal short axis (PSA), taking the measure as the average of 3 measurements in consecutive beats.

Results
We studied a total of 212 children (10.9 ± 3.0 years and 51.9% males), 45 (21.3% were obese), of which 7.2% were diagnosed with hypertension (HBP), 5.1% with metabolic syndrome and 5.3% as prediabetic. The thickness of the epicardial fat in PLA was related to Obesity 2.2 ± 0.7 mm vs 1.75 ± 0.5 mm p (&lt;0.001); HBP 2.16 ± 0.9 mm vs. 1.86 ± 0.5 mm (P &lt;0.05); Metabolic syndrome 2.23 ± 0.8 mm vs 1.81 ± 0.5 mm (P &lt;0.05), in PSA: Obesity 2.36 ± 0.7 mm vs 1.78 ± 0.6 mm p (&lt;0.001); HBP 2.31 ± 0.6 mm vs 1.88 ± 0.6 mm (P &lt;0.05); Metabolic syndrome 2.43 ± 0.8 mm vs 1.87 ± 0.6 mm (P &lt;0.01) and overall combining PLA and PSA views: Obesity 2.27 ± 0.7 mm vs 1.76 ± 0.5 mm p (&lt;0.001); HBP 2.23 ± 0.7 mm vs 1.85 ± 0.5 mm (P &lt;0.05); Metabolic syndrome 2.23 ± 0.7 mm vs 1.84 ± 0.5 mm (P &lt;0.01).

Conclusion
In a random Spanish pediatric population correlation is found by echocardiography of the thickness of epicardial fat with obesity, HBP and metabolic syndrome. Being this a rapid test, non-invasive and without ionizing radiation.
P1417 Acceptability of a virtual reality system for examination of congenital heart disease patients
Authors: Wheeler G , Deng S , Pushparajah K , Schnabel J A , Simpson J M , Gomez A 
Published: January 2020

Abstract

Funding Acknowledgements
Work supported by the NIHR i4i funded 3D Heart project [II-LA-0716-20001]
Background/Introduction
Virtual Reality (VR) has recently gained great interest for examining 3D images from congenital heart disease (CHD) patients. Currently, 3D printed models of the heart may be used for particularly complex cases. These have been found to be intuitive and to positively impact clinical decision-making. Although positively received, such printed models must be segmented from the image data, generally only CT/MR may be used, the prints are static, and models do not allow for cropping / slicing or easy manipulation. Our VR system is designed to address these issues, as well as providing a simple interface compared to standard software. Building such a VR system, one with intuitive interaction which is clinically useful, requires studying user acceptance and requirements.

Purpose: We evaluate the usability of our VR system
can a prototype VR system be easily learned and used by clinicians unfamiliar with VR.

Method
We tested a VR system which can display 3D echo images and enables the user to interact with them, for instance by translating, rotating and cropping. Our system is tested on a transoesophageal echocardiogram from a patient with aortic valve disease. 13 clinicians evaluated the system including 5 imaging cardiologists, 5 physiologists, 2 surgeons and an interventionist, with their clinical experience ranging from trainee to more than 5 years’ of experience. None had used VR regularly in the past. After a brief training session, they were asked to place three anatomical landmarks and identify a particular cardiac view. They then completed a questionnaire on system ease of learning and image manipulation.
Results: Results are shown in the figure below. Learning to use the system was perceived as easy for all but one participant, who rated it as ‘Somewhat difficult’. However, once trained, all users found the system easy to use. Participants found the interaction, where objects in the scene are picked up using the controller and then track the controller’s motion in a 1:1 way, to be particularly easy to learn and use.

Conclusion
Our VR system was accepted by the vast majority of clinicians, both for ease of learning and use. Intuitiveness and the ability to interact with images in a natural way were highlighted as most useful - suggesting that such a system could become accepted for routine clinical use in the future.
Abstract P1417 Figure. VR system evaluation participant feedbac
P1421 Patients with severe aortic regurgitation showed systolic dysfunction and increased stroke work despite preserved EF; clues for reconsidering optimal time point of surgery
Authors: Reil J C , Reil G-H , Borer J S , Hecker N , Aboud A , Schaefers H-S , Langer H F , Sievers H-H , Ensminger S 
Published: January 2020

Abstract

Background
Current guidelines recommend surgery in patients with severe aortic regurgitation (AR) with clinical symptoms or subnormal ejection fraction (EF). Furthermore, surgery should be considered in patients with severe AR, preserved EF and increased left ventricular diameters (LVEDD &gt;70mm, LVESD &gt;50mm). The aim of the study was to investigate LV systolic function as well as mechanical energetics using non-invasive pressure-volume- and strain analysis in patients with severe AR and preserved EF as well as moderately dilated ventricles (LVEDD &lt;70mm).

Methods and Results
Echocardiographic strain and single beat pressure-volume analyses were performed in patients with severe AR and moderately increased ventricular size (LVEDD &lt; 70mm, EF &gt;50% n = 39) as well as healthy, age-matched controls (n = 20) using echo-derived volume and arm-cuff blood pressure measurements. Load independent parameters of systolic contractile function like end-systolic elastance (Ees) and end-systolic volume at 100mmHg (ESV100) were calculated as well as stroke work ((SW) and total pressure volume area (PVA = SW + potential energy). Patients with AR demonstrated significant depression of systolic function beyond ejection fraction: global longitudinal strain was reduced compared to controls (-16 ±2.5% vs. -21.5 ±2%; p &lt; 0.001). Accordingly load independent parameters of LV contractility like Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p &lt; 0.001), ESV100 (65.7ml ±19.4 vs. 42.4ml ±19.8; p &lt; 0.05) were reduced despite comparable ejection fractions (EF: 0.56% ±0.05 vs. 0.60% ±0.07 p = 0,10). End-diastolic volume of AR patients was markedly elevated (236ml ±90 vs. 136ml ±30; p &lt; 0.001), while PVA (20470mmHg x ml ±10400 vs. 11907mmHg x ml ±2877; p &lt; 0.01) and stroke work (13200mmHg x ml ±5700 vs. 7606 mmHG x ml ±2048; p&lt; 0.01) were markedly elevated indicating waste of energy.

Conclusion
Patients with severe AR and moderately enhanced LV showed depressed values of contractility and waste of energy using more advanced parameters of LV systolic function although EF was preserved. The data may demonstrate that surgery is performed too late in many of those patients and may give clues for reconsidering guidelines to meet the optimal time point of surgery.
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P1423 Significantly higher 1-year mortality rate in patients undergoing TAVR with higher right ventricular volumes, as calculated by pre-procedural CT angiography
Authors: Maret E , Rozenbaum Z , Lax L , Shmilovich H , Finkelstein A , Steinvil A , Halkin A , Banai S , Cohen D , Topilsky Y , Berliner S , Fleischmann D , Aviram G 
Published: January 2020

Abstract

Background
Cardiac gated computed tomography angiography (CCTA) is the mandatory pre-interventional imaging planning procedure in patients eligible for trans-catheter valve implantation (TAVR). Automated analysis of the cardiac chambers" volumes including the right ventricle (RV), can be obtained from the CCTA and thus contribute to patient selection.

Objectives
To assess the prognostic implications of increased RV volume using a fast automated volumetric analysis software on preprocedural CCTA data among patients undergoing TAVR.

Methods
CCTA of patients who underwent TAVR at two medical centers – Stanford University Medical Center (California, USA) and Tel Aviv Medical Center (Israel) – between 2013 and 2016 were analyzed by an automatic four chamber volumetric analysis (4CVA) software, and grouped according to their RV volume index, into those with the largest RV (upper 5th percentile of RV volume index (&gt;120 ml/m2; n = 16) versus those within the 95th percentile lower volumes index (≤120 ml/m2; n = 307). Differences in baseline characteristics between the groups were adjusted for with a propensity score. The risk for one year mortality following the TAVR was compared between the two groups.

Results
In total 323 patients were included. There were no major differences in background and demographic characteristics between the study groups. A significantly higher 1-year mortality rate was found for patients with large RV (31.3% vs. 7.5%, p = 0.008). After adjustment for clinical characteristics, patients with RV volume index &gt;120 ml/m2 were at almost a 5 times higher risk for 1-year mortality compared to patients with smaller RV (HR 4.9, 95% CI 1.8-13.1, p = 0.002). The addition of echocardiographic parameters to the propensity score did not eliminate the significance of RV volume index &gt;120 ml/m2 as an independent predictor for mortality at 1-year. An analysis of RV as a continuous variable demonstrated that the risk for 1-year mortality increased by 2% for every 1 ml/m2 RV volume enlargement (p = 0.013).

Conclusions
Cardiac volumetric data by CCTA performed for procedural planning may help predict outcome in patients undergoing TAVR.
Abstract P1423 Figure. Cox survival curves according to RVi
P1425 Association between severity of mitral regurgitation and right ventricular function in patients with moderate to severe mitral regurgitation assessed by invasive hemodynamics measurements
Authors: Omar M 
Published: January 2020

Abstract

Funding Acknowledgements
-

Background
Primary mitral regurgitation (MR) will cause volume overload to the left ventricle (LV) but due to systolic reguritant flow the pulmonary circulation will be affected often leading to post-capillary pulmonary hypertension and thus increased afterload to the right heart. As a consequence right ventricular (RV) dysfunction may be a consequence of MR.

Purpose
To assess the association between RV function assessed with cardiac magnetic resonance imaging (CMRI) and hemodynamics at rest and during exercise in ambulatory patients with primary mitral regurgitation (MR).

Methods
In an observational study, patients with significant primary MR with effective regurgitant orifice ≥0.30 cm2 and LV ejection fraction &gt;60% were examined with right heart catheterization during rest and exercise and CMRI at rest. Patients were examined in semi-supine position (30 degree). From right heart catheterization pulmonary artery systolic pressure (PAPs) was measured, where RV stroke work index (RVSWI = 0.0136*(mean pulmonary artery pressure – right atrial pressure *stroke volume index) and pulmonary artery compliance (PAC= stroke volume / (PAPsystolic – PAPdiastolic)) was calculated. Patients were dichotomized according to effective regurgitant orifice (ERO) (≤0.4 cm2).

Results
The two groups (total n = 46) have same baseline characters with no significant differences. In both groups resting RVEF was normal and no difference in RV stroke volume was seen between the groups at rest or with exercise. However RVSWi was significantly higher in patients with ERO &gt; 0.4, (rest p = 0.0039, exercise p = 0.01), Figure. The increase in RVSWi was driven by increased sPAP and where significantly in ERO &gt; 0.4 at rest at during exercise (rest p = 0.00027, exercise p = 0.0352). At rest PAC was significantly higher in ERO above 0.4, but during exercise no differences was found in the two groups. RVEF at rest measured by CMRI showed no correlation with RVSWi in the two groups (r = 0.11, p = 0.45)

Conclusion
In ambulatory patients with mitral regurgitation above 0.4 cm2, RVSW is associated with an increased right ventricle workload and contractility at rest and during exercise which especially is driven by increased post capillary pressure whereas pulmonary arterial compliance only is mildly affected.
Abstract P1425 Figure. Ventricle function at rest/exercise