bluuebunny/crossref_metadata_2025_split huggingface dataset:
P791 Left atrial stiffness as a predictor of cardiac events in patients with heart failure and reduced ejection fraction: the impact of diabetes
Authors: Bytyci I , Pugliese N R , Bajraktari A , Mazzola M , Bajraktari G , Henein M Y , Dini F L 
Published: January 2020

Abstract

Background and Aim
Diabetes mellitus (DM) affects left ventricular remodeling in patients with heart failure (HF), but its effect on left atrial (LA) remodeling and their combined effect on survival and other clinical events (CE) remain to be elucidated. We evaluated in this study the relationship between DM and left atrial (LA) remodeling in a group of HF patients with reduced ejection fraction (HFrEF),

Methods
This studied 136 consecutive HFrEF patients (65 ± 11 years), 36 diabetics, using conventional and tissue Doppler echocardiography. LA dimension and function were measured and cavity stiffness was calculated with the formula: LA stiffness = E/e’ratio/LA strain.

Results
The age, gender, LV end-systolic dimension, LV end-diastolic dimension, LV EF and BNP level did not differ between diabetic and non-diabetic patients. Diabetic patients with HFrEF had higher NYHA functional class (p = 0.02), reduced right ventricle (RV) systolic function (p = 0.01) and increased LA stiffness (p = 0.02) .
At follow up of 55 ± 37 months, survival free from CE was 69% in non-diabetics compared with 44.4% in diabetics (X2 12.7; p&lt; 0.0001). The CE free survival was lower in patients with increased LA stiffnes, irrespective of the presence of DM: 1) Patients with HFrEF without DM and normal LA stiffness (85%); 2) Patients with HFrEF without DM and with increased LA stiffness (50%); 3) Patients with HFrEF with DM and with normal LA stiffness (71%) and patients with HFrEF with DM and with increased LA stiffness (27%) (X2 29.6; p&lt; 0.0001, Figure 1).

Conclusion
Compromised LA stiffness as surrogate of LA remodeling is associated with poor outcome in patients with heart failure and reduced EF. The presence of diabetes in patients with HFrEF and increased LA stiffness has incremental prognostic value.
Abstract P791 Figure.
P794 Treadmill exercise stress echocardiography in children; our experience.
Authors: Cotrim C , Joao I , Guardado J , Cordeiro P , Sampaio M ANA , Marques A , Cafe H , Martins R , Cotrim H , Baquero L 
Published: January 2020

Abstract

Background
Exercise stress echocardiography (ESE) is routinely used in adults but its role in children (C) is less established

Purpose
To assess the feasibility and clinical value of ESE in outpatient children

Methods
We enrolled 309 consecutive C (mean age = 14,1 ± 2,6 years, range 6-17 yrs) who underwent treadmill ESE between 2002 and 2019: One group (Group I) of 258 C including: 237 with exercise related symptoms (chest pain and/or dyspnea and/ or lypotimia-syncope), 15 with resting ECG alterations, 6 with positive ECG stress test and other group of C (Group II) including: 10 asymptomatic for screening requested by parents, 11 with symptoms unrelated to exercise, 12 with antecedents of sudden death in the family, and 17 with known pathology - 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, 1 each with Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, aortic switch operation. Regional wall motion abnormalities (RWMA) by 2-D and continuous wave Doppler (transvalvular or transaortic or intraventricular (IVG) gradients were assessed in all.

Results
The success rate was 309/309 (100%). Only one complication (allowing asthma diagnosis by serendipity) occurred: a severe asthmatic crisis in one girl studied because of chest pain with exercise (with ESE negativity), Stress-induced RWMA occurred in 2 pts (one with HCM, the other with normal coronary arteries). A significant orthostatic exercise induced IVG (&gt; 30 mmHg) was present in 101 of the 258 C (39%) studied due to symptoms, ECG alterations or positive stress ECG.

In group II the C with induced IVG attained
greater heart rate (HR) 184 ± 12 vs 174 ± 16 (p &lt; 0,001); greater blood pressure (BP) 150 ± 19 mmHg vs 136 ± 23 mmHg (p &lt; 0,001). The OR to the reproduced symptoms that motivated the exam during the SE comparing the 101 C with IVG with the 158 without IVG was 8,22 (4,83-13,99) p &lt; 0,001 (95% CI).

Conclusions
Treadmill ESE is feasible and safe in young people. RWMA are of limited usefulness in our outpatient C group. Doppler often documents significant exercise induced IVG, occult at rest that associate with symptoms.
Abstract P794 Figure. ESE Induced IVG in a C with chest pain
P806 Cavitation phenomenon in mechanical valves: not only microbubbles
Authors: Vriz O , Archi F , Aldmawi M , Ahmed M , Alhumaid M , Alnahdi F , Raim A , Galzerano D , Kinsara M J , Alshahid M 
Published: January 2020

Abstract

Introduction
It is well described the presence of microbubbles (MBs) which are high-velocity, small, bright echoes presences that occur with the closing/opening of the mechanical double disk valve, more frequently in mitral position but less frequent growth of the cavitation bubbles are described.
We considered the echo studies of patients with growth of cavitation bubbles and we evaluate the possible impact of the hemodynamic parameters of their formation and then misdiagnosis with endocarditis.

Methods
We analyzed retrospectively the echocardiographic studies of 49 patients with growth of cavitation bubbles and we went back to all studies until the date of surgery if available, to see in how many of those echos, this phenomenon was present.
Patient"s blood pressure (BP) and heart rate (HR) measurement were available for each echo study. For the present analysis the last echo study with or without growth of cavitation bubbles were considered. The last echo study without growth of cavitation bubbles was considered as control group.

Results
Fourty nine patients (M26/F23) with mean age of 46.5 ± 13.6 years were identify as having growth of the cavitation bubbles and a total of 325 echo studies were reviewed. All patients had mitral valve replacement but 4, that had only aortic mechanical valve. 43% had mitral-aortic valve replacement and 5 had 3 or 4 valves replaced. The follow-up period was of 3697 ± 2481 days, 52%±31% of the echo studies reviewed had growth of the cavitation bubbles.
At the time of the study systolic BP was 124 ± 12.5 vs 121.1 ± 16.4 mmHg, p = 0.1 (echo study with versus without growth cavitation respectively), diastolic 72.7 ± 10.1 vs 69.4 ± 14.9 mmHg, p= 0.2; HR 81.3 ± 19.4 vs 73.7 ± 14.1 bpm, p = 0.05. No statistical differences in trans mitral gradients were found between the two groups (peak 11.8 ± 3.9 vs 11.7 ± 4.3 mmHg, p = 0.7; mean 4.6 ± 1.9 vs 4.2 ± 1 mmHg.6p = 0.1). 33 TEE were performed and in 50% of cases because of suspecion of endocarditis. Only 2 TEE were positive for endocarditis and one positive for pannus and high gradients across the valve in addition to cavitation.

Conclusion
Cavitation phenomenon in mechanical valves, in particular mitral bi-leaflet valve is well known but growth of cavitation bubbles is seldom described. We found that this fenomenon is frequently present although not constant, is related with increased HR and can be responsible of misdiagnosis with endocarditis.
Abstract P806 Figure.
P817 Lung ultrasound in the evaluation of pulmonary congestion in patients with aortic stenosis
Authors: Szabo I , Gargani L , Illes B , Frigy A , Varga A , Agoston G 
Published: January 2020

Abstract

Background
Aortic stenosis (AS) has a prolonged latent period, as AS worsens, the left ventricular adaptations become inadequate and impaired systolic and/or diastolic dysfunction, may lead to clinical heart failure (HF). The development of HF is an inflexion point in the natural history of AS. Pulmonary congestion is a nearly universal pathophysiological finding in HF, and may precede symptoms. Lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, non-invasive tool to assess pulmonary interstitial edema.

Aim
To assess pulmonary interstitial edema with LUS in patients with moderate and severe aortic stenosis, to define performance of LUS compared with clinical assessment and echocardiographic parameters.

Methods
Sixty-eight consecutive patients (36 women, mean age 74 ± 9 years) with moderate or severe aortic stenosis were enrolled. Exclusion criteria were as follows: moderate or severe aortic regurgitation, moderate or severe mitral regurgitation, cardiomyopathies and pulmonary disease. All patients underwent comprehensive echocardiography examination and LUS according to a previously validated 28 scanning-site assessment.

Results
we found a significant number of B-lines (≥15) in 79% of patients. B-lines were positively correlated with left atrial volume index (p &lt; 0,05, r = 0,3) and estimated pulmonary pressure ( p &lt; 0,0001, r= 0,62 Figure 1.) The number of B-lines didn’t correlate with the severity of AS (mean gradient vs. B-lines: p = 0,2, valve area vs. B-lines: p = 0,2.), however properly reflects different functional status of the patients (p &lt; 0,0001, Figure 2.)

Conclusion
Lung ultrasound is a promising tool to detect lung congestion related to AS. The severity of congestion doesn’t correlate with the severity of AS, albeit B-lines better reflect the deteriorating functional status of the patients and the haemodynamic consequences related to AS.
Abstract P817 Figure. Correlation PASP vs Blines, NYHA/B-lines
P824 Impact of cardiovascular risk factors and treatment strategies on the presence of intramyocardial hemorrhage visualized by magnetic resonance in patients with reperfused infarction
Authors: Igual Munoz B , Elena Sanchez Lacuesta E S L C , Jose Luis Diez Gil J L D G , Maria Ferre Valverdu M F V , Francisco Ten Morro F T M , Vicente Miro Palau V M P , Maryem Ezzitouny M E , Jose Leandro Perez Bosca JLPB , Rafael Paya Serrano R P S 
Published: January 2020

Abstract

Intramyocardial hemorrhage (IMH) is considered a marker of tissue damage severity in patients with reperfused ST-segment elevation myocardial infarction (STEMI) and has been associated with a poor prognosis despite successful revascularization of the culprit artery . We aim to study the impact of cardiovascular risk factors and treatment strategies on the presence of IMH studied with T2* -w cardiovascular magnetic resonance (CMR) in this clinical setting

METHODS
A prospective observational study including patients with repefused STEMI who underwent an MRI during the first week post-revascularization were conducted . The presence of IMH was analyzed in ECG triggered T2 * w sequences as presence of hipointensity area . Clinical data including cardiovascular risk factors and treatment strategies at cath lab were studied.

RESULTS
94 patients with reperfused STEMI were included. Demographic data are shown at the the table. No significant association was observed between the presence of IMH and the different treatment strategies used. All data were introduced in a multivariate model including presence of thrombus, total ischemia time and culprit coronary artery. The analysis showed previous infarction as an independent risk factor (OR: 6 p = 0.03, CI: 1.1-29) while history of hypertension (OR: 0.9, p = 0.04, CI: 0.1- 0.9) and systolic blood pressure showed independent protective effect (OR: 0.3 p = 0.02 IC: 0.9-0.99.)
CONCLUSIONS.
1. Previous infarction was shown to be an independent risk factor for IMH .
2. Arterial hypertension and systolic blood pressure showed a protective effect.
Age (years) 62 ±13 Male sex 72 (77) Diabetes mellitus 32 (34) Hypertension 53 (56) Hyperlipidaemia 52 (55) Current or prior smoking 55 (58) Time to reperfusion 203 (142-300) Infarct-related artery LAD 38 (41) RCA 49 (52) Cx 7 (7) Infarct size (% LV mass) 18 ± 11 MO (% LV mass) 3.15 (1.44-5.48)
Abstract P824 Figure. Intramyocardial hemorraghe T2* sequences
P836 Long-term survival of a rare case of pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication of endocarditis of a bicuspid aortic valve
Authors: Al Shehadat M , Khalifa E , Mohamed S , Ghareep A , Gomaa M , Alkuwari M , Helmy S 
Published: January 2020

Abstract

Introduction
This is a case report of a rare condition of pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF).

Case presentation
The patient was a 42-year-old Filipino gentleman. He first presented to us in 2014, for routine echocardiographic examination as a part of a preoperative assessment for a non-cardiac surgery. Patient was asymptomatic and had a history of bicuspid aortic valve, which was complicated by endocarditis in 2006, and was treated with antibiotics.
Echocardiography findings: Transthoracic echocardiography (TTE) showed a bicuspid aortic valve of no hemodynamic significance . A P-MAIVF was noted by Transesophageal echocardiography as a cavity expanding posteriorly into the left atrium from the left ventricular outflow tract, with a narrow neck at the junction of the aortic posterior cusp and the anterior mitral leaflet (Figure A). The cavity showed the characteristic expansion during ventricular systole, and collapse in diastole. Color flow showed the flow through the neck in systole and emptying during diastole (Figures C,D). There was mild mitral incompetence and no fistula was detected. Diagnosis was confirmed by cardiac magnetic resonance (Figure B).

Follow up
Because of the known complications of this condition, some of which are potentially fatal (such as rupture into the pericardium and tamponade), he was offered a surgical repair, which he had refused. Alternative conservative follow-up strategy was implemented and we had the opportunity to follow him for more than 5 years. During these years he was asymptomatic and uncomplicated. There was no change in the size of the pseudoaneurysm or its flow pattern.

Conclusion
This report demonstrates a rare case of P-MAIF as a complication of bicuspid aortic valve endocarditis and a long-term patient survival of a potentially fatal condition without corrective surgery.
Abstract P836 Figures A,B,C,D
P840 A surprising outcome
Authors: Rocha R , Fernandes R , Carvalho J , Pais J , Bras D , Guerreiro R , Aguiar J 
Published: January 2020

Abstract

Introduction
infective endocarditis(IE) is a high morbidity and mortality disease, and heart failure,central nervous system embolization and annular abscess account for common complications.Nevertheless,intracardiac fistula is rare and predicts higher mortality and urgency for surgery.

Case
84years old male patient,with an aortic bioprosthesis valve Perimount n23 since 2015,was admitted to internal medicine ward 3months before,due to Enterococcus faecalis bacteremia.at that time,transoesophageal echocardiography(TEE) revealed moderate to severe mitral valve(MV) regurgitation(vena contracta 0.7cm) and trivial tricuspid regurgitation,but did not showed any suggestive images of endocarditis.the patient was treated with 14days of amoxicillin-clavulanate.
On the current presentation,due to fadigue to mild physical activity and fever for 2weeks,he was admitted to cardiology ward for further investigation.blood cultures were positive for the previous agent,so antibiotherapy with ampicillin 12g/day and gentamicin 240mg id was started.TEE revealed thickening of aortic bioprosthesis’ leaflets with preserved systolic opening.aortic valve annulus thickening,mainly near the non-coronary cusp,was evident, without characteristic features of peri-annular abscess.on ventricular side of the prosthesis,there was a vegetation(10.7x10.8mm). a small nodule lesion,coherent with a second vegetation,was present on the MV’s posterior leaflet,without regurgitation’s worsening. a third one was observed on the septal leaflet of the tricuspid valve(7.3x6.5mm),which also caused an increasement in severity of the regurgitation,quantified as moderate.
On the sixth day,the patient presented with right arm paresis,so a brain CT was performed,showing an ischemic lesion on the left middle cerebral artery.Reevaluation,5days later,owing to new neurological changes,showed multiple acute vertebrobasilar embolic strokes.
As a result of poor medical response and embolic strokes,the patient was referred to surgical treatment. however, due to prohibitive surgical risk (euroscore 59%), the patient was refused.
After 6weeks of blood culture driven antibiotherapy,a reevaluation TEE revealed a periprosthetic pseudoaneurysm with small aorta-to-right atrium fistula.no vegetations were found.

Conclusion
rate complication of cardiac fistulae is high,60%of the patients develop heart failure and mortality rate is higher than 40%.although conservative treatment was addressed,after 8months discharge,the patient remains with few heart failure symptoms(NYHA classII).
P845 Deep vein thrombosis, pulmonary embolism and patent foramen ovale: a lethal mix
Authors: Vera Sainz A , Garcia Guimaraes M , Jimenez C , De La Cuerda F , Gonzalez E , Montes A , De Rueda C , Rojas A , Cecconi A , Diego G , Benedicto A , Dominguez L , Monguio E , Jimenez Borreguero L J , Alfonso F 
Published: January 2020

Abstract
A 50-year-old woman without remarkable medical history was admitted at the Emergency Department for acute dyspnoea. The patient had been recently submitted to C5-C6 microdiscectomy. She was tachypneic and oxygen saturation was 88%. CT angiography showed bilateral pulmonary embolism (PE) (Figure 1A, yellow arrowheads) with signs of right ventricle overload. Bilateral deep vein thrombosis was also confirmed. The patient was admitted at the Intensive Care Unit, clinically stable. Few hours later, she presented sudden hemodynamic and respiratory deterioration, requiring invasive mechanical ventilation and vasopressors. Due to recent cervical surgery, systemic fibrinolysis was ruled out. Decision for percutaneous thrombectomy and inferior vena cava filter placement was made. Nevertheless, percutaneous thrombectomy was unsuccessful due to the impossibility to catheterize pulmonary artery. Contrast injection demonstrated that the guiding catheter was located in the left atrium (Figure 1B), suggesting a patent foramen ovale (PFO). Transoesophageal echocardiogram confirmed the presence of a 5x6 mm PFO with right-to-left shunt (Figures 1C – yellow arrows, and 1D). In addition, a 4 cm mobile mass attached to the aortic valve and protruding throughout the left ventricle outflow tract was visualized, suggesting paradoxical embolism (Figure 1E – white arrows). Accordingly, open surgical approach with pulmonary thrombectomy, PFO closure and removal of the left-sided thrombus was decided. Unfortunately, despite careful cannulation, thrombus was not found when aortic valve was inspected. Worst suspicions were confirmed, when the patient presented non-reactive mydriatic pupils. A brain CT showed signs of an extensive bihemisferic ischemic stroke (Figure 1F) presumably related to cerebral embolization of aortic thrombus. The patient finally died. Autopsy study was not consented.
PFO has been associated with paradoxical embolisms and risk of stroke in PE. This case strikingly illustrates that treatment of these patients may be challenging in spite of an adequate diagnosis and management.
Abstract P845 Figure.
P858 Cardiovascular toxicity induced by immunotherapy and tyrosine kinase inhibitors
Authors: Calcullo D , Di Lisi D , Iacopelli P , Nugara C , Bronte E , Evola V , Iacono F , Immordino F , Lunetta M , Novo S , Russo A , Novo G 
Published: January 2020

Abstract

Background
in the recent years, survival of cancer patients increased enormously through the use of new anticancer drugs such as molecular target drugs (tyrosine kinase inhibitors- TKIs, immunotherapy). Immunotherapy includes anti-BRAF and anti-MEK drugs (although evidences are scarce, these drugs seem to be capable of causing cardiovascular toxicity too); TKIs includes inhibitors of VEGF, VEGFR and other kinases.

Purpose
to assess cardiovascular toxic effects of TKIs and immunotherapy, to identify early signs of cardiac and vascular toxicity using speckle tracking echocardiography and arterial stiffness measurement.

Methods
a prospective study was carried out evaluating 45 patients treated with immunotherapy or TKIs. Population was divided into 2 groups: Group A (17 patients with melanoma treated with anti- BRAF and anti-MEK) and Group B (28 patients with solid cancer treated with TKIs-anti VEGF). Cardiological evaluation including electrocardiogram, conventional echocardiogram with tissue Doppler imaging (TDI) and left ventricular global longitudinal strain (GLS) measurement and carotid ultrasound scan was carried out before starting therapy and at a follow-up time of 6 and 12 months. Cardiovascular events such as heart failure, arterial hypertension, arrhythmias, Qtc interval prolongation, stroke, arterial and venous thrombosis were assessed during follow-up.

Results
mean follow-up was 7 months for anti-BRAF and 13 months for TKI. Neither cardiovascular adverse events nor significant reductions in LVEF or other echocardiographic parameters during follow-up were observed in Group A: we did not observe significant changes in GLS (-18,4 [RI -19,9 a -15,8] vs. -18,3 [RI -18,9 a -16,1] or in vascular parameters (PWV 7,3 ± 1,4 vs. 6,7 ± 1,5, β mean wave 8,5 [RI 6,3-12] vs. 7,4 [RI 4,9-9,4]; α mean wave 6,8 [RI 3,1-6,2] vs. 9,6 [RI 2,4-4,6]). As regards Group B, new onset of arterial hypertension in 35% of population but no significant changes in LVEF or other echocardiographic parameters including GLS ( -18,6 ± 2,3 vs. -18,3 ± 3,3) were observed. Significant changes were furthermore found in vascular parameters with increased arterial stiffness during follow-up (PWV 7,82 ± 1,23 vs. 10,02 ± 2,73; p = 0,04, β mean wave 5,33 ± 1,98 vs. 8,43 ± 3,03; p = 0,02, α mean wave 10,79 ± 4,03 vs.16,82 ± 6,38; p = 0,03).

Conclusions
according to the literature data, immunotherapy seems to have a safe cardiovascular profile. Anti-VEGF drugs seem to predominantly cause vascular damage, early identifiable through arterial stiffness measurement.